I’ve written about how cost and coverage shape health, and one of the biggest examples is Medicaid expansion, which is part of the Affordable Care Act.

It’s kind of a wonky topic, but the evidence is very surprising. KFF reviewed more than 300 studies and reports and found that Medicaid expansion increased health coverage, improved affordability and access to care, and produced budget savings for states. It also reduced uncompensated care costs at hospitals. Some studies even linked it to better health outcomes and earlier cancer diagnosis.

Here’s why this connects to other things I’ve been writing about. Remember how a lot of rural hospital closures happened in states that didn’t expand Medicaid? That’s not a coincidence. When more people have coverage, hospitals and clinics get paid for care they used to give for free, which helps them stay open. So a single coverage decision can affect whether an entire community has a hospital or not.

It’s easy to ignore these types of debates because they feel distant and boring. But this stuff decides in a very real way who can actually see a doctor and who can’t. To me, that makes it about as far from boring as it gets. The communities around the world need this type of debate.