After more than a half-decade of unsuccessful attempts to defund Planned Parenthood, the GOP appears on the verge of actually doing it. 

The health care bill released by Senate Republicans on Thursday would block Medicaid patients from accessing family planning and preventative health care at Planned Parenthood clinics for one year. That means 60 percent of Planned Parenthood’s 2.5 million patients will no longer be able to go there for affordable birth control, pap smears, testing and treatment for sexually transmitted infections, or breast exams. And it means that the family planning provider would lose nearly a half-billion dollars in federal reimbursements ― a financial hit that would force many of its clinics to close, especially in poor and rural areas. 

Republicans have been trying to defund Planned Parenthood since 2011, when then-House Speaker John Boehner (R-Ohio) threatened to shut down the federal government over the issue, because Planned Parenthood clinics offer abortion services. The House has voted nearly a dozen times to strip funding from Planned Parenthood, but the more moderate Senate never managed to pass the bill, in part because doing so would be unpopular with a majority of the American public. 

Now, because Republicans are using the reconciliation process to push the health care legislation through the Senate, it only needs 50 votes to pass. So, even if the two moderate Republicans who have vocally opposed defunding Planned Parenthood ― Sens. Lisa Murkowski (R-Alaska) and Susan Collins (R-Maine) ― vote against the bill, the Senate could still pass it with a tie-breaking vote from Vice President Mike Pence. 

“Everything is going to be trying to get to 50,” Sen. John Thune (R-S.D.), a member of Senate leadership, told Politico. “The people who are opposed to having that provision in the bill, I’m sure there will be discussions with them to figure out what it will take to get the vote.”

Four other senators are reluctant to support the bill for other reasons, saying it isn’t conservative enough: Sens. Rand Paul (R-Ky.), Mike Lee (R-Utah), Ron Johnson (R-Wis.), and Ted Cruz (R-Texas). But they said they were open to negotiation.  

President Donald Trump, despite wavering on the Planned Parenthood issue during his campaign, has since made it clear with his own budget proposal that he is eager to cut the family planning provider out of the federal government.

For Republicans, the only obstacle now, aside from getting 50 votes, is the Senate’s “Byrd rule,” which states that a reconciliation bill can only include provisions directly related to the budget and deficit reduction. Defunding Planned Parenthood clearly runs afoul of the rule, but Republicans could find a workaround that allows them to keep the provision in.  

If enacted, the health care law would have an immediate impact. The Congressional Budget Office estimated in March that defunding the provider would cause 15 percent of low-income and rural women to lose access to any kind of family planning services, because community health centers are not prepared to fill the void.

State efforts to block money to Planned Parenthood have been disastrous for women. When Texas cut Planned Parenthood out of its women’s health program in 2011, 30,000 women lost access to publicly funded family planning services, and the maternal mortality rate in the state doubled. After Indiana slashed Planned Parenthood funding and forced five clinics to close, the state was unable to deal with an exploding HIV outbreak. 

Cecile Richards, president of Planned Parenthood, sounded the alarm after seeing the Senate bill on Thursday.

“If this is the Senate’s idea of a bill with heart, then the women of America should have fear struck in theirs,” Richards said. “Slashing Medicaid and blocking millions of women from getting preventive care at Planned Parenthood is beyond heartless. One in five women in this country rely on Planned Parenthood for care. They will not stay silent as politicians vote to take away their care and their rights.”