Justice Anthony Kennedy’s retirement has created the most important vacancy on the Supreme Court in our lifetimes. Whoever fills Justice Kennedy’s seat will join an evenly divided court with the ability to affect the laws of the United States and the rights of its citizens for generations. Enormously important issues hang in the balance: the right of workers to organize, the pernicious influence of dark money in politics, the right of Americans to marry who they love, the right to vote.

Perhaps the most consequential issues at stake in this Supreme Court vacancy are affordable health care and a woman’s freedom to make the most sensitive medical decisions about her body. The views of President Trump’s next court nominee on these issues could well determine whether the Senate approves or rejects them.

President Trump’s own words tell us that his nominee to the court will almost certainly vote to overturn Roe v. Wade and eviscerate affordable access to health care for millions of Americans. President-elect Donald Trump said in November of 2016 that “I’m pro-life; the judges will be pro-life.” During the campaign, he speculated that after he appointed two or three judges to the bench, Roe v. Wade “will go back to the individual states.”

In practice, sending Roe v. Wade back to the states would claw back a constitutional freedom to abortion that all American women have had for over 40 years. There are at least 20 states poised to ban abortion immediately if the 1973 decision is overturned, and legislatures in Iowa, Mississippi and Louisiana have already passed strict anti-abortion laws that could trigger challenges to the decision.