Millions of people lose health insurance.

Undocumented workers face new threats of deportation.

Progress on reducing greenhouse gases starts to reverse.

Conservatives regain a majority in the Supreme Court, and are poised to expand their influence.

Deficits rise, forcing cuts to programs on which the poor and middle class depend.

Those are some of the headlines you could see over the next four years, now that Donald Trump has been elected the 45th president of the United States.

Trump did not run a substantive campaign. He talked about policy only sporadically, without much detail and frequently in contradictory terms. This created the impression that he didn’t have ideas about what he wanted to do ― and that he’d act unpredictably.

Trump also fought with Republican leaders in Congress, particularly House Speaker Paul Ryan, and adopted a few key positions ― particularly on trade ― that were at odds with the party’s orthodoxy. This created the impression that he wouldn’t be able to govern, because he wouldn’t be able to collaborate with Congress.

But like the polls that predicted a Clinton win, these perceptions about Trump are flawed. The truth is that Trump has always had some basic ideas about how he’d like to reshape public policy.

And for all of his bluster about challenging the establishment, Trump and the Republicans in Congress believe in many of the same things.

Predicting how a Trump presidency will play out is difficult at this point. Neither party really prepared for this eventuality and there are some pretty big unknowns, like whether Democrats can use the filibuster to block Republican proposals ― and whether Republicans change Senate rules in response. Governing is a lot harder than campaigning, and it will require confronting trade-offs that Trump ― and, to some extent, Republicans in Congress ― have never confronted before. But *even allowing for all of that,* it’s not hard to imagine Trump working closely with a Republican Congress, in order to rewrite vast swaths of the federal code.

One obvious area of consensus is Obamacare. Repealing and replacing President Barack Obama’s signature health care law has been an explicit goal for both Trump and the Republicans, and in just the last two weeks Trump has made clear he intends to make it a priority.

The “replace” part of that vow remains fuzzy, so it’s impossible to say precisely what that would mean. And in the one test case for repeal so far, a newly elected Republican governor in Kentucky decided not to follow through on a promise to back out of its Medicaid expansion ― a major component of Obamacare ― because doing so would deprive hundreds of thousands of insurance.

But even if Trump and Republicans decided not to go full repeal, or to replace the health care law with a meaningful alternative, the end result is likely to be far fewer people with insurance or far less financial protection from medical expenses ― because the thrust of Republican plans are to scale back consumer protections and reduce government spending.

One way or another, it mean reversing the progress of the last few years, so that the health care system looks more like the one that existed before reform ― with cheaper, skimpier policies available to people in good health, but fewer insured overall and bigger bills for people with serious medical problems.

Taxes are another area of broad agreement. Trump may have presented himself as a threat to the establishment and champion of the little guy, but when it comes to economic policy he’s actually a very ordinary Republican who believes in policies that are very good for businesses and the wealthy, and not so good for everybody else.

And so both Trump and his Republican allies have called to reduce or eliminate the estate tax, to lower income tax rates, and to give give new breaks to corporations. Analyses of these tax plans by independent organizations, such as the Brookings-Urban Tax Policy Center, show that benefits flow disproportionately to the wealthy.

But those tables actually understate the extent to which tax cuts shift resources, because these tax cuts end up depriving the federal government of trillions of dollars of revenue. That creates deficits that, inevitably, lead to cuts in programs on which the poor and middle class tend to rely. Those can include everything from food stamps to Medicare.

There are some areas where Trump and the Republicans are likely to be at odds ― either because he’s already taken different positions than they have, or because he’ll change his mind. He really has been vague and inconsistent on many issues. An example is the minimum wage, an issue on which most Republicans share a common view. (They oppose raising it.)

But on domestic policy, at least, those fights are likely to be the exception, not the rule. And on those issues where Trump couldn’t bend Congress to his will, he’d still be executive authority at his disposal.

That is likely to mean peeling back Obama’s new regulations on everything from power plant emissions to banking activities, while failing to enforce the regulations that stay on the books. And of course Trump could make broad changes to immigration enforcement, just like Obama did.

Even if Trump doesn’t follow through on all of his campaign promises, it’s likely he will increase deportations of undocumented residents already here ― and scale back temporary protections that Obama afforded them.

And that’s the thing to remember. Both Trump and Republicans have embraced radical agendas for governing. They might end up realizing only a portion of them. But that would still add up to a tectonic shift in policy.

Elections have consequences. And the consequences of this election will be big.