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US Senator Johnny Isakson, who was recovering from back surgery, is wheeled away from the Senate chamber on Capitol Hill in Washington, Thursday.

WASHINGTON Senate Republicans on Thursday continued to roll back Obama-era regulations, approving a bill that restores the right of states to starve local Planned Parenthood chapters of federal funds.

But it wasnt easy, as they took extraordinary measures to pass the bill when yet another fissure opened up in GOP ranks.

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To notch the victory on a key ideological goal of Christian conservatives, GOP leaders had to summon a cavalry consisting of Vice President Mike Pence and a senator who had been at home in Georgia recuperating after spinal surgery.

Pence cast a rare tie-breaking vote not once, but twice, to get the family planning measure across the congressional finish line and onto President Trumps desk for an expected signature. Far from a resounding legislative victory, Thursdays passage of the Planned Parenthood bill revealed just how fragile the Republicans Senate majority really is.

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Two of the five women in the Senate GOP caucus Susan Collins of Maine and Lisa Murkowski of Alaska voted no on the procedural motion, joining a united Democratic caucus and imperiling the bill.

The measure would undo a rule preventing states from blocking funding for family planning clinics that also provide abortions.

The Republicans needed 51 votes to clear the procedural hurdle. Senate majority leader Mitch McConnell held the vote open for an hour Thursday morning, as he waited for Republican Senator Johnny Isakson, flying in Thursday from his home state of Georgia, to land and rush over from the airport.

Recovering from two back surgeries, the most recent performed on March 15, Isakson had gotten clearance from his doctor to return to Washington Thursday for one day only, said a spokeswoman. He used a walker to navigate the Senate floor. Elsewhere, he was seen being pushed in a wheelchair by an aide.

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Then Pence swept in, with a smile, as he cast the needed 51st vote to push the bill forward. It was the second time Pence, in his role as president of the Senate, cast the deciding vote in barely two months. For comparison, former vice president Joe Biden never cast a tie-breaking vote.

By 4:30 p.m. Thursday, Pence had cast a third. The bill was approved on final passage, again by a vote of 51-to-50.

The showdown highlights that the GOP call to strip funding from Planned Parenthood is not a political slam dunk for every member of the party.

I dont think that we should be doing anything to be backtracking on access to health care for women, said Murkowski after the final vote.

Collins was even more blunt. If youre serious about trying to reduce the number of abortions, the best way to do that is to make family planning more widely available, she said after casting her final no vote against the bills passage.

Theres already a law on the books that bans any federal tax dollars from going to fund abortions at Planned Parenthood or any health care provider. Beyond that existing law, Collins said, I personally believe that it is not appropriate to put restrictions on the use of family planning money.

At issue Thursday was so-called Title X family planning funding that goes to clinics to provide low-income and uninsured women with contraception, fertility services, cervical cancer treatment, and screenings for sexually transmitted disease.

The legislation passed by the Senate enables states to revive policies diverting those federal funds from Planned Parenthood clinics, or to enact new restrictions. Conservatives argue that no taxpayer money should go to abortion providers like Planned Parenthood for any services.

Both Murkowski and Collins hail from states with large rural populations, where Planned Parenthood is sometimes the only provider of womens health services, supporters say.

Republicans supporting rolling back the Title X regulation cast it as an issue of states rights, though no GOP senators rose to defend the measure during the block of debate time.

I just cant believe theyre doing this, Democratic Senator Elizabeth Warren said in a brief interview after the vote. She said the impact on Massachusetts is likely to be nonexistent because she doesnt think state lawmakers will move to block funds from Planned Parenthood or other providers, but it will hurt people in other parts of the country.

After the final vote, Iowa Senator Joni Ernst, lead author of the Senate repeal measure, said if Washington and Massachusetts want to continue giving federal funding to Planned Parenthood in their states, theyre free to do so. The rollback merely empowers states over a Washington knows best mentality, she said.

Senate Democrats took full advantage of the opportunity to portray Republicans as going to great lengths to hold together a vote that would prevent women from getting essential health care services.

Amazing what GOP leaders will do to make sure womens health centers dont get funded, tweeted New York Senator Kirsten Gillibrand, a possible 2020 Democratic presidential contender

Today as a woman I am angry, Washington Senator Patty Murray, the third-ranking Senate Democrat, said on the floor. She warned that Republicans who vote against women and with their extreme base today ... will be held accountable.

Conservatives have been champing at the bit to gut funding for Planned Parenthood now that Republicans control all the levers of power in Washington. They secured changes to the House GOP health bill that would have yanked funding from Planned Parenthood for a year, before that health bill went down in flames.

GOP leaders needed just a simple majority on both votes for the family planning bill as opposed to the usual 60 needed to clear a filibuster because they were acting under an obscure law called the Congressional Review Act. It gets around a filibuster but can only be used to repeal regulations issued in the last several months of a previous administration.

Now that they have a GOP president in the White House, congressional Republicans have effectively killed off seven regulations with the CRA, including regulations keeping coal companies from dumping waste into streams and waterways and a rule requiring the Social Security Administration to report to the federal firearms background check system when some beneficiaries have been deemed mentally impaired.

Using the CRA, Congress this week sent Trump a resolution overturning an internet privacy rule that bars Verizon, Comcast, and other providers from selling users browser history without their permission.

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Senate Republicans scramble to muster votes targeting Planned Parenthood - The Boston Globe