The destructive toll of Donald Trump’s presidency is beginning to emerge, foreshadowing what’s likely to come as the White House and congressional Republicans begin to reverse, repeal and replace federal laws and regulations and downsize agencies.

While Trump’s red-state supporters may be cheering now, they’ll soon feel the consequences. Take the Muslim travel ban, if upheld. Thousands of the doctors across rural America are from the countries targeted by Trump, a new analysis by FiveThirtyEight.com reported. “It’s no secret that the U.S. faces a physician shortage in many parts of the country, especially when it comes to doctors in relatively low-paying specialties like primary care and psychiatry.”

Add to that whatever is done to undermine Obamacare and Medicaid, and one set of dominos is lining up and poised to fall. A possible doctor shortage in the regions that elected Trump is only the start. Since taking office, a mixture of Trump’s executive orders, new proposed legislation in Congress and directives by just-installed agency heads—the first in a coming wave of appointees—is taking aim to destroy a swath of policies adopted to enhance public health, protect the environment and help ordinary Americans by curbing corporate greed.

This destructive template doesn’t stop in Washington, either. If anything, it gives license to GOP-held state legislatures to step on and pre-empt progressive laws—such as minimum wage, LGBTQ rights, paid sick days, gun control, natural gas drilling, and immigration sanctuaries—passed in cities where Democrats rule and reside.

“If people had a sense of the number of threats to local decision making there are, either under consideration or that have already been passed by legislatures, their heads would spin,” Democrat Andrew Gillum, the mayor of Tallahassee, Florida, told PewTrust’s Stateline, in a new piece forecasting more conflict.

It Starts at the Top

Trump’s executive orders may be vague, overreaching and even unconstitutional in some cases, promising more than the intricate legal gears of government can deliver. But they set an unmistakable tone and direction. To review, his first was to overturn Obamacare, followed by freezing new federal regulations and hiring of non-military employees; barring funds for international family planning; reviving the Keystone XL and Dakota Access pipelines; speeding up issuing of permits to thwart environmental impact review; building a Mexican border wall; expanding the federal deportation machine; deregulating Wall St. finance rules, and more.

Critics have been quick to pounce on the inconsistent and hypocritical statements made by Trump and his team. Last Friday, for example, when surrounded by top Wall Street bankers as he signed an order intended to gut the Dodd-Frank financial reform, Trump said, “We expect to be cutting a lot out of Dodd-Frank, because frankly I have so many people, friends of mine, that have nice businesses and they can’t borrow money.”

Two days later on Fox News Sunday, Vice President Mike Pence fed the network most watched by Trump’s base a different line. “The message that we are sending to Main Street is that we are going to pull back this mountain of red tape that is stifling access to capital and loans.”

Trump’s critics may sneer at Trump for bowing to Wall Street while Pence panders to Main Street, and pledge to carry on resisting. But such personal reactions ignore a growing privatization juggernaut. Beyond the nonstop coverage of the president’s latest dumb tweets, a deeper and darker narrative is unfolding at a policy level. In almost all areas of public responsibility, the fulcrum upon which government moves is swiftly being redirected. And it is almost impossible to keep up with small changes that will have big impacts.

For example, look at what the Federal Communications Commission just did after Trump elevated Ajit Pai, an ex-lawyer for Verizon who was in the panel’s minority of Republicans under Obama, as its new chairman. Under Pai, the FEC released a dozen directives further privatizing the internet in ways that prey on consumers.

“He stopped nine companies from providing discounted high-speed internet service to low-income individuals. He withdrew an effort to keep prison phone rates down, and he scrapped an effort to break open the cable box market,” the New York Times reported. A Wall Street industry analyst said, “The speed of the ruling and the chairman’s tone are very encouraging to internet service providers. I think it’s a down payment on [cutting] net neutrality, with much more to follow.”

Pai didn’t need Senate confirmation, which is the case for the thousands of federal appointees each president makes. As Matt Wood, policy director for Free Press said, “The public wants an FCC that helps people. Instead, it got one that does favors for powerful corporations that its chairman used to work for.”

Congress Joins In

This same pattern is recurring across federal government. But it’s not just with presidential appointments and executive orders. The most solid legal footing for any policy is to be a law passed by Congress and signed by the president, with fine-print regulations adopted under an ensuing rulemaking process.

Most of the press attention is now focused on Trump’s nominees to lead federal agencies and their beliefs. All of Trump’s finalists to lead the Food and Drug Administration want to reverse decades of precedent for approving new drugs. One contender, Jim O’Neill, a former Health and Human Services Department officials who is an associate of Peter Thiel, Trump’s friend and a Silicon Valley billionaire, wants people to use new drugs “at their own risk.” While that kind of deregulation steps on scientific protocol, to say nothing of possibly leading to medical marketing that’s even more hyped than it is now, his views are part of a pro-privatization continuum that is sweeping Congress.

A parallel legislative effort now under way would “redefine science to make issuing health regulations almost impossible,” Stanton Glantz, a UC San Francisco professor who has long studied and criticized the way tobacco companies have flouted public health laws, wrote to his list-serv on Monday. Glantz is referring to a bill slated for a hearing Tuesday in the House Committee on Science, Space and Technology that would limit the research that can be used by the Environmental Protection Agency for drafting industry-curbing regulations.

As Sharon Lerner reported for Intercept.com, this science-curtailing approach was “based on a strategy cooked up by tobacco industry strategists more than two decades ago” by limiting EPA to using data “that can be replicated or made available for independent analysis.” The problem with that standard, she wrote, is “health research often contains confidential personal information that is illegal to share,” thus thwarting precise replication and laws protecting the public. Another part of the bill would allow “industry to keep much of its own inner workings and skewed research secret from the public, while delegitimizing studies done by researchers with no vested interest in their outcome."

This trend of protecting industry profits while disregarding public impacts isn’t just found in that one bill. Late last week, the House and Senate both voted to “overturn a [U.S. Securities and Exchange Commission] rule designed to stop oil companies striking corrupt deals with foreign governments” by requiring U.S. firms to disclose their billions in payments to foreign governments “in return for rights to natural resources,” said GlobalWitness.org, an anti-corruption group.

“Global Witness notes with concern the complete fabrication of the facts by the Republican leadership in their presentation about the [to-be-discarded] Cardin-Lugar transparency provision,” the group said. “They have relied on the American Petroleum Institute’s ‘facts,’ which have been discredited over the past six years in multiple fora, while being totally unwilling to hear an alternative view.”

License to Pre-Empt

The emerging federal takeover by corporate privateers has a statewide corollary: Republican-controlled legislatures and governors pre-empting progressive local laws adopted in the Democratic strongholds and cities in their states. If anything, the developments in Washington will only empower the stateside Republicans.

Democrats in deep blue coastal states like California see themselves as a new line of defense against Trump’s excesses. Their ability to draw lines and say no will be tested in federal courts soon enough. The executive orders to take away federal funds from sanctuary cities that do not help immigration authorities to deport visa-less immigrants will be a key early test case.

But across much of the nation, a different political dynamic threatens Democrats. Most Democrats live in cities under Democratic mayors, even in red states. Many cities have adopted progressive local laws that Republicans in their capitals want to overrule by pre-empting them with new laws affecting the entire state. In 2017, the GOP controlled the entire Legislature and governor’s office in 24 states. In contrast, Democrats controlled 78 percent of the nation’s 40 largest cities.

Republicans, increasingly, have sought to block actions by cities on a range of economic, environmental, human rights and workplace issues, Pew’s Stateline just wrote. “The stage looks set for more confrontation between cities and states this year,” they predicted. “Already state lawmakers in Texas and Arkansas are weighing bills that would ban cities from declaring themselves ‘sanctuaries…’ Lawmakers in Kentucky, Virginia and six other states are considering preventing localities from allowing transgender people to use some restrooms.”

The progressive policies targeted by red states for pre-emption include: new gun controls, anti-fracking ordinances; creation of local utility districts, plastic bag fees and much more. “About 32 states now prohibit localities from regulating ride-hailing companies such as Uber, 23 [states] ban the local minimum wage, 15 [states] ban cities from requiring companies to offer sick days, and three ban [LGBTQ] anti-discrimination ordinance,” Stateline reported.

Surveying the entire spectrum of Trump’s executive orders, his federal agency appointees, the flurry of congressional pro-privatization legislation, and state-side attacks on Democrat-run cities, reveals the true extent of the coming assault on basic government and progressive values that puts people before profits. With Congress and federal agencies swiftly being occupied by corporate privateers, progressives are going to be looking to local lines of defense for the kinds of public services and safety nets they want. But those too are under attack.

“This is really about cities asserting the rights of cities to decide for themselves, consistent with their own community’s values, what solutions are in the best interest of their community,” Tallahassee’s Gillum told Stateline.

In Trump’s America, with the help of a heavy-handed Republican Congress and Republican legislators ready to pre-empt progressive policies, Gillum’s premise will be put to the test. The only thing certain is that more confrontation is coming.