Republican legislation letting states deny federal family planning money to Planned Parenthood and other abortion providers squeezed narrowly through the Senate Thursday, rescued by an ailing GOP senator who returned to the Capitol after back surgery and a tie-breaking vote by Vice President Mike Pence. 
 
 
 
 In Congress' latest clash mixing the politics of abortion, women's health and states' rights, Pence cast the decisive vote in a 51-50 roll call. The tally had been tied after two GOP senators, Alaska's Lisa Murkowski and Maine's Susan Collins, joined Democrats opposing the measure. 
 
 
 
 Senate approval sent the legislation to President Donald Trump, who was expected to sign it. The House voted its consent last month. 
 
 
 
 The bill erases a regulation imposed by former President Barack Obama shortly before he left office that lets states deny family planning funds to organizations only if they are incapable of providing those services. Some states have passed laws in recent years denying the money to groups that provide abortions. 
 
 
 
 Passage gives Republicans and anti-abortion groups a needed victory just six days after the party's highly touted health care overhaul disintegrated in the House due to GOP divisions. Besides erasing much of Obama's 2010 health care law, the failed House bill would have blocked federal funds for Planned Parenthood for a year. 
 
 
 
 There is already a ban on using federal funds for abortion except for rare instances. 
 
 
 
 Democrats assailed the legislation as an attack on women, two months after Trump's inauguration prompted a women's march on Washington that mushroomed into anti-Trump demonstrations around the nation. 
 
 
 
 "While Trumpcare was dealt a significant blow last week, it is clear that the terrible ideas that underpin it live on with Republicans in Congress," said Sen. Patty Murray, D-Wash., using a nickname for the failed House health care bill. Murray, among a stream of Democratic women senators who spoke, called the Senate measure "shameful" and "dangerous." 
 
 
 
 Republicans said the measure would give states more freedom to decide how to spend family planning funds. States would be free to divert money now going to groups that provide abortion to other organizations that don't, like community health centers. 
 
 
 
 "It substituted Washington's judgment for the needs of real people," Senate Majority Leader Mitch McConnell, R-Ky., said of Obama's rule. 
 
 
 
 With Republicans holding 52-48 control of the Senate, the Collins and Murkowski defections could have derailed the bill because Sen. Johnny Isakson, R-Ga., has been absent since Feb. 20, when he had spinal surgery. 
 
 
 
 He had a second operation March 15 and has been recuperating in Georgia under doctor's orders. But he got permission to return to Washington for one day, his office said, and he did so using a walker. 
 
 
 
 "We didn't know at the time what it would be but it turned out to be the vice president's tie-breaker," Isakson told reporters after an earlier procedural vote. 
 
 
 
 The federal family planning program was created 1970 and in 2015 served 4 million clients at nearly 4,000 clinics. Most of the money is for providing services like contraceptives, family planning counseling, breast and cervical cancer screening and sexually transmitted disease prevention. It has a $286 million federal budget this year. 
 
 
 
 Most recipients are women, and two-thirds have incomes at or below the federal poverty level, around $12,000 for an individual. Six in 10 say the program's services are their only or most frequent source of health care. 
 
 
 
 Dawn Laguens, executive vice president of the Planned Parenthood Federation of America, mocked Pence. 
 
 
 
 "Mike Pence went from yesterday's forum on empowering women to today leading a group of male politicians in a vote to take away access to birth control and cancer screenings," she said. 
 
 
 
 The Congressional Review Act has lets lawmakers undo regulations enacted in the last months of the Obama administration with a majority vote. Congress has already used the law to eliminate Obama regulations that strengthened protections for streams near coal-mining operations and prevented some people with mental disorders from gun purchases. 
 
 
 
 Under the Constitution, the vice president casts tie breaking votes. Pence broke his first tie on the nomination of Education Secretary Betsy DeVos. ||||| CLOSE The Senate was deadlocked at 50 on a procedural vote to bring legislation to cut Planned Parenthood to the floor. Vice President Mike Pence cast the tie-breaking vote. USA TODAY 
 
 A Planned Parenthood supporter attends Rep. Jason Chaffetz's town hall meeting at Brighton High School in Cottonwood Heights, Utah, on Feb. 9, 2017. (Photo: Rick Bowmer, AP) 
 
 WASHINGTON — Vice President Pence cast a tie-breaking Senate vote Thursday to pass legislation that will allow states to withhold federal funds from Planned Parenthood and other health care providers that perform abortions. 
 
 The measure, which now goes to President Trump for his signature, dismisses an Obama-era rule banning states from denying federal funds to such organizations. 
 
 Pence's vote was needed to break a 50-50 tie. Republicans Susan Collins of Maine and Lisa Murkowski of Alaska broke with their party, voting against the measure. 
 
 Republicans have said the Obama rule should be overturned to allow states the right to steer funds away from abortion providers, if they choose. 
 
 Sen. Joni Ernst, R-Iowa, said the measure reverses a rule that "attempted to empower federal bureaucrats in Washington and silence our states." 
 
 Democrats condemned the measure throughout the day, with Senate Minority Leader Chuck Schumer of New York calling it "another example of the Republican war on women." 
 
 "It would let states treat women as second-class citizens who don’t deserve the same access to health care as men," he said. 
 
 The House in February had voted 230-188 largely along party lines to reject the rule under the Congressional Review Act, which allows Congress to overturn recently enacted regulations. 
 
 The rule prohibits states from withholding family-planning funding from providers for reasons other than their ability to offer family-planning services. It took effect Jan. 18, two days before President Obama left office. 
 
 Since 2011, 13 states have restricted access to such grants, disrupting or reducing services in several instances. 
 
 Read more: 
 
 Women’s marches across the country have protested cuts to reproductive health care services. 
 
 Pence, an evangelical Christian, was a leader in efforts to defund Planned Parenthood while serving in Congress and he co-sponsored “personhood” legislation calling for constitutional rights at the moment of fertilization. As governor of Indiana, he signed several anti-abortion bills, including one that banned abortions solely because of genetic abnormalities — legislation that was suspended by a federal judge. 
 
 In January, Pence became the highest-ranking official to appear in person at the annual March for Life demonstration. He told attendees then that the Trump administration would work with Congress to permanently bar taxpayer funding of abortion and abortion providers. 
 
 “Life is winning in America,” he said then, to cheers. “And today is a celebration of the progress that we have made in the cause.” 
 
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 Planned Parenthood is a key target of a Senate bill passed Thursday. (Lucas Jackson/Reuters) 
 
 This post has been updated. 
 
 Senate Republicans were forced to call on Vice President Pence to pass an antiabortion measure Thursday, marking the second time they’ve cast a help line to the new administration to move legislation. 
 
 Pence delivered the tiebreaking vote on a resolution reversing an Obama administration rule that prevented states from withholding family-planning dollars from Planned Parenthood and other clinics that provide abortions. The vice president’s appearance in the Senate chamber was needed after two Republicans, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, defected. No Democrats supported the resolution. 
 
 The measure, a priority for groups that oppose abortion, would give a thumbs-up to Tennessee and other conservative states to resume policies blocking Planned Parenthood clinics from getting federal funding through the Title X family-planning program. Those dollars can’t be used for abortions, but conservatives feel abortion providers shouldn’t receive any taxpayer funds. 
 
 While courts have not allowed states to withhold Medicaid money from Planned Parenthood, they’ve generally allowed states to redirect family-planning dollars to other health providers. 
 
 “It’s a simple statement of where we used to be,” said Sen. James Lankford (R-Okla.). “States could choose to have Planned Parenthood as part of their Title X funding [but] states should not be compelled to.” 
 
 [States with more Planned Parenthood clinics have fewer teen births and sexually transmitted diseases] 
 
 The women’s health organization dodged a bullet last week when a House bill repealing parts of the Affordable Care Act and blocking Planned Parenthood’s Medicaid funding was pulled amid a rebellion of conservative and moderate Republicans. But it remains a key target for conservatives. 
 
 President Trump is expected to sign the Title X measure, which the House approved in February, though his administration has yet to release a statement of intent on it. 
 
 Sen. Patty Murray (D-WA) said Thursday she is apprehensive that Republicans will continue trying to strip streams of federal dollars from Planned Parenthood through other means this year, including by attaching riders to a spending bill. The money Planned Parenthood receives through Medicaid cannot be used for abortions. 
 
 “We should all be aware there is more headed our way,” Murray said on the Senate floor. “We are going to fight these efforts every step of the way.” 
 
 Conservative activists, who saw in the ACA repeal bill their first realistic chance to block Medicaid from reimbursing any services at Planned Parenthood clinics, are urging Congress to pass a defunding measure before it breaks for an April recess. 
 
 “You have a clear path to accomplish this goal,” several dozen groups, including Susan B. Anthony List, March for Life and Family Research Council, write in a letter being sent to members Friday. “There are no excuses for inaction.” 
 
 The Title X bill is a small but significant victory for abortion opponents. Thirteen states have blocked Planned Parenthood and other abortion providers from getting the family planning dollars, which can be used for services such as contraception and screening for sexually transmitted diseases. 
 
 But even this legislation was perilously close to defeat. West Virgina Sen. Joe Manchin III, the Democrat most likely to support it, instead sided with his party. That meant Republicans had to bring in not only Pence, but also Sen. Johnny Isakson (R-Ga.), who has been absent for several weeks recovering from two back surgeries. 
 
 In both a procedural vote in the morning as well as the final afternoon action, Isakson brought the measure to a 50-to-50 tie, and Pence cast his vote for its final passage. 
 
 
 
 Sen. Johnny Isakson (R-Ga.), who is recovering from back surgery, leaves the Senate chamber after voting on the Title X legislation on Thursday. (J. Scott Applewhite/AP) 
 
 Isakson, who used a walker to get onto the floor, exited in a wheelchair. He told reporters that he had always planned to ease back into his routine this week by flying up from Atlanta, where he is undergoing a 12-week rehabilitation, to cast some votes. 
 
 “We didn’t know at the time what it would be, but it turned out to be the vice president’s tiebreaker,” Isakson said. 
 
 [Fact Checker: Schumer’s claim that ‘millions of women turn’ to Planned Parenthood for mammograms] 
 
 The lawmaker initially expected to be needed on the health-care legislation the Senate was to take up this week, since its final passage and several amendments could have been decided by a single vote. But with that effort now in tatters, the Senate floor was quiet this week until Thursday’s debate on Title X funding. 
 
 “I have watched the Congress of the United States on television for eight weeks trying to rehab from spinal surgery — I know more about it than I knew about it when I was here,” Isakson joked. 
 
 Thursday’s vote was Pence’s second tiebreaker of his young term. The first came Feb. 7, when he cast the deciding vote to confirm Betsy DeVos as education secretary. Pence is expected to return to the Senate on Thursday afternoon for a final vote on the Title X measure. 
 
 The last time a vice president had to break a tie on final passage of legislation was nearly a dozen years ago, when Richard B. Cheney voted for the Deficit Reduction Act of 2005. 
 
 Cheney broke eight ties as vice president, mostly to pass amendments or advance legislation on procedural votes. Joe Biden never had to break a tie during his eight years as vice president. Al Gore broke four ties — all on legislation or procedural matters. 
 
 Ed O’Keefe and Paul Kane contributed to this report.
– The Senate on Thursday advanced legislation that would allow states to block federal funding to Planned Parenthood, after calling in Vice President Pence to break a tie, Politico reports. First, Republican Sen. Johnny Isakson was called in to the procedural vote, despite the fact that he's recovering from back surgery. He walked in with a walker but did cast his vote, bringing the total to 50-50. Republicans hold a 52-48 majority in the Senate, but Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska voted with Democrats on this issue, forcing Republicans to keep the vote open for just over an hour to get their win, Fox News reports. The legislation would allow states to block funding that's earmarked for family planning, and Collins explained that's why she opposes it: "It’s important to recognize that there is already a bar against using federal funds for abortion and that bar stays in effect. That’s a prohibition that I personally support, but I’m a strong supporter of family planning funds." Now that the procedural vote has passed, the Senate can hold a final vote later Thursday to officially repeal an Obama-era regulation that kept states from blocking Planned Parenthood from receiving funding from Title X family planning grants. The House already voted to reverse the regulation in February, USA Today reports. This is the second time Pence has had to break a tie since becoming VP; the last time a VP had to do it prior to Pence was in 2005, the Washington Post reports.