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I did not go into the office on 10/14/2013 as that fell during my school's Fall Break, but I returned to work as per usual on Monday 10/21/2013.  After talking with my supervisor about what she had planned for me, I got started for the day by sitting in with her on a conference call regarding continued enrollment efforts for the ACA as well as Governor Corbett's recently issued memo "Healthy Pennsylvania" - the title he has given to his executive decision to pursue Medicaid Expansion (ME) in Pennsylvania.  Corbett's decision to expand Medicaid is a frought issue for advocates.  On the one hand, we and many other organizations spent most of the summer campaigning for the PA General Assembly to vote to accept the federal government's offer to finance Medicaid Expansion - a campaign that ultimately failed.  However, Corbett recently announced that, despite having earlier stated that he would leave the decision up to the General Assembly, he had decided instead to approve ME himself.  ME is a major step forward within the larger struggle to reform healthcare coverage in the US, and on that front Corbett's decision was a positive one.  On the other hand, as the conference call and the Healthy Pennsylvania memo made clear, ME under Corbett will not entail the expansion of Pennsylvania's Medicaid system as we know it - which is a shockingly progressive system given Pennsylvania's track record in similar policy areas, and actually stands at the forefront of state Medicaid systems across the country.  Instead, Corbett's Healthy Pennsylvania will entail placing stricter job and job seeking requirements on people seeking Medicaid coverage, and even more critically will remove many of the benefits that have made PA's Medicaid package so good.  Furthermore, because the decision is Corbett's on a whim, there is no timeline he must adhere to in order to pursue ME; as such, having announced his intention to pursue it, he can now ignore the issue until public pressure forces him to do otherwise.  

The call also focused on what steps the coalition could take next to address ME.  Importantly, as my supervisor had discussed with me before the call began, the coalition would ultimately take a position in support of ME.  For all that Corbett's Healthy Pennsylvania would cost in concessions, in the end it would significantly expand access to healthcare to a vast number of Pennsylvanians; and given that the coalition's mission is to extend healthcare coverage to as many in the state as possible, the trade-off is at this point a necessary one.  Individual organizations within the coalition, though, maintain the freedom to be critical of Healthy Pennsylvania while also still working with the larger coalition.  This presents an interesting contrast to my earlier conundrum with organizational integrity with regard to individual organizations unable to take a stance on abortion while working within a coalition that supported it.  In this case, though, it feels as though each organization is able to retain more of its own institutional integrity by issuing criticisms of the governor's plan and fighting against the cutbacks it demands, while also recognizing that their involvement in a larger mission to bring access to more people is also important and valid.  In this way the organizations almost avoid having to make a value choice between quality and extent of care versus breadth of access.  To this end, while not dismissing the problematic nature of making this half-choice, this situation felt far less troubling than the previous one.

Various coalition members brought up lobby days and related activities as already ongoing (as ever) and to be continued as a method of ensuring that ME was carried out.  Beyond that, though, there was little strong consensus - or even very strong discussion - about what else could be done.  I am unsure how I feel about this.  On the one hand, I absolutely believe that more than lobbying should be facilitated, given how inaccessible such practices are to the larger community - both for the community's awareness of the activities or, more importantly, its ability to get involved.  And in this vein there were various suggestions - hosting another action day for which organizations would recruit community members to come to Harrisburg to demonstrate public interest to legislators, using email blasts to get people talking to their legislators - but nothing was really decided upon, nor did there seem to be a sense of urgency.  On the other hand, though, many of the individual organization in the coalition at this point have other issues and campaigns to be focusing on.  With the promise of ME extended, many organizations are now able to devote their attentions to other issues that had been left more on the wayside during the summer healthcare battles. 

Beyond listening to the conference call, I was also assigned to read over the text of Healthy Pennsylvania and mark up the document with comments, to assist my supervisor in writing an official comment memo that a coalition we head was planning to submit in response to the document.  This proved interesting not just in that I got to read some of the material that had spurred some of the call's earlier conversation, but it also presented an interesting contrast to the various pieces of legislation I have read in my time with the organization.  Whereas I have already had the opportunity to note the density and inaccessibility of legislative language, Healthy Pennsylvania was written in very easy to follow language but with the same end result: discerning the intention and real repurcussions of the document was difficult as an outsider to that discourse.  My supervisor had told me in advance how various points we opposed would be phrased, and if it weren't for that jumping off point much of the document may very well have seemed positive.  Lacking specifics and clearly politically oriented to generate a positive opinion of the governor, I found piecing out the text's actual meaning very difficult for a document so apparently easy to read.  Between this and legislation, then, I am led to question the value, problem, and supposed necessity of bureacracy and its pathologies.  This is not a new concept for me - various courses have touched on it before, always intriguingly - but to be faced with such confounding documents yet continuing to work with those same structures and institutions that produced them has made my distrust and criticism of bureaucracy and entrenched institutionalism that much more real and personally frustrating.

Between the conference call and reading over Healthy Pennsylvania I spent time accompanying my supervisor and two other staff members on a site visit to a potential location for a conference we host annually in the spring.  There was less noteable about this in the course of my usual focus on policy, advocacy, and outreach, but certainly it was valuable as a further opportunity to experience the reality of what work is necessary to accomplish various endeavors as an organization.