This story first appeared on: NPR.

Former President Donald Trump’s election victory and return to the White House will likely bring changes that will reduce the nation’s public health insurance programs; would potentially increase the uninsured rate and create new barriers to abortion and other reproductive services.

The repercussions will be felt far beyond Washington, D.C., and could include the erosion of the Affordable Care Act’s consumer protections, the imposition of work requirements in Medicaid, funding cuts to safety-net insurance, and challenges to federal agencies that protect public health.

Abortion restrictions may be tightened across the country, with a possible effort to restrict the mailing of abortion drugs.

With the rise of vaccine skeptic Robert F. Kennedy Jr. to Trump’s close advisers, public health interventions with rigorous scientific support, whether fluoridating public water supplies or vaccinating children, could face criticism.

Trump’s victory will give a much larger platform to skeptics and critics of federal healthcare programs and actions. Public health officials worry that, in the worst case scenario, the U.S. could see a surge in preventable diseases; weakening public confidence in established science; and debunked concepts such as the link between vaccines and autism have been adopted as policy.

Trump said an NBC News interview On November 3, he announced that he would “decide” on banning some vaccines, said he would consult with Kennedy, and described him as “a very talented man.”

Here is what is known about what the Trump administration might do on some important issues in healthcare:

Changes to Obamacare

While Trump has said he will not seek to repeal the Affordable Care Act again, his administration faces an urgent decision next year on whether to extend increased premium subsidies for Obamacare insurance plans. Without enhanced subsidies, steep premium increases It is anticipated that this will result in lower enrollments. Current uninsurance rate, about 8%may rise.

Policy details didn’t go much beyond the “plan concepts” Trump said during his debate with Harris, but Vice President-elect J.D. Vance later said the administration would seek to inject more competition into ACA markets.

While Republicans claim a majority in the Senate as well as the White House, control of the House of Representatives has not yet been resolved as of Wednesday afternoon.

Polls show ACA is successful found support among the publicThey include provisions such as pre-existing condition protections and allowing teens to stay on family health plans until age 26.

Trump supporters and others who worked in his administration say the former president wanted to improve the law in a way that would cut costs. Those who say he has already shown he will be strong in bringing down high health care prices point to his efforts to pioneer price transparency on medical costs during his presidency.

“On compliance, I think he will make progress in the first term,” said Brian Blase, who served as Trump’s health adviser from 2017 to 2019. “Minimizing fraud and waste.”

Efforts to weaken the ACA could include cutting enrollment outreach funds, allowing consumers to buy more health plans that do not comply with ACA consumer protections, and allowing insurance companies to charge higher premiums to sicker people.

Democrats say they expect the worst.

“We know what their agenda is,” said Leslie Dach, executive director of Our Protection, a health policy and advocacy organization in Washington, D.C. He worked in the Obama administration helping implement the ACA. “They will raise costs for millions of Americans, eliminate insurance coverage for millions, and give tax breaks to the wealthy along the way.”

Theo Merkel, director of the Private Health Reform Initiative at the right-wing Paragon Health Institute, which Blase leads, said the enhanced ACA subsidies expanded by the Inflation Reduction Act in 2022 did nothing to improve plans or lower premiums. He said they were covering up the low value of the plans with larger government subsidies.