Association for Public Policy Analysis & Management

Little is known about how the Affordable Care Act (ACA) legislation will be implemented in non-profit addiction health service (AHS) organizations. Guided by a conceptual model of organizational implementation of new practices in health care systems, this study relied on qualitative data collected in 2013 from a sample of 30 AHS managers in Los Angeles County, California. Interviews were transcribed, coded, and analyzed using a constructivist grounded theory approach with ATLAS.ti software. In-depth qualitative interviewing was used to facilitate an understanding of the perceptions and interpretations that managers ascribed to changes precipitated by the ACA and how these perceptions affected their environments and interactions. To visually present the data for further analysis, focused codes were used to create data-family matrices. Analysis within and across cases and coding categories of the families led to the construction of several overriding themes, or axial codes, related to perceptions and expectations regarding the ACA.  Findings showed that managers anticipated several potential impacts, including increased use of AHS services, shifts in the duration and intensity of AHS services, and workforce professionalization due to ACA implementation. Managers also expected positive effects of the ACA but were not prepared for actions to align programs’ strategic change plans with policy expectations. Implications from these findings point to the need for health care policy interventions to help managers effectively respond to ACA principles of improving standards of care and reduce disparities.