What is Trump’s plan for healthcare issues including ACA, abortion in his second term and RFK. Jr’s involvement with health agencies

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

On Wednesday morning, Trump surpassed the 270 electoral votes needed to secure the presidency, and that could mean major changes to the healthcare landscape.

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

Here’s what a second Trump term would mean for health care policy, including health insurance and reproductive rights.

Future of the ACA and Medicare

Trump has been inconsistent about what his plans are for 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 promised to replace it in a post on his social media plan form, Truth Social.

He has since changed course. In March, Trump said he has “no intention of ending the ACA,” but said he wanted to make it “better” and “cheaper,” in a post on Truth Social.

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

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

Trump has promoted Medicare Advantage, which is administered by commercial insurers. In addition, Project 2025 – a plan of conservative policy proposals proposed by the Heritage Foundation and not endorsed by Trump – has proposed Medicare Advantage as the default option for Medicare coverage.

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

People with pre-existing conditions are also at risk. 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 J.D. Vance has proposed placing people with chronic conditions in separate risk pools, which could increase premiums for those with pre-existing conditions.

Kennedy pledges to remove fluoride from drinking water, vaccine review

At a charity dinner last month in New York City, Trump promised that Kennedy would “get rid of health.”

Kennedy, an environmental lawyer with no public health or medical background, has been vocal about certain health policies he would like to address, including fluoride in drinking water and vaccine overhauls.

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

He has claimed that fluoride in drinking water affects the neurological development of children and that other countries that 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 teeth caused by bacteria in the mouth. According to the agency, fluoride also replaces minerals lost from teeth due to acid breakdown.

In addition, Kennedy told NPR that he would “immediately” work to increase research into vaccine safety, though he insisted, “We’re not going to take vaccines away from anyone.”

“We’re going to make sure Americans have good information,” he said. “At the moment, the science about the safety of vaccines in particular shows enormous shortcomings. We are going to ensure that these scientific studies are done and that people can make informed choices about their vaccinations and the vaccinations of their children.”

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

In an interview with NBC News, he also suggested laying off many employees in the FDA’s nutrition department.

Uncertainty about the future of reproductive rights

Although Trump has taken credit for ending Roe v. Wade — which was overturned by the U.S. Supreme Court in 2022 — he hesitated during his campaign to make his position on abortion known.

During the presidential debate in September, he said he believed in exceptions for rape, incest and saving the mother’s life, but declined to say whether 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, saying abortion laws depend on the will of voters in individual states.

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

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

He did not provide any details about what it means to be a “protector” in this capacity.

Will McDuffie of ABC News contributed to this report.