What a 2nd Trump term may look like for health care issues including ACA, abortion

Former President Donald Trump is set to return to the White House after winning Tuesday night’s election.

As of Wednesday morning, Trump surpassed the 270 electoral votes need to secure the presidency, and that could mean major changes to the health care landscape.

During his campaign, Trump vowed to make the Affordable Care Act “better” and to protect “women.” He also suggested that Robert F. Kennedy Jr. would shape the public health agenda of his administration.

This is what a second Trump term would mean for health care policies including health insurance and reproductive rights.

Future of the ACA and Medicare

Trump has been inconsistent on what his plans are regarding the Affordable Care Act (ACA), the landmark law signed in 2010 by then-President Barack Obama.

During his first term, Trump tried several times to repeal the ACA but was unsuccessful. In November 2023, he also vowed to replace it in a post on his social media planform, Truth Social.

Since then, he has shifted course. In March, Trump said is “not running to terminate” the ACA but said he wanted to make it “better” and “less expensive,” in a post on Truth Social.

During the September presidential debate, he said he had “concepts of a plan” and said it would be “better health care than Obamacare,” but offered few details.

There could also be changes to Medicare, a federal health insurance program for people aged 65 or older and younger people with disabilities.

Trump has promoted Medicare Advantage, which is run by commercial insurers. What’s more, Project 2025 — a plan of conservative policy proposals proposed by the Heritage Foundation and not endorsed by Trump — has proposed Medicare Advantage be the default option for Medicare coverage.

Experts have said this could privatize the program and prevent people from receiving care from doctors and hospitals that don’t accept Medicare Advantage.

Also at risk are those with pre-existing conditions. Under the ACA, insurers cannot charge more or deny coverage to someone or their child because of a pre-existing health condition. However, Vice President-elect JD Vance has suggested placing people with chronic conditions into separate risk pools, which could raise premiums for those with pre-existing conditions.

Kennedy vows to remove fluoride from drinking water, vaccine review

During a charity dinner last month in New York City, Trump pledged that Kennedy would “go wild on health.”

Kennedy, an environmental lawyer with no public health or medical background, has been vocal on certain health policies he would like to tackle including fluoride in drinking water and review of vaccines.

In an interview with NPR on Wednesday morning, Kennedy doubled down on his promise that the Trump administration will recommend that local governments remove fluoride from their water supplies.

He has claimed that fluoride in drinking water affects children’s neurological development and that other countries which have removed fluoride from their water supplies have not seen an increase in cavities.

The Centers for Disease Control and Prevention says fluoride prevents cavities and repairs damaged to teeth caused by bacteria in the mouth. Fluoride also replaces minerals lost from teeth due to acid breakdown, according to the agency.

Additionally, Kennedy told NPR he would work “immediately” to increase research into the safety of vaccines, though he insisted, “We’re not going to take vaccines away from anybody.”

“We are going to make sure that Americans have good information,” he said. “Right now, the science on vaccine safety, particularly, has huge deficits in it. We’re going to make sure those scientific studies are done, and that people can make informed choices about their vaccinations and their children’s vaccinations.”

Top U.S. Food and Drug Administration officials have said that FDA-approved vaccines are “high quality, effective, and safe.”

In an interview with NBC News, he also suggested firing many workers at the FDA’s nutrition department.

Uncertainty about the future of reproductive rights

Although Trump has taken credit for ending Roe v. Wade — which was overruled by the U.S. Supreme Court in 2022 — he was hesitant during his campaign to state his stance on abortion.

During the presidential debate in September, he said he believed in exceptions for rape, incest and to save the mother’s life but declined to say if he would veto a national ban.

However, in October, he wrote on the social platform X that he would not support a federal abortion ban, and said abortions laws are up to the will of the voters in individual states.

Trump told CBS News in August he would not use the 150-year-old Comstock Act to ban mail delivery of medication abortion pills, which drew rebuke from some conservatives and anti-abortion advocates.

In September, during a rally in Pennsylvania, he said he would be a “protector” of women and that they “wouldn’t be thinking about abortion” if he were elected. He doubled down on these claims last month during a rally in Wisconsin, with Trump saying he would “protect” women “whether the women like it or not.”

He has not offered specifics on what being a “protector” means in this capacity.

ABC News’ Will McDuffie contributed to this report.