ATLANTA (AP) — Sen. Johnny Isakson is recuperating from his second back surgery this year at his Georgia home, complicating Republican leaders’ plans as they count the votes for the GOP health care overhaul and a Supreme Court nominee.

Aides to the third-term Republican senator said Wednesday that Isakson is still awaiting his physician’s approval to travel back to Washington.

The senator underwent back surgery Feb. 20 to address what aides described as “spinal deterioration caused by arthritis.” He had a second surgery March 15 to address a hairline fracture that had developed at the base of his spine during his recovery from the first surgery.

Isakson’s spokeswoman, Amanda Maddox, said her boss remains in touch with colleagues.

Senate Majority Leader Mitch McConnell, R-Ky., told The Associated Press this week that he wants the Senate to move ahead on legislation to repeal and replace former President Barack Obama’s health care overhaul and to vote on Supreme Court nominee Neil Gorsuch before the mid-April recess.

The outcome of the House vote on its GOP health care bill was in doubt. In the Senate, where Republicans hold a 52-48 advantage, six Republicans have expressed their opposition to the House bill.

Isakson, 72, has not said how he would vote, but he has been a persistent critic of the Affordable Care Act as a federal overreach that limits patient choice. He said via written statement Wednesday that he wants “to return health-care decisions back to the states” and “ensure that funding for benefits is available” to the neediest Americans.

The House Republican bill repeals major parts of the Obama health law enacted in 2010, caps future funding for Medicaid and cuts taxes for the wealthy. The Congressional Budget Office has said the measure would toss 24 million off coverage in a decade.

On the Supreme Court nomination, Gorsuch has full GOP support. In the AP interview, McConnell said he hoped Gorsuch would get Democratic votes in the end, but seemed ready to change Senate rules, if necessary, to confirm him with a simple majority rather than the 60 votes now required to move forward.

“Gorsuch will be confirmed; I just can’t tell you exactly how that will happen, yet,” McConnell said.

If Isakson is absent, McConnell would need nine Democrats and independents to break any filibuster.

Isakson announced in 2015 that he had been diagnosed with Parkinson’s disease, a degenerative neurological condition that affects motor skills and, in some sufferer’s, cognition. Isakson was re-elected in November 2016 with 55 percent of the vote.

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