2017 had been shaping up as a year focused on fixing the Affordable Care Act’s insurance markets, slowing prescription drug price hikes, expanding Medicaid, improving mental healthcare and spreading value-based payment and delivery.

Suddenly there’s a new, more conservative agenda. And almost everything in healthcare is up in the air.

Insurers and providers were counting on continuing to add paying customers under the ACA’s premium subsidy framework, with more states expanding Medicaid to low-income adults. But after the surprise presidential victory of Republican Donald Trump, industry groups have no clear idea what the new framework will be if Trump and the Republican Congress make good on their pledge to repeal and replace Obamacare.

Beyond that, there’s great uncertainty whether and at what level Republicans will fund a wide range of health programs, including medical research, mental health and addiction services, public health, community health centers and the Children’s Health Insurance Program. Trump’s picks for cabinet-level posts, notably Rep. Mick Mulvaney (R-S.C.) at the Office of Management and Budget, are no fans of government social spending.

“It’s hard to plan a business with this many outstanding questions,” said Ceci Connolly, CEO of the Alliance for Community Health Plans, which represents not-for-profit insurers.

Republican experts say there’s no question Congress will push to repeal the ACA via a party-line, expedited budget bill. It’s likely they’ll also try to erase or roll back the law’s Medicaid expansion. But these observers acknowledge that congressional GOP leaders themselves don’t know what they’re going to put in the ACA’s place—or precisely how they’ll do it.

“They’re working through that,” said Dean Rosen, a Republican lobbyist who formerly served as a senior Republican Senate staffer. “Republicans will own the changes, and they have to be very careful they don’t find themselves in the same position as the Obama administration, defending an unpopular, partisan piece of legislation.”