“The one I am counting on the most [to push nationalized health care] is Trump.” This might seem like an odd statement from the Left, especially considering it it came from RoseAnn DeMoro, the executive director of the National Nurses United union. The nurses union is one of a number of organizations that see Donald Trump’s stance on the Affordable Care Act as a potential opportunity to get states on board with universal health care. As the Republican-led Congress guides the country back to the dark ages of pre-existing conditions, aiming to leave millions without health care, it looks like it is up to the states to change the way America thinks about its medical care.

The nurses aren’t the only people looking at Trump’s election for its potential silver linings alongside the mammoth, terrifying dark cloud. Bernie Sanders took the temperature of the single-payer movement (also known as Medicare for All) with a huge action on Jan. 15. The event, held simultaneously in a number of cities across the country, was explicitly designed to save the ACA, but many who attended and spoke at these events had their sights set on a fight for Medicare for All. A number of prominent Democrats, including California senator Kamala Harris, spoke at these events. This rally dovetailed with the National Single-Payer Strategy Conference in New York, which brought over 500 groups together from across the nation to discuss the future of single-payer. As Trump’s repeal threats loom, single-payer is gaining steam in an unprecedented way.

Sanders doubled down on Medicare for All in his recent CNN primetime debate with Senator Ted Cruz, and with the launch of his Medicare for All plan on his website. Many states have followed Sanders’ lead. California has been a leader in the single payer movement, though a bill has yet to pass the state assembly. In California, Lieutenant Governor Gavin Newsome and leading gubernatorial candidate has been a backer of Medicare for All; he launched a version of universal health care as the mayor of San Francisco called “Healthy San Francisco.” A number of organizations are working toward Medicare for All in the state. Along with the nurses union, Health Care for All California, Health Care Action California, and the Democratic Socialists of America are leading a growing network of single-payer advocates. California has also been host to numerous actions in favor of universal health care in recent weeks, including a major protest at House Majority Leader Kevin McCarthy’s office in Bakersfield. Rumor is that a new bill will be announced at the end of February, aimed at hitting the ballot in time for the midterm elections.

Other blue states are experiencing similar momentum in the aftermath of Trump’s election. New York State already passed a bill through its assembly in 2015 that would make universal health care a reality. Though the bill is not yet law, this shows that there is robust support for single-payer in the state. Agitation in favor of single-payer in Oregon has led to government-commissioned studies on the viability of single-payer; this has motivated Health Care for All Oregon to push forward with rallies and meetings around single-payer. Health Care for All Washington has employed a similar strategy, planning rallies and marches similar to what is going on all along the West Coast.

States that don’t yet have a broad base of single-payer support are getting in on the action as well. Red and purple state voters are taking to town halls and city squares to make their voices heard. Town halls across the country have been flooded with voters concerned with preserving the ACA and expanding it to cover all people. Many voters like this woman in Tennessee have called out insurance companies and politicians on their payroll. Republican representatives across the country are having a similar experience to Florida representative Gus Bilirakis who endured two hours of testimonials in favor of the ACA at a recent town hall.

The energy behind single-payer across the country is heartening, but the progress in blue states is more than positive energy, it could lead to real results. While Republicans spend their time dismantling national health care, it may take just one state to become a case study for single-payer, whether it be in Washington, Oregon, California, Colorado, or New York. A successful attempt at single-payer on a state level could translate the nascent energy and anger around health care in red states into a meaningful legislative push in what will hopefully be a post-Trump 2020. While politics on a national level look bleak, a brighter, healthier future might be on the horizon.