Former President Donald Trump’s election victory and imminent return to the White House will likely lead to changes that will cut the nation’s public health insurance programs, increasing the uninsured rate, while imposing new barriers to abortion and other reproductive care.

The repercussions will be felt far beyond Washington, D.C., and could include an erosion of consumer protections under the Affordable Care Act, the imposition of work requirements in Medicaid, and cuts to safety net funding. security, as well as challenges to federal agencies that protect public health. Abortion restrictions could be strengthened nationwide with a possible effort to restrict the mailing of abortion medications.

And with the rise of vaccine skeptic Robert F. Kennedy Jr. to Trump’s inner circle of advisers, public health interventions have rigorous scientific support — whether fluoridation of public water supplies or vaccination of children – could be criticized.

Trump defeated Vice President Kamala Harris with 277 electoral college votes, the Associated Press reported at 5:34 a.m. ET on Wednesday. He won 51% of the vote nationally to Harris’ 47.5%, according to the AP.

Trump’s victory will provide a much larger platform for skeptics and critics of federal health care programs and actions. In a worst-case scenario, public health officials worry, the United States could see an increase in preventable illnesses; a weakening of public confidence in established science; and debunked notions – such as the link between vaccines and autism – adopted as policy. Trump said in an NBC News interview on November 3, he said he would “make the decision” whether to ban certain vaccines, saying he would consult with Kennedy and calling him a “very talented guy.”

Even though Trump has said he will not try to repeal the Affordable Care Act again, his administration will face an immediate decision next year on whether or not it will support an extension of enhanced premium subsidies for Obamacare insurance plans. Without the improved subsidies, sharp increase in premiums resulting in a drop in enrollment are projected. The current rate for the uninsured, about 8%would almost certainly increase.

The details of the policy don’t go much beyond the “concepts of a plan” that Trump said during his debate with Harris, although Vice President-elect JD Vance later said the administration would seek to inject more competition into ACA markets.

Republicans are expected to claim a majority in the Senate, in addition to the White House, while control of the House remains unresolved as of Wednesday morning.

Polls show the ACA has gained public supportincluding provisions such as protection for pre-existing conditions and allowing young people to continue to benefit from family health plans until the age of 26.

Trump supporters and others who worked in his administration say the former president wants to improve the law in ways that reduce costs. They say he has already shown he will be tough on curbing high health care prices, pointing to efforts during his presidency to pioneer transparency prices of medical care.

“As far as affordability goes, I would see him building on the first term,” said Brian Blase, who served as Trump’s health adviser from 2017 to 2019. Compared to a Democratic administration, a- He said, there will be “much more focus” on “minimizing fraud and waste.” »

Efforts to weaken the ACA could include cutting funds for enrollment outreach, allowing consumers to purchase more health plans that do not comply with the ACA’s consumer protections, and authorization for insurers to charge higher premiums to the sickest people.

Democrats say they expect the worst.

“We know what their agenda is,” said Leslie Dach, executive president of Protect Our Care, a health care policy and advocacy organization in Washington, DC. He worked in the Obama administration to help implement the ACA. “They will raise costs for millions of Americans and strip millions of people of their health care coverage and, all the while, they will give tax breaks to the rich.”

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

Other Trump supporters say the president-elect could support maintaining Medicare’s authority to negotiate drug prices, another provision of the IRA. Trump has championed lowering drug prices and proposed a testing model in 2020 that would have linked prices of some Medicare drugs to lower costs abroad, said Merkel, who worked at Trump’s first White House. The pharmaceutical industry sued to block the program.

In Trump circles, some names have already been floated as possible leaders of the Department of Health and Human Services. They include former Louisiana Gov. Bobby Jindal and Seema Verma, who led the Centers for Medicare & Medicaid Services during the Trump administration.

Kennedy, who suspended his independent presidential campaign and supported Trump, told supporters that Trump had promised him control of HHS. Trump said publicly before Election Day that he would give Kennedy a significant role in his administration, but he may have difficulty winning Senate confirmation for a Cabinet position.

While Trump has pledged to protect Medicare and said he supports funding home care benefits, he has been less specific about his intentions regarding Medicaid, which provides coverage to low-income and disabled people. Some health analysts expect the program to be particularly vulnerable to spending cuts, which could help finance extended tax breaks that expire at the end of next year.

Possible changes include imposing work requirements on beneficiaries in some states. The administration and congressional Republicans could also try to revamp how Medicaid is funded. Now, the federal government pays states a varying percentage of the program’s costs. Conservatives have long sought to cap federal allocations to states, which critics say would result in draconian cuts.

“Medicaid will be a big target in the Trump administration,” said Larry Levitt, executive vice president of health policy at KFF, a nonprofit health information organization that includes KFF Health News.

The potential future of reproductive health rights is less clear.

Trump said decisions about abortion restrictions should be left to the states. Thirteen states ban abortion with few exceptions, while 28 others restrict the procedure based on length of gestation. according to the Guttmacher Institutea research and policy organization focused on promoting reproductive rights. Trump said before the election that he would not sign a national abortion ban.

Ballot measures to protect abortion rights passed in four states, including Missouri, which Trump won by about 18 points, according to preliminary AP reporting. Abortion rights measures were rejected by voters in Florida and South Dakota.

Trump could decide to restrict access to abortifacient drugs, used in more than half of all abortions, either by withdrawing FDA authorization for these drugs or by enforcing a 19th century law, the Comstock Act, which, according to opponents of abortion, prohibits their delivery. Trump said he generally would not use the law to ban postal delivery of drugs.

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KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the major operating programs of KFF — the independent source for health policy research, polling and journalism.