If the Trump administration decides to repeal or replace the Affordable Care Act, what will happen to the provision that says birth control is preventive care and should be free? Trump has flip-flopped on the ACA and has not addressed the birth-control mandate specifically, and last weekend, House Speaker Paul Ryan dismissed the concern as a “nitty-gritty” detail to be resolved later. But Vice-president-elect Mike Pence hinted in an October interview that he wanted to get rid of it. And there are a few ways he and his team could do it.

Republicans could try to fully repeal Obamacare, but they don’t have a 60-vote supermajority in the Senate so it’s unlikely. Any changes to the law would probably have to come through a process known as budget reconciliation, or cutting provisions that would save the government money.

Republicans already tried that late last year with a bill — ultimately vetoed — that would have eliminated subsidies that help people pay for their insurance, as well as a Medicaid expansion that gave coverage to an additional 6 million people. The bill would have also nixed the mandate that employers with more than 50 full-time workers must provide insurance and the requirement that people pay a tax penalty if they didn’t have insurance, as well as restricted funding to providers like Planned Parenthood that offer abortions. (Mind you, Planned Parenthood also provides birth control on a sliding scale to millions of women across the country.)

Money notes that the contraception mandate for insurance offered by employers and purchased through the marketplace would be safe from a Trump-led reconciliation process because these plans don’t affect the federal budget. But Medicaid spending does, so Congress could halt full birth-control coverage from Medicaid plans and decrease the number of people who are eligible for Medicaid in the first place. Such a move could have devastating effects for lower-income women, who have higher rates of unintended pregnancies and are less likely to be able to afford abortions. The effects would be multiplied if Planned Parenthood lost its family-planning funding.

But the contraceptive mandate could be scrapped without ever involving Congress. All the Trump administration would have to do is ask its new Department of Health and Human Services to redefine preventive care as not including birth control. That would fly directly in the face of expert medical opinion, but, then again, the Trump-Pence ticket hasn’t exactly been known for scientific prowess.

If a Trump administration did successfully roll back the contraceptive-coverage mandate (or somehow fully repeal Obamacare), many insured women wouldn’t be affected until 2018 health plans kick in. And even then, lots of plans would still cover birth control, just perhaps not every prescription method would be included and there would likely be co-pays or co-insurance. The New York Times reports that, before Obamacare, 28 states required health plans to cover contraception and 85 percent of employer plans did so. (Any plan that covers preventive services must also cover birth control, per an Equal Employment Opportunity Commission ruling in 2000.)

Any changes to Medicaid coverage, though, could be immediate. We need to have free birth control, including the most effective long-acting methods, for the health and prosperity of women and any children they choose to have. And if millions of women lose their health insurance, we’ll need Planned Parenthood more than ever.

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