With a 21-10 vote, the Texas Senate passed a bill Tuesday banning coverage for abortion in private health insurance plans, including those offered in the Affordable Care Act’s federal health exchange. The measure is the first abortion-related legislation to pass out of either chamber this session.

Senate Bill 575 by state Sen. Larry Taylor (R-Friendswood) would only allow private insurance to cover abortion in cases of medical emergencies, which current law defines as “life-threatening physical condition aggravated by, caused by, or arising from a pregnancy that, as certified by a physician, places the woman in danger of death or a serious risk of substantial impairment of a major bodily function unless an abortion is performed.”

Under Taylor’s plan, anyone with private health insurance who wants abortion coverage would need to buy a supplemental plan.

“This bill is all about choice,” Taylor said as he introduced the bill. Women can still choose to get an “elective” abortion, he said, “they’ll just have to come up with another way to pay for it other than having people across Texas who buy insurance be forced to pay for something they don’t believe in.”

According to the Guttmacher Institute, a national research organization that tracks abortion and reproductive health policy, 10 states already prohibit insurance companies from covering abortion, and another 15 states prohibit abortion coverage in health exchange plans.

All but one Senate Democrat—Sen. Eddie Lucio Jr. (D-Brownsville)—voted against Taylor’s bill.

State Sen. Kirk Watson (D-Austin) took issue with the bill’s lack of exemptions for rape or non-viable pregnancies. He laid out a series of hypothetical situations in which a woman may find herself needing insurance coverage for an abortion, which Taylor called “extreme” examples.

“A person who finds themselves in any of the three scenarios I just talked about might consider our actions to be extreme if we make this difficult decision more difficult by denying insurance coverage,” Watson replied.

Taylor walked back his remark, calling Watson’s hypotheticals “extremely rare.”

State Sen. Sylvia Garcia (D-Houston), who also voted against the bill, raised concerns that requiring women to buy supplemental coverage for abortion would create an extra cost for those who can’t afford it. Many women in her east Houston district, she told her Senate colleagues, can’t pay for an abortion out-of-pocket. Garcia also pointed out that after the Legislature passed House Bill 2 in 2013, dozens of abortion clinics have closed and access has been reduced statewide. Other women’s health services, including contraception, are still hard to come by in some parts of the state.

“It seems that we’re making it impossible for [women] to have funding for these things,” Garcia said. “It’s unfortunate that we’ve already denied access to poor women, now we’re talking about women with [private] insurance.” After a final vote from the Senate, the bill heads to the House. A similar bill by state Rep. Marsha Farney (R-Georgetown) has been left pending in the House State Affairs Committee.