| Course | MMHA 6451 Public Policy Analysis |
|---|---|
| Week | Week 7 |
| Paper type | Stakeholder impact table |
| Length | About 1,000 words, 6 pages |
| Format | APA 7 student paper |
| School | Walden University |
| Program | Master of Healthcare Administration (MHA) |
| Updated | October 2026 |
Free sample paper for MMHA 6451 Week 7
Who Gains and Who Pays if Senate Bill 214 Passes: A Stakeholder Impact Table for Certificate of Need Repeal
Student Name
Walden University
MMHA 6451: Public Policy Analysis
Instructor Name
Month Day, Year
Who Gains and Who Pays if Senate Bill 214 Passes: A Stakeholder Impact Table for Certificate of Need Repeal
Purpose
This installment follows Option A, the bill as filed, through every group with a stake in it. Repeal is the option as introduced, so it is the one legislators will debate first, and its effects set the baseline for the amendments analyzed later. For each stakeholder, Table 1 records what repeal would change, the direction of the impact, its size with a brief reason and the group's likely response. Sizes are rated high, moderate or low and are judgments based on the evidence gathered in earlier installments, not measurements.
Stakeholder Impact Table
Table 1 lists the stakeholders in the order the committee is likely to hear from them.
Table 1
Effects of Repeal by Stakeholder
| Stakeholder | What repeal changes | Direction | Size and reason | Likely response |
|---|---|---|---|---|
| Cobalt River's three hospitals | Commercially insured cases move to new centers | Negative | High: outpatient surgery is a major margin source | Seek joint ventures with surgeons; oppose or seek amendments |
| Safety-net hospital in the capital | Loses some commercial cases that fund uncompensated care | Negative | High: thin margins and high Medicaid share | Oppose; testify on charity care |
| Physician investors planning centers | Can open without review | Positive | High: removes cost and delay | Support; open centers in metropolitan areas |
| Surgeons without ownership stakes | More settings to operate in; possible pressure to invest | Mixed | Moderate | Divided |
| Commercial insurers | More low-price settings available | Positive | Moderate: savings depend on steering | Support; adjust networks |
| State Medicaid program | Uncertain center participation | Mixed | Moderate: savings only if centers accept Medicaid | Neutral; may seek participation rules |
| State health planning agency | Loses review workload for centers | Mixed | Low: frees staff, reduces oversight | Neutral |
| Employers purchasing coverage | Possible lower outpatient prices | Positive | Low to moderate | Support through business groups |
| Commercially insured patients | More choice and possibly lower cost sharing | Positive | Moderate | Generally unaware until affected |
| Medicare patients | More center options for covered procedures | Positive | Low to moderate | Unorganized |
| Medicaid patients | Access depends on whether centers participate | Uncertain | Moderate | Represented by advocates |
| Uninsured patients | Hospitals that serve them lose margin | Negative | Moderate to high | Represented by advocates and safety-net hospital |
| Rural residents | Little change; centers open where surgeons are | Neutral | Low: surgeon supply limits entry | Unorganized |
Who Pays
The table's central finding is that repeal's gains and costs fall on different people. The gains go to physician investors, commercial insurers, employers and commercially insured patients, who would have more low-cost settings to choose from. Procedures in centers often take less time and cost less (Munnich & Parente, 2014), so these gains are real. The costs fall mainly on hospitals that use margins from commercially insured surgery to fund care for uninsured and Medicaid patients. Centers tend to attract the more profitable procedures and patients (Plotzke & Courtemanche, 2011), and physician ownership has been associated with higher volume among owners (Hollingsworth et al., 2010). When those cases leave, the hospital's remaining patients are, on average, less profitable, and the cross-subsidy that funds uncompensated care shrinks.
The uninsured and the safety-net hospital in the capital therefore bear a cost that is not visible in the bill itself. Cobalt River bears a cost too, and its stake should be kept separate: the system would lose margin, but it also has the resources to respond through joint ventures with its own surgeons, while the safety-net hospital has fewer options. Nonprofit hospitals' charity care already varies widely relative to their tax benefits (Bai et al., 2021), so the loss of surgical margin could reduce charity care unevenly across the state.
Who Is Unaffected
Rural residents appear in the table as largely unaffected, which may surprise supporters of the bill. Repeal removes a barrier to opening centers, but it does not create surgeons in counties that lack them. The Week 5 problem statement found that surgeon supply, not CON review, is the more likely reason 51 of the state's 60 nonmetropolitan counties have no center. Unless an option adds an incentive for rural locations, the access benefits of repeal will concentrate where centers already are.
Rows That Will Matter Most
Two rows will carry the most weight in the Week 8 scoring. The uninsured patients row bears on the safety-net stability criterion, where repeal is likely to score lowest. The Medicaid patients row bears on both access and cost, because repeal's benefit to Medicaid enrollees depends entirely on whether new centers accept Medicaid, something repeal alone does not require. These two rows explain why the conditioned license in Option C was designed as it was: it keeps repeal's competition while attaching duties aimed at the groups the table shows would otherwise pay (Bardach & Patashnik, 2020).
Likely Coalitions
The response column suggests two coalitions. Supporters of repeal are likely to include physician investors, commercial insurers, employer groups and organizations that favor reducing regulation generally. Their argument will center on competition and lower prices, and it will be credible, because the evidence on center efficiency supports it. Opponents are likely to include the safety-net hospital, hospital associations and advocates for uninsured patients. Their argument will center on the loss of cross-subsidy for uncompensated care.
Cobalt River's position is complicated. The system would lose margin under repeal and might be expected to join the opponents. Yet its surgeons include several who would welcome new centers, and the system could respond by forming joint ventures with them. If the system simply opposes repeal, legislators are likely to read the opposition as protection of its market. If it supports a conditioned license instead, it can show that it accepts competition while asking that new entrants share the burden of uninsured care. That position may also be the one most likely to attract both the safety-net hospital and some supporters of repeal, since it keeps the bill's main feature. The surgeons without ownership stakes are the group most likely to move between coalitions, and their views should be sought before the system testifies. Their support would make any position the system takes more persuasive to legislators.
References
Bai, G., Zare, H., Eisenberg, M. D., Polsky, D., & Anderson, G. F. (2021). Analysis suggests government and nonprofit hospitals' charity care is not aligned with their favorable tax treatment. Health Affairs, 40(4), 629-636. https://doi.org/10.1377/hlthaff.2020.01627
Bardach, E., & Patashnik, E. M. (2020). A practical guide for policy analysis: The eightfold path to more effective problem solving (6th ed.). CQ Press.
Hollingsworth, J. M., Ye, Z., Strope, S. A., Krein, S. L., Hollenbeck, A. T., & Hollenbeck, B. K. (2010). Physician-ownership of ambulatory surgery centers linked to higher volume of surgeries. Health Affairs, 29(4), 683-689. https://doi.org/10.1377/hlthaff.2008.0567
Munnich, E. L., & Parente, S. T. (2014). Procedures take less time at ambulatory surgery centers, keeping costs down and ability to meet demand up. Health Affairs, 33(5), 764-769. https://doi.org/10.1377/hlthaff.2013.1281
Plotzke, M. R., & Courtemanche, C. (2011). Does procedure profitability impact whether an outpatient surgery is performed at an ambulatory surgery center or hospital? Health Economics, 20(7), 817-830. https://doi.org/10.1002/hec.1646
Reading the MMHA 6451 Week 7 instructions
Stakeholder assignments usually ask for a structured map of who is affected by a policy and how. Pick one option, usually the proposal as introduced, and list every group with a stake, including patients divided by coverage and groups that are unorganized. For each, record what changes, the direction, the size with a brief reason and the response you expect. Keep size ratings simple and explain them. Then write a narrative that identifies who gains, who pays and through what mechanism, using evidence. Note any group the policy leaves unaffected despite claims made for it. Describe likely coalitions and where your organization stands. Close by naming the rows that will matter most when you score the alternatives.
How the MMHA 6451 Week 7 example is put together
A purpose paragraph explains why repeal is mapped first and that sizes are judgments. Table 1 lists fourteen stakeholders across five columns. The who-pays section explains the cross-subsidy from commercially insured surgery to uninsured care, drawing on three studies of surgery centers, and notes that Cobalt River can respond through joint ventures while the safety-net hospital cannot, citing Bai and colleagues. A section on rural residents explains why repeal changes little for them. A section on coalitions describes supporters and opponents and the system's complicated position. The closing section points to the uninsured and Medicaid rows and links them to the conditioned license design, citing Bardach and Patashnik.
MMHA 6451 Week 7 rubric: what earns full marks
The stakeholder analysis is graded on completeness and reasoning. A table that includes unorganized groups and divides patients by coverage earns more than one listing only institutions. Each row needs a direction, a size with a reason and a plausible response; unexplained ratings lose points. The narrative carries the larger share of credit: it should identify the mechanism by which costs and benefits are distributed, with evidence. Honest treatment of groups that are unaffected shows rigor. Connecting the findings to the next stage of analysis is credited. Clear formatting, credible sources and APA style complete the rubric. Rows for unorganized groups, such as rural residents, are where careful students separate themselves.
Common MMHA 6451 Week 7 mistakes, and how to avoid them
Stakeholder tables often list the obvious players and leave out patients, or treat patients as one group. Split them by coverage, since a policy can help the commercially insured and hurt the uninsured at the same time. Give a reason for every size rating, even a short one. In the narrative, follow the money: who gains, who pays and why. Be candid about your own organization's interest and how it might respond. Watch for claims the policy cannot deliver, such as rural access when the barrier is something else. Think about coalitions, because that is how stakeholder positions turn into votes. We can build a stakeholder table and narrative for the option your term project is analyzing.
Get a MMHA 6451 Week 7 example written to your instructions
Name the policy and the alternative your table should test, and put them with the Week 7 prompt and rubric. The MMHA 6451 impact table arrives with direction, magnitude and response for every group, in 24 to 48 hours; a first one is free. Each group is described generically and belongs to a state no atlas lists.
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MMHA 6451 Week 7 questions, answered
Where can I find a free MMHA 6451 Week 7 sample paper?
The stakeholder table and its narrative can be read here free of charge.
Which option does the MMHA 6451 Week 7 table analyze?
Repeal of certificate of need review for new surgery centers, the bill as introduced.
Who gains under repeal?
Physician investors, commercial insurers, employers and commercially insured patients, through more low-cost settings.
Who pays?
Hospitals that fund uninsured care from commercial surgical margins, especially the safety-net hospital, and the uninsured patients they serve.
Why are rural residents largely unaffected?
Surgeon supply, not review, is the main reason most rural counties lack centers.