Donald Trump’s return to the White House stands to significantly shape the health of Californians — the foods they eat, the medicines they take, the costs they face and more.

Trump has said he’ll grant a prominent health role to supporter Robert F. Kennedy Jr., who has made discredited claims about vaccines and bucked the advice of pediatricians and dentists by advocating an end to water fluoridation. Policy analysts expect cuts to Medicaid.

And though Trump has publicly distanced himself from the conservative Project 2025 playbook, many of its proposals overlap with Trump’s agenda and the Republican Party platform. As such, analysts say its detailed proposals on opioid addiction, contraception, mental health treatment and more bear watching.

“I think everything is on the table,” said Gerald Kominski, a senior fellow at the UCLA Center for Health Policy Research.

Already, California Atty. Gen. Rob Bonta has vowed to take the incoming president to court if his administration tries to stymie the state’s progressive agenda.

“Every action they take will likely provoke a lawsuit,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. “California was a leader in the legal opposition to the first Trump administration, and I would expect that to be the case again this time.”

But some of those moves may not have legal remedies, Levitt cautioned. For example, if Kennedy makes changes to the Food and Drug Administration that weakens its ability to ensure foods and medicines are safe, “there’s not a whole lot California will be able to do to stop that.”

Elections matter. Here are six ways this could affect the Golden State.

Reproductive rights

While Trump has publicly claimed credit for being able to “kill” Roe vs. Wade through his Supreme Court appointments, he’s been harder to pin down on his plans for abortion in a second term. He has said on social media that he wants to leave the matter up to the states, and favors exceptions for rape, incest or life-threatening pregnancies.

With a state constitution that names abortion as a fundamental right, California has some of the strongest reproductive healthcare protections in the U.S.

Yet the administration could attempt to restrict abortion in the state by limiting access to mifepristone, one of the most common drugs used in medication-induced abortions. Conservative groups have been trying to get courts to withdraw the FDA’s approval for the drug.

More than 60% of abortions in the U.S. are induced with medication, according to the Guttmacher Institute, a research group that supports abortion rights.

Project 2025 suggests limiting access to mifepristone by reviving a 19th century law called the Comstock Act that prohibits sending abortion-causing agents by mail. Though both Trump and Vice President-elect JD Vance said during the campaign that they would not enforce it, Vance was among 40 Republican lawmakers who signed a letter last year asking the Department of Justice to do just that. That could matter if Vance has another change of heart and tries to sway his boss.

“Obviously, it would be challenged in court, but we could see a huge disruption to the provision of medication abortion if they decided to try to enforce that,” said Amy Friedrich-Karnik, director of federal policy at the Guttmacher Institute.

Vaccines

Public health experts have been alarmed by Trump’s embrace of Kennedy, who dismisses overwhelming evidence that vaccines are safe. A recent study estimated that a federal program to help pay for childhood immunizations against diseases such as measles, polio and rotavirus has prevented more than 1 million deaths and 32 million hospitalizations since its inception in 1994.

This week, Kennedy said he wouldn’t take vaccines away from anyone who wanted them. “People can make individual assessments about whether that product is going to be good for them,” he told NBC News.

Trump himself said he would cut federal funding to schools with vaccine mandates. His campaign said he was talking about COVID-19 vaccines in particular, but as a candidate, he repeatedly made the pledge without clarifying that. California requires elementary and secondary school students to be immunized against a range of diseases unless they have a medical exemption; the COVID-19 shot is recommended but not mandatory.

In other areas of public health, Trump has said he “probably would” disband the White House Office of Pandemic Preparedness and Response Policy, even as the country is facing a mounting threat from bird flu.

And Kennedy triggered concerns by calling fluoride “an industrial waste” and saying he would push to have the mineral removed from drinking water. The CDC says fluoridation to prevent tooth decay is one of the 20th century’s greatest public health achievements, and more than half of Californians live in communities with fortified water.

Gender-affirming care

California law requires health plans and insurers licensed by the state to provide transgender enrollees with medically necessary gender-affirming care. It also aims to protect doctors from laws that criminalize such care in other states.

But access to gender-affirming care could still be undermined by federal action. Trump said he would press Congress to block the use of federal funds for gender-affirming care, a position also reflected in the Republican Party platform.

A prohibition could be modeled on the decades-old Hyde Amendment, which prevents federal funds from being used to pay for abortions, or tied to appropriations bills, said Julianna S. Gonen, director of federal policy for the National Center for Lesbian Rights.

If implemented, people who rely on public programs such as Medicaid or Medicare could end up with “really limited access to gender-affirming care,” said Lindsey Dawson, director for LGBTQ Health Policy for KFF.

California officials might decide to have the state pick up the tab. Gonen said it would be “very hard” for the Trump administration to block states from doing so, although the last Trump administration threatened to withhold some Medicaid funding from California over its abortion policies.

Trump has taken particular aim at gender-affirming care for transgender youth, and he has a stated goal of prohibiting it “in all 50 states.” He said hospitals that provide such treatment would be cut off from Medicaid and Medicare funding. Gonen said losing that money would be “an existential threat” for health facilities.

Medicaid

In his first term, Trump proposed changes that would reduce federal spending on Medicaid. Trump has promised to spare Medicare and Social Security, but that could make Medicaid a target if spending cuts are needed, some public health experts believe.

“Medicaid would definitely be on the chopping block,” said Edwin Park, a research professor at Georgetown University’s McCourt School of Public Policy.

Cuts in Washington could force California to either pony up more money or shrink existing programs. California has relied on its own dollars to expand its Medicaid program, known as Medi-Cal, to cover people regardless of their immigration status, said John Baackes, chief executive of L.A. Care, the largest publicly operated health plan in the country. But amid budget deficits, “there’s a limitation of what California can do.”

Park added that Trump’s Republican allies have also floated plans that would restrict or prohibit state taxes on healthcare providers, further squeezing funding for Medicaid programs.

Nutrition and food safety

After Kennedy dropped out of the race and endorsed Trump, the former president seemed eager to delegate responsibility for food policy to his new ally, telling supporters last month that “I’m gonna let him go wild on the food.”

Kennedy told NBC that he would work to remove chemical additives from foods that are banned in Europe but still allowed in the U.S. Some of those substances, including red dye No. 3, will become illegal in California in 2027 under a law signed by Gov. Gavin Newsom last year.

Kennedy said he would eliminate the FDA departments tasked with assessing the safety of food ingredients because they are not “doing their job.” It’s not clear if Trump would go along with that.

Project 2025 calls for a repeal of the nation’s dietary guidelines on the grounds that they’ve gone astray by considering the environmental impact of food production. Project 2025 also embraces genetic engineering and other crop biotechnology. It’s not clear if Trump supports those proposals, though in his first term he eased restrictions on genetically engineered foods.

The Affordable Care Act

Trump tried unsuccessfully to roll back the Affordable Care Act during his first term. This time around, Trump has said he would only replace the landmark law if a better plan were devised.

Vance raised the idea of dividing up “risk pools,” which are used to share medical costs and calculate insurance premiums. Critics cautioned that doing so could drive up rates for elderly people with chronic conditions.

Mark A. Peterson, a professor at the UCLA Luskin School of Public Affairs, said that despite continued jabs at the law, “it’s very unlikely that Republicans will want to take on the Affordable Care Act. It did not go well for them last time … and now the Affordable Care Act is more popular than ever.”

A more immediate target may be a set of enhanced subsidies for people buying health insurance through Affordable Care Act marketplaces, which are due to expire at the end of 2025. One analysis found that if that happens, more than 1.5 million Californians would see their annual costs rise by an average of $967.

The Trump campaign has criticized the subsidies, arguing they helped insurance companies more than patients.