First came GOP House Speaker Mike Johnson's pledge last Monday to overhaul the Affordable Care Act if Donald Trump wins the presidential election. Then Howard Lutnick, the co-chair of Trump's transition team, on Wednesday endorsed Robert F. Kennedy Jr's vaccine skepticism and suggested that a future Trump administration would empower Kennedy to help oversee vaccine data. Three days later, Kennedy announced that Trump would seek to remove fluoride from Americans' drinking water as a Day 1 priority.

The assorted proposals also add up to an agenda that would likely damage public health. Policy experts say that if the Affordable Care Act is overhauled, vaccine confidence declines and fluoride is removed from public water systems, the nation could see a spike in the uninsured rate, a return of vaccine-preventable diseases and more oral health problems, particularly in vulnerable communities.

The stances have also forced prominent Republicans to explain why top Trump surrogates are voluntarily attacking popular, ingrained health programs and public health interventions. The Affordable Care Act, which has become widely popular since Trump attempted to repeal it, has been credited for helping tens of millions of Americans gain health coverage since its 2010 passage. More than 90 percent of children born in the United States have been vaccinated against polio and measles, mumps and rubella, helping protect them from severe infectious diseases. Twelve presidential administrations - including Trump's - have overseen recommendations to add fluoride to water, which has been praised as one of the great public health achievements of the 20th century.

"Independents favor a much more positive health policy message than being presented here by Republicans," Robert Blendon, a longtime pollster and professor at Harvard School for Public Health, has spent more than 50 years analyzing presidential campaigns, wrote in an email.