Vice President Mike Pence took the rare step of breaking a tie in the U.S. Senate on Thursday, casting the deciding vote to roll back protections for reproductive health funds.
Using the Congressional Review Act, which allows lawmakers to repeal recently minted regulations, senators killed a rule intended to keep federal grants flowing to clinics that provide contraception and other services in states that want to block the funding.
The rule was enacted in the final weeks of former President Barack Obama's administration, giving lawmakers the opening to nullify it under the review law.
In recent years, states such as Texas have kept some health care providers from receiving the grants as part of the country's longstanding fight over abortion.
It was the second time on Thursday that Pence used his role as the chamber's president to end a deadlock. He was called to the capitol earlier to carry the resolution through a procedural vote.
Saying the rule usurps states' rights, Republicans argued local lawmakers should decide how health care money is distributed.
Their main concern is that federal money is being used to provide abortions, although the grants are specifically barred from funding those procedures. Republicans, including President Donald Trump, generally oppose abortion.
"This regulation is an unnecessary restriction on states that know their residents' own needs best," said Republican Senate Majority Leader Mitch McConnell.
Democrats said the resolution was an attack on women's health, contending the rollback will make it harder for low-income and rural women to obtain screenings for cancer and other diseases, as well as contraception.
Most resolutions killing recent Obama-era regulations have sailed through the Republican-controlled Congress. They need to win only simple majorities in both chambers to go to the president for signing.
The congressional review law was used only once successfully until this year. The family-planning resolution marked the 13th time it has been deployed effectively since the beginning of February, as well as the first time a resolution has come within a hair's breadth of failing.
"Republicans didn't listen to us," said Senator Patty Murray of Washington, the senior Democrat on the health committee. "They didn't listen to women across the country who made it clear that restricting women's access to the full range of reproductive care is unacceptable."
The nonprofit Planned Parenthood, which provides abortions and many other health and contraception services, receives some of the federal funding.
Noting the recent collapse of the Republican health care bill in the U.S. House of Representatives, Dawn Laguens, executive vice president of Planned Parenthood Federation of America, said Thursday's votes were close because "people are sick and tired of politicians making it even harder for them to access health care."