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

On Wednesday morning, Trump surpassed the 270 electoral votes needed to secure the presidency, which could lead to major changes in the health care landscape.

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

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

The Future of the ACA and Medicare

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

During his first term, Trump repeatedly attempted to repeal the ACA, but was unsuccessful. In November 2023, he also pledged to replace him in a post on his social media plan, Truth Social.

Since then, he has changed course. In March, Trump said he was “not running to end” the ACA, but wanted to make it “better” and “cheaper,” in an article on Truth Social.

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

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

Trump promoted Medicare Advantage, run by commercial insurers. Additionally, Project 2025 — a plan of conservative policy proposals proposed by the Heritage Foundation and not endorsed by Trump — proposed that Medicare Advantage be the default option for Medicare coverage.

Experts said it could privatize the program and prevent people from receiving 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 JD Vance has suggested placing people with chronic illnesses in separate risk groups, which could increase premiums for those with pre-existing conditions.

Kennedy commits to eliminating fluoride from drinking water, reviewing vaccines

At a charity dinner last month in New York, Trump promised that Kennedy would “go wild on health care.”

Kennedy, an environmental lawyer with no background in public health or medicine, has spoken out about some health policies he would like to address, including fluoride in drinking water and overhauling vaccines.

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

He said fluoride in drinking water affects children’s neurological development and that other countries that have eliminated 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 teeth damaged by bacteria in the mouth. Fluoride also replaces minerals lost from teeth due to acid breakdown, according to the agency.

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

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

Top U.S. Food and Drug Administration officials have said the 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 took credit for ending Roe v. Wade – who was overturned by the U.S. Supreme Court in 2022 – was hesitant during his campaign to express his position 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 refused to say whether he would veto a national ban.

However, in October, he wrote on the social platform

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

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

He did not elaborate on what it means to be a “protector” in this capacity.

ABC News’ Will McDuffie contributed to this report.