Ohio senators on Thursday dealt a blow to abortion access in the state with the approval of a budget amendment that advocates say is designed to force the closure of at least one clinic.

The Senate Finance Committee on Wednesday added the measure to the state’s $71 billion budget bill. The full Republican-majority senate approved the measure a day later.

The amendment would deny by default certain clinic licensing applications if the state Department of Health doesn’t act on the application within 60 days.

The Ohio legislature in 2013 passed a law, also added as a budget bill amendment, requiring that abortion clinics in the state have a transfer agreement with a local, private hospital willing to accept clinic patients in an emergency. First-trimester abortions are an extremely safe medical procedure, with only 0.05 percent ended in hospital visits.

Alternatively, clinics can apply for variances, which are essentially transfer agreements with physicians instead of hospitals and are subject to re-application every two years. The Women’s Med Center abortion clinic in Dayton, Ohio applied for a variance more than a year ago but has not heard back from the state. Before yesterday’s amendment, it could operate while the application was pending.

Under the measure passed yesterday, if the department takes no action on the Dayton clinic’s application, it will be denied by default.

An abortion clinic in Cincinnati also operates with a variance. Advocates worry that when the Cincinnati provider must reapply for its variance permit, the state will ignore the application and let it be denied by default.

During a floor debate of the amendment on Thursday, state Sen. Peggy Lehner said that the variance amendment is meant to pressure the Department into deciding on applications more promptly.

Kellie Copeland, executive director of NARAL Pro-Choice Ohio, said that the measure would allow GOP Gov. John Kasich’s administration to more easily close clinics without having to take any direct actions. “It allows Kasich to look like he doesn’t have his hands on this,” Copeland told Rewire. “Kasich and the department can shirk their responsibilities.”

Kasich is expected to run for the Republican presidential nomination in 2016.

A second abortion restriction amendment was added to the budget bill on Wednesday but was removed Thursday evening. That proposal would have defined the word “local” for the purposes of the 2013 transfer agreement law as within 30 miles. Advocates contend that definition is a clear attempt to force the closure of Capital Care Network (CCN), Toledo’s only remaining abortion clinic, which has a transfer agreement with a hospital 50 miles away in Ann Arbor, Michigan.

CCN originally had a transfer agreement with the University of Toledo Medical Center, but lawmakers nullified that contract after the 2013 law required transfer agreements be made with private hospitals only. CCN was unable to find another in-state hospital that would sign a transfer agreement. The clinic is fighting to stay open and is in the middle of a legal battle in county court that centers on the question of whether 50 miles is too far.

The 30-mile amendment would have resolved that question. But Democratic state Sen. Sandra Williams removed the proposal from the budget bill. Williams offered an amendment to strike the language.

State Sen. Charleta Tavares (D-Columbus) had earlier in the day introduced an amendment to remove both the transfer agreement and variance language from the budget bill. “My colleagues believe this is a direct attack on women,” she said.

Her amendment was voted down along party lines.

Since the passage of the 2013 restriction, half of Ohio’s abortion clinics have closed, and the other half continue to struggle to comply with the rule. These restrictions and closures have forced pregnant people in the state to go to Michigan for abortions.

Michigan is one of two states that saw abortion rates rise between 2010 and 2014, according to a recent study, and out-of-state patients drove that increase.