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.

CAMARILLO, Calif. — A Southern California wildfire has destroyed 132 structures, mostly homes, in less than two days, fire officials said Thursday as raging winds were forecast to ease.

The fire started Wednesday morning in Ventura County and has grown to about 32 square miles at 5% containment. Its cause has not been determined.

Ten people have been injured in the course of the fire, Ventura County Sheriff James Fryhoff said. Most of them suffered from smoke inhalation or other non-life-threatening injuries.

Fire officials said 88 other structures were damaged but did not specify whether they had been burned or affected by water or smoke damage.

Some 10,000 people remained under evacuation orders Thursday as the Mountain Fire continued to threaten some 3,500 structures in suburban neighborhoods, ranches and agricultural areas around Camarillo in Ventura County.

County fire officials said crews working in steep terrain with support from water-dropping helicopters were focusing on protecting homes on hillsides along the fire’s northeast edge near the city of Santa Paula, home to more than 30,000 people.

Kelly Barton watched as firefighters sifted through the charred rubble of her parents’ ranch home of 20 years in the hills of Camarillo with a view of the Pacific Ocean. The crews uncovered two safes and her parents’ collection of vintage door knockers undamaged among the devastation.

“This was their forever retirement home,” Barton said Thursday. “Now in their 70s, they have to start over.”

Her father returned to the house an hour after evacuating Wednesday to find it already destroyed. He was able to move four of their vintage cars to safety but two — including a Chevy Nova he’d had since he was 18 — burned to “toast,” Barton said.

Kelly Barton, left, is hugged by a family friend after arriving at her parents’ fire-ravaged property in the aftermath of the Mountain Fire, Thursday, Nov. 7, 2024, in Camarillo, Calif.

Ethan Swope/AP

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Officials in several Southern California counties urged residents to be on watch for fast-spreading blazes, power outages and downed trees during the latest round of notorious Santa Ana winds.

Santa Anas are dry, warm and gusty northeast winds that blow from the interior of Southern California toward the coast and offshore, moving in the opposite direction of the normal onshore flow that carries moist air from the Pacific. They typically occur during the fall months and continue through winter and into early spring.

Ariel Cohen, the National Weather Service’s meteorologist in charge in Oxnard, said Santa Ana winds were subsiding in the lower elevations but remained gusty across the higher elevations Thursday evening.

The red flag warnings, indicating conditions for high fire danger, expired in the area except for in the Santa Susana Mountains, Cohen said. The warnings will expire by 11 a.m. Friday in the mountains.

The Santa Ana winds are expected to return early-to-midweek next week, Cohen added.

The Mountain Fire was burning in a region that has seen some of California’s most destructive fires over the years. The fire swiftly grew from less than half a square mile to more than 16 square miles in little more than five hours on Wednesday. By Thursday evening it was mapped at about 32 square miles and Gov. Gavin Newsom had proclaimed a state of emergency in the county.

Marcus Eriksen, who has a farm in Santa Paula, said firefighters kept embers from spreading to his home, his vehicles and other structures even as piles of compost and wood chips were engulfed.

The flames were up to 30 feet tall and moving quickly, Eriksen said Thursday. Their speed and ferocity overwhelmed him, but the firefighters kept battling to save as much as they could on his property. Thanks to their work, “we dodged a bullet, big time,” he said.

Sharon Boggie said the fire came within 200 feet of her house in Santa Paula.

“We thought we were going to lose it at 7:00 this morning,” Boggie said Thursday as white smoke billowed through the neighborhood. She initially fled with her two dogs while her sister and nephew stayed behind. Hours later the situation seemed better, she said.

The Ventura County Office of Education announced that more than a dozen school districts and campuses in the county were closed Thursday, and a few were expected to be closed Friday.

Utilities in California began powering down equipment during high winds and extreme fire danger after a series of massive and deadly wildfires in recent years were sparked by electrical lines and other infrastructure.

Power was shut off to nearly 70,000 customers in five counties over the heightened risk, Southern California Edison said Thursday. Gabriela Ornelas, a spokesperson for Edison, could not immediately answer whether power had been shut off in the area where the Mountain Fire was sparked.

The wildfires burned in the same areas of other recent destructive infernos, including the 2018 Woolsey Fire, which killed three people and destroyed 1,600 homes near Los Angeles, and the 2017 Thomas Fire, which burned more than a thousand homes and other structures in Ventura and Santa Barbara counties. Southern California Edison has paid tens of millions of dollars to settle claims after its equipment was blamed for both blazes.

(Reuters) – A California state agency said Thursday it is mandating enhanced data reporting requirements for autonomous vehicles including reports for incidents where self-driving cars get stuck.

The California Public Utilities Commission (CPUC) is requiring companies to file detailed trip-level incident reports that cover both collision and non-collision incidents, including citations and stoppage events. In June, GM self-driving unit Cruise agreed to pay the maximum $112,500 penalty to the CPUC for failing to promptly provide complete information to the commission about a serious crash involving one of its robotaxis last year.

(Reporting by David Shepardson)