The debate over abortion and women’s health entered a new phase Thursday as Congressional Republicans delivered what’s arguably their first real blow in years to Planned Parenthood and other abortion providers.

In a dramatic vote in the Senate, Vice President Mike Pence cast the tie-breaking 51st vote on a bill that would let states block more than $200 million in Title X funding from going to Planned Parenthood or any organization that provides abortions. “Title X” refers to the federal family planning program, established in that section of the 1970 Public Health Service Act.

The move reversed a rule protecting abortion provider, something President Barack Obama put in place on his second-to-last day in office. The bill has already passed the House and now moves to President Donald Trump’s desk. He is expected to sign it.

So, what just happened?

The bill and original rule

This bill repeals a rule that went into effect on Jan. 18, as Obama was leaving office. The rule barred states from distributing Title X funding based on whether an organization provides abortion services.

What does this GOP bill do?

It will be up to states to decide if abortion providers can access this funding. In recent years, more than a dozen states have tried to block Title X funding to Planned Parenthood and abortion providers. Planned Parenthood says it serves roughly 1.5 million people under Title X.

How did the funding work exactly?

Under federal law, taxpayer dollars cannot fund most abortions. But Title X funding could pay for other family planning services at clinics which separately provide abortions. The vote Thursday means states can now block the funding for other family planning services at clinics which also provide abortions.

How can this pass without 60 votes in the Senate?

It falls under a special category of legislation – repealing rules passed in the final 60 legislative days of an outgoing administration. Under the Congressional Review Act, Congress has an easier path toward rolling back such rules.

The measure passed the House 230-188 in February on a mostly party-line vote, with just two Republicans in that chamber voting against the bill.

How did the vote go down?

The 50-50 split vote came after two Republicans, Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, voted no and forced GOP leaders to call on Vice President Pence to cast the deciding vote.

The vast majority of votes for the legislation were from men, who make up 80 percent of the 115th Congress. But the bill did receive support from two dozen Republican women in Congress, and was sponsored by women in both chambers, including Republican Rep. Diane Black (R-Tenn) and Sen. Joni Ernst (R-Iowa). They, along with other Republicans, argued that family planning funding and policy should be handled by the states.

How are Democrats reacting?

“As a direct result of the vote today, extreme politicians in states across the country will have the power to [block the rights of women],” said Sen. Patty Murray, (D-WA), the highest-ranking female senator in the leadership of either party.

“As a woman I am angry,” she continued. “I am furious about what attacks like this mean for our daughters and granddaughters.”

After a line of Democrats came to the Senate floor to oppose the measure, Murray pointed out that most Republicans who voted for the measure opted not to defend it on the Senate floor.

“What is most striking is the deafening silence from [a] group of almost entirely male politicians who are making it harder for women” to get the health care they need, she said.

How is Planned Parenthood reacting?

The organization issued a statement which read, in part, “Four million people depend on the Title X family planning program, and this move by DC politicians would endanger their health care. This would take away birth control access for a woman who wants to plan her family and her future. Too many people still face barriers to health care, especially young people, people of color, those who live in rural areas, and people with low incomes.”

How are groups on the right reacting?

Marjorie Dannenfelser, president of the Susan B. Anthony list, also issued a statement. She praised Republicans for “ensuring that states are not forced to fund America’s abortion giant, Planned Parenthood” and she pointed to the next fight. “Today’s vote makes it clear Congress also has the votes to send to President Trump a reconciliation bill that defunds Planned Parenthood of more than $400 million in taxpayer funding and instead funds community health centers,” she wrote.

“This legislation does not prevent Planned Parenthood or any other entity from receiving Title X funds,” Ernst said immediately after the vote. “If states [want] to distribute Title X sub-grants to Planned Parenthood, this legislation to overturn the Obama Administration’s rule won’t prevent them from doing so.”