I, like most Americans, looked on with disappointment when it became increasingly evident that Donald Trump was to be elected president of the United States. As a medical student, I shuddered at the prospect that the progress we have made over the last 8 years could dissipate. I feared for the patients I have encountered and for future patients I hope to care for over the course of my career in medicine.

Now, it appears Trump is waffling with respect to what is his policy position will be regarding the ACA. His ambivalence is concerning, but it presents an opportunity for advocacy and discussion by healthcare workers on behalf of our patients and the communities we serve. Outlined below are 5 policy points that I believe should be prioritized in advocacy efforts as we strive to preserve the ACA in this precarious era of healthcare in a Trump administration.

1. Protecting Medicaid

The Medicaid expansion was the most effective component of the ACA that led to increased coverage. By expanding the eligibility threshold to 133% of the federal poverty level, over 4 million people have been able to register for Medicaid coverage. If not for the states that blocked the Medicaid expansion, this number would have likely doubled.

Newt Gingrich, likely to have a large role within a Trump administration, has proposed a block Medicaid grant to states — significantly reducing the federal contributions to Medicaid. Consequently, states would be forced to cut back benefits and many Americans will lose their eligibility.

This is a matter of fiscal responsibility. Ask any health professional — keeping people insured and offering subsidized preventative services is much cheaper than the cost of ER visits, hospital stays, and preventable complications from chronic disease. Additionally, a reminder to Mr. Trump and those in his political circles — many of the white working class individuals in the Rust Belt and Coal Country who elected Mr. Trump largely rely on Medicaid. Given the mortality rates among rural white Americans, cutting their coverage will be an unequivocal disaster with respect to their health outcomes.

2. Preserving Mental Health Care Reform

In the final two years of the Carter administration, a significant mental health policy was introduced. What took over 2 years to research, developed, and implement was subsequently overturned in a one-paragraph executive action by President Reagan. This was a tremendous setback in progress on mental healthcare, and we must be cognizant of this history going forward.

In 2008, under President Bush, congress passed a parity law that required large group health insurance plans to cover mental health at the same standards as standard medical and surgical care, and it also incorporated addiction treatments into standard mental health care. The ACA extended these stipulations to other plans, including Medicaid. Essentially, it filled in some of the gaps remaining following President Bush’s progressive reform.

What are the implications if the ACA, along with these mental health stipulations, are repealed? We will likely see an exacerbation of the addiction epidemic that has been plaguing rural communities — since addiction care will be inaccessible to many of those without insurance. This once again includes communities in rural areas that largely voted Trump into power. Furthermore, we could see increases in mass shootings and gun violence (although, the evidence is unclear as congress still prohibits the CDC from investigating gun violence through a public health lens).

Mental health needs to be covered and at the forefront of our nation’s health agenda. After the progress lost in the Carter to Reagan transition, we can’t let our progress with respect to mental health care dissipate during another administration transition.

3. Incentives for Innovation and Quality

The ACA, largely in Title III, places specific emphasis on fostering innovation in order to improve outcomes and accountability in our health care system. These innovations have specifically targeted African-Americans, Hispanics, and other minorities that have faced tremendous health disparities in our nation both historically and presently. Some of these methods have included payment systems rooted in accountability models, quality tracking, precision medicine, exploring ways to protect Medicare, and research into various team-based care coordination models.

As a result, we have already seen improved metrics: patient safety satisfaction has risen, hospital-acquired infections have plummeted, hospital readmissions have fallen, and there are some indications of reduced racial health disparities. This often overlooked component of the ACA has been instrumental in encouraging health care professionals to develop a systems-based public health lens and find ways to offer quality care in a more cost-effective way. The American taxpayer thus benefits from this. This effort is at risk should Title III and related components of the ACA be repealed.

4. Preventing Discrimination for Pre-existing Conditions

As a result of the ACA, individuals cannot be denied health coverage due to pre-existing conditions. This is one of the central components of the ACA that have allowed uninsured Americans to seek health insurance for the first time. This includes individuals with various chronic diseases like diabetes or asthma, genetic disorders, cancers like non-Hodgkin lymphoma, and so many more.

As a health care professional, I believe one of the most painful things is to encounter a patient where you know an easy and suitable treatment is available, but the patient is unable to access it due to costs or lack of insurance. This could once again be a large-scale reality should this stipulation be repealed. No matter what health care policies are implemented under Trump, we cannot go back to a time in which insurance companies are able to legally discriminate against Americans.

5. Protecting Women’s Health

Women’s health has made tremendous gains following the implementation of the ACA, and we are at risk of losing this progress. Women can no longer be charged more than men for the same plan. Out-of-pocket costs for contraception and reproductive counseling have been eliminated. Additionally, plans are required to include maternity care, women’s wellness visits, and preventive services specific to women. Some of these preventative services include mammograms, HPV screening (the virus that causes cervical cancer), and other chronic conditions.

In an appeal to many of Trump’s pro-life political allies, the abortion rate in the Obama administration has fallen to its lowest level since 1973. The improvements in women’s health care from the ACA likely have played a large role in this. When women have access to comprehensive health care in a stable economy, it appears there is less demand for abortion services.

Women have long faced tremendous discriminatory practices in our nation’s health care system. A loss of this progress and expanded services will have detrimental effects for women — not just in their health, but it will affect their careers, livelihoods, and ability to care for their families.

6. Preserving Obama’s Global Health Security Agenda

I LIED — I know I said 5, but this extra point is not specifically related to the ACA. This past month, President Obama advanced the Global Health Security Agenda (GHSA). Global Health, an area that saw a lot of support in both the Bush and Obama administrations, is not likely on Trump’s policy radar. However, as we have witnessed from the outbreaks of Ebola and Zika, the GHSA has significant implications with respect to our national health security. It is easier and more cost effective to work internationally in order extinguish the “spark” abroad then trying to put out the fiery flames of a disease outbreak that spreads to us at home.

Final Thoughts

The ACA isn’t perfect, and I originally had hoped we could spend the next four years discussing ways to improve upon the health policies it outlines — rather than fighting to preserve its very essence.

As health care professionals, we take an oath to care for our patients. We have been trained extensively as to what that oath means in a clinic and a hospital setting — But I believe that oath goes a step further. We are called to be advocates for our patients, especially the poorest and most vulnerable. This is especially true at a precarious time like this in our health care system.

At my white coat ceremony at Georgetown University, a right of passage for students entering the incredible profession of medicine, I will always remember the words that Dr. Knowlan said while speaking to us: “Yes, today you begin the longest journey of your life, so the philosophers say, the journey that brings the talents and skills of the mind and hands to the heart, and extends them further in the service of others. And as you do, remember: the patient, the patient, the patient — He [or she] needs you now more than ever.”

I couldn’t agree more. Patients truly do need us — both as healers as well as advocates — now more than ever.