I've spent most of my adult life organizing, and the question I hear more than any other is some version of "does my vote even matter?" I understand why people ask. They're working, raising kids, caring for parents, and trying to cover bills that keep climbing. Politics can feel like noise from far away.

This year I have a simple answer. What happens on November 3 will show up in your insurance premium, at the pharmacy counter, and in whether the people you love can get care when they need it.

Start with cost. The extra tax credits that kept marketplace health insurance within reach for millions of families ran out at the end of last year. For people who kept the same plan, premium payments more than doubled on average. About three million fewer people are enrolled now than a year ago. Many who stayed moved to plans with higher deductibles, so they pay more every month and more again when they get sick.

Behind those numbers are families choosing between staying insured and paying rent. More than four in ten people who kept their coverage say the higher cost has made it harder to afford groceries, utilities or housing.

Then there's Medicaid. About one in five Americans gets health care through it. That includes children, seniors in nursing homes, people with disabilities, and millions of working adults whose jobs don't come with insurance.

Last year Congress cut more than $900 billion from Medicaid over the next ten years. The biggest piece is a new rule that starts January 1, 2027. Adults covered through Medicaid expansion will have to document 80 hours a month of work or community service, or prove they qualify for an exemption, to keep their coverage. The Congressional Budget Office estimated about five million people will lose Medicaid because of it.

Most adults on Medicaid already work or face real barriers to working. The trouble is the paperwork. When Arkansas tried a work requirement, 18,000 people lost coverage, and many people never knew the rule existed.

This matters for treatment as much as anything. Medicaid is the single largest payer for mental health and addiction care in the country. The new law exempts people with a substance use disorder, but an exemption only helps if the system can find you and you can prove it. When coverage gets harder to keep, treatment gets harder to reach. Programs lose funding, wait lists grow, and someone who is ready to ask for help today gets told to come back next month.

I'm a person in long-term recovery. I know what it means when help is there on the day someone is ready for it. Recovery is what happens when people have care and a community around them. Millions of us are living openly and freely today, working, raising families and showing up for our neighbors. Access to treatment is how more people get that chance.

And this reaches well beyond recovery. It's the parent putting off a scan because of the deductible, and the grandmother whose home care hours depend on a state budget. It's whether the hospital in a small town can keep its doors open.

Here is why the date matters. January 1 comes less than two months after the election. The people we choose on November 3 will be the ones in office as these rules roll out. Members of Congress decide whether the tax credits come back and whether the cuts stand. Governors and state legislators decide how Medicaid runs in your state, how hard it is to stay enrolled, and what gets funded when federal dollars shrink. Every seat in the U.S. House, a third of the Senate, 36 governors and most state legislatures are on the ballot.

So vote. Check your registration today at vote.gov, because deadlines are different in every state and some are days away. Early voting is already open or about to open in many states. Make a plan for when and how you'll cast your ballot, and fill it out all the way down. The offices at the bottom are often the ones closest to your health care.

Then do one more thing and bring someone with you. Text three friends and ask if they have a plan. Give a neighbor a ride. Ask candidates at every level where they stand on Medicaid, on the cost of coverage and on access to treatment. If you have a few hours, knock on doors or make calls for the people you believe in.

I've watched ordinary people change policy by showing up together. Nobody is going to do this for us, and that has always been the good news about organizing. We get to do it ourselves.

See you at the polls.