Vice President Mike Pence cast a tie-breaking vote in the U.S. Senate Thursday to shred family planning safeguards enacted under the Obama administration.

President Obama’s attempt to stop state-level interference in federal funding for family planning clinics, including Planned Parenthood affiliates, fell victim to President Trump’s first 100 days in office. Pence delivered the death knell to the U.S. Department of Health and Human Services (HHS) rule aimed at helping people with low incomes access family planning services a day after addressing a “Women’s Empowerment Panel” at the White House.

White House Press Secretary Sean Spicer that same day told reporters that Trump “made women’s empowerment a priority” during his campaign. The claim doesn’t square with the expectation that Trump will sign the GOP’s latest attack on reproductive health care, as he has done with other Republican-backed efforts to kill Obama-era regulations.

Protections Gone for Vulnerable Patients

HHS finalized the rule in the last weeks of the Obama administration—opening it up to repeal through the Congressional Review Act, an arcane procedural tool that GOP lawmakers can use to undo the last six months of Obama-era regulations within the first 60 days of the new Congress and with a Republican president willing to sign off on their efforts. The rule clarified existing law and sent a clear message that state officials can’t stop reproductive health-care providers from receiving federal Title X funds if they offer abortion care.

Planned Parenthood receives about $60 million in federal Title X funds, per nonpartisan Congressional Budget Office data from 2015. The health-care organization’s affiliates treat about 1.5 million patients through Title X, according to internal accounting. That’s roughly one-third of the HHS-estimated four million Title X patients served in 2015.

Of the four million Title X patients, 30 percent self-identified as Black or African American, Asian, Native Hawaiian or Pacific Islander, or American Indian or Alaska Native; 32 percent self-identified as Hispanic or Latino; and 13 percent had limited English proficiency.

Janel George, director of federal reproductive rights and health for the National Women’s Law Center, told Rewire in December that Title X provides a “safety net” for “people who are already underserved and impacted by disparities,” including men, adolescents, and many uninsured people in states that did not expand Medicaid under Obamacare.

Senate Majority Leader Mitch McConnell (R-KY) in a statement on Thursday repeated a favorite GOP talking point, stressing how Republicans would “return power back to the people—and we’ll do so without decreasing funding for women’s health by a penny.”

But reproductive health-care advocates expect congressional Republicans to wield the upcoming fiscal year 2018 appropriations process against Title X, as they have repeatedly sought in years past.

“Our patients who rely on Title X family planning funding—including people of color, people with low incomes, and those who live in rural areas—already face systemic barriers to getting health care. Voting to weaken access to high-quality providers, like Planned Parenthood, for these patients is pure discrimination,” Dr. Willie Parker, board chair of Physicians for Reproductive Health and a prominent abortion provider, said in a statement.

“Title X clinics are often the only high-quality provider in my patients’ communities and the only way they can get well-woman exams, birth control, and cancer screenings—and this would eliminate more options for them to get quality care they need.”

GOP Undermines Health Care Over Democrats’ Pleas

The U.S. House of Representatives in February forced a nearly party-line vote to ax the Title X protections. Senators voted on the House-passed measure (HJ Res. 43) from anti-choice House Budget Committee Chair Diane Black (R-TN), though Sen. Joni Ernst (R-IA) had introduced an identical Senate version (SJ Res. 13).

Mixed-choice GOP Sens. Susan Collins (ME) and Lisa Murkowski (AK) defected when the bill reached the Senate floor, leaving two tie-breaking votes up to Pence. The vice president smirked as he tipped the 50-50 Senate during a mid-morning procedural vote, allowing the measure to come to the floor for a final vote requiring his ballot that afternoon. 

Sen. Patty Murray (WA), the top Democrat on the Senate Health, Education, Labor, and Pensions Committee, demanded more of her GOP colleagues.

“It will take one Republican this afternoon on the final vote to say yes for the women in their state and states’ rights to say no,” Murray said on the floor immediately following the procedural vote.

That afternoon, about two dozen Democrats spoke out against repealing the safeguards, to no avail.

Sen. Maggie Hassan (D-NH) noted the consequences for health outcomes of LGBTQ people. “What we cannot do is eliminate services and discriminate against providers who have been providing critical, cost-effective health care for millions of Americans for decades,” Hassan said.

Murray: Back Off Planned Parenthood

Murray took to the floor to warn Pence and congressional Republicans against tying efforts to “defund” Planned Parenthood to the showdown expected when government funding runs out at the end of April.

House Republicans sought to strip Planned Parenthood of some $390 million in Medicaid reimbursements for one year through their failed Obamacare repeal effort. House Speaker Paul Ryan (R-WI) told reporters Tuesday that Republicans won’t target Planned Parenthood in the stopgap continuing resolution to fund the government for the rest of the fiscal year.

“We think reconciliation’s the tool because that gets it into law,” Ryan said after a closed-door House GOP caucus meeting. Reconciliation is the same fast-track process that House Republicans used for their Obamacare repeal bill in an effort to bypass the Senate’s 60-vote threshold for most controversial measures.

Members of the ultra-conservative House Freedom Caucus largely responsible for tanking the Obamacare repeal seem to be eyeing a recycled reconciliation bill to defund Planned Parenthood. Anti-choice groups like the Susan B. Anthony List are pushing that strategy on Capitol Hill.

Still, Murray issued a ultimatum should Republicans pivot to the continuing resolution.

“I want to be very clear from the outset that that is a complete nonstarter,” she said.