Donald Trump’s decision to nominate one of Congress’s staunchest opponents of abortion as health secretary has drawn immediate condemnation from reproductive rights and public health groups.

The groups warned that the selection of Tom Price – a six-term congressman from Atlanta’s suburbs who is best-known for laying plans to repeal and replace Obamacare, and for attempting last year to defund Planned Parenthood through a budget maneuver – would have dire consequences for abortion rights and contraceptive coverage for millions of US women.

“Trump is sending a clear signal that he intends to punish women who seek abortion care,” said Sasha Bruce, the senior vice-president of Naral Pro-Choice America. “Tom Price is someone who has made clear throughout his career that he does not trust women to make our own decisions about our healthcare … As chair of the budget committee, he has been on the frontlines of the efforts to dismantle the lifesaving Affordable Care Act, as well as the dangerous attempts to defund Planned Parenthood.”

Marjorie Dannenfelser, the president of the Susan B Anthony List, an anti-abortion political action committee, called Price “an excellent choice”.

“He has a 100% pro-life record,” Dannenfelser said, noting that Price was crucial to a 2015 attempt in Congress to defund Planned Parenthood. “As HHS [health and human services] secretary, he will play a key role in developing a robust healthcare reform proposal that protects life and consciences, while promoting options for low-income individuals and families.”

A Georgia congressman, Price has been at the center of the congressional fight to repeal the Affordable Care Act, also called Obamacare, ever since it was enacted, repeatedly introducing legislation that helped form the basis for the Republicans’ replacement plans. His nomination is a signal that Trump plans to make profound changes to the healthcare regime enacted under Barack Obama.

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Advocates worry that this includes vast changes to women’s access to reproductive healthcare. Price is a staunch and longtime foe of abortion rights. As the chair of the House budget committee, he shepherded a bill through the House that defunded Planned Parenthood through the budget reconciliation process, meaning Senate Democrats had no opportunity to filibuster the bill. Obama vetoed it last year.

“Picking Price says to me that Mr Trump means it, that he wants to abolish the Affordable Care Act and he’s going to follow through on those statements he made on the campaign trail,” said Susan Wood, a professor of health policy at George Washington University. “Planned Parenthood funding, support for family planning services around the country – all these are at risk.”

Obamacare included an unprecedented expansion of contraception coverage at no extra cost, an achievement that proponents of the law worry Price will try to undermine.

Price’s proposals to replace Obama’s signature healthcare legislation have variously offered legal protections to healthcare providers refusing to offer abortion services and forbidden the use of federal subsidies to pay for insurance plans that offer abortion coverage. His plans have also eliminated mandatory coverage of contraception for plans sold on the open market.

It is not clear whether Price has designs on the contraceptive mandate, the Obamacare provision that requires all private healthcare plans to cover, at no extra cost, a wide range of contraceptive drugs and devices, and prompted an increase in the availability of contraception.

But he is hostile to the idea that some women require assistance to pay for birth control, and once challenged a reporter to “bring me one woman” who struggled to afford contraception. The Trump administration has signaled its opposition to requiring all healthcare plans to cover contraceptives. In an interview recorded just before the election, Vice-President-elect Mike Pence suggested that the Trump administration might issue a rule allowing business owners to refuse to cover contraception based on their religious beliefs. Price’s department would be responsible for drafting and enforcing such a rule.

But Price’s influence will extend even further, from Planned Parenthood’s federal funding to the Food and Drug Administration, the agency responsible for vetting and approving new drugs and medical devices.

“I am very worried that the incoming administration will once again politicize the agency,” said Wood, who served as the director of the FDA’s Office of Women’s Health under the George W Bush administration. In 2005, she resigned over political interference in the agency’s attempts to make the morning-after pill available over-the-counter.

Under Trump and Price, Wood worries that the FDA will go even further. She fears that political forces could cause the agency to not only overregulate abortion and contraceptive drugs but even re-evaluate drugs and devices the agency has already approved.

Early this year, for example, the FDA approved new labelling for an abortion drug that reduced the number of visits a woman has to make to a clinic for a medication abortion and extended the number of weeks into a pregnancy the drug is available. The move made the drug more widely accessible and was assailed by opponents of abortion.

Trump has pledged to run an anti-abortion administration. “So the question becomes whether they step even further and start trying to take things off the market,” said Wood.

Price could also help curtail funding to Planned Parenthood, the reproductive health organization that is a lightning rod for conservatives. Republicans are expected to have the votes in the House and Senate to block federal funding for Planned Parenthood. A bill Congress approved in 2015 cut off Medicaid funding, although it preserved Title X family planning funds for low-income women.

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But Price could grease the skids for states looking to defund Planned Parenthood even without the action of Congress. In 2011, the Department of Health and Human Services issued a memo that stated that federal law prevented states from excluding a qualified provider from Medicaid on the basis of the medical services it offered – such as abortion. Price’s office could reverse course and offer a different interpretation of federal law. That would green-light states’ attempts to ban Planned Parenthood clinics from receiving Medicaid dollars, although those efforts would still be subject to courtroom battles.

“The direction that the Trump administration is moving, on governmental support of reproductive health services, is really in the opposite direction of where the Obama administration has gone,” said Alina Salganicoff, the director of women’s health policy at the Kaiser Family Foundation, a not-for-profit public health organization. “There hasn’t been any action from them yet, but going on what they’ve been talking about – removing public funding for Planned Parenthood – and their records on contraceptive coverage, they’re moving strongly in that direction. Price is someone they believe will implement their priorities.”