The Senate Republican majority is razor-thin enough on social policy that Vice President Mike Pence needed to break two ties Thursday to let states block family planning money from health care providers, most prominently Planned Parenthood.

Sen. Johnny Isakson didn’t expect to return to the Capitol after back surgery to be casting such consequential votes.

“I’m in the fifth week of about a 12-week rehab from my spinal surgery, and I want to start getting all my routines back to normal, and so I called and told them I thought I could be back this week,” the Georgia Republican said. “And if I could vote, I’d like to vote.”

But Isakson’s return turned out to be critical on a pair of 51-50 votes, with Pence, in his capacity as president of the Senate, casting tiebreakers on proceeding to and then later clearing a Congressional Review Act measure that would block an Obama-era Health and Human Services rule keeping states from denying Title X funds to Planned Parenthood.

“We didn’t know at the time what it would be, but it turned out to be the vice president’s tiebreaker,” Isakson told reporters.

They were the second and third tiebreakers cast by Pence, following the one for confirmation of Betsy DeVos as Education secretary.

Title X has provided about $286 million annually in recent years to certain health care providers, and Planned Parenthood has received about $25 million of that money.

Federal money cannot be used to fund abortions, except in the cases of rape or incest or to save a woman’s life. But politicians and advocates who oppose abortion don’t want any taxpayer dollars supporting any of Planned Parenthood’s operations.

In addition to providing abortions, Planned Parenthood is also a safety-net health care center for many low-income women and families to receive services like screenings for cancer or sexually transmitted infections.

Senate Democrats panned the measure, and pointed to the close votes, on which Republican Sens. Susan Collins of Maine and Lisa Murkowski of Alaska crossed the aisle in opposition, as evidence that the measure should not have been taken up.

“Taking resources away from these providers would be cruel — and it would have the greatest impact on women and families who are most in need,” said Sen. Patty Murray, the top Democrat on the Health, Education, Labor and Pensions Committee. “It would undo a valuable effort by the Obama administration to ensure that health care providers are evaluated for federal funding based on their ability to provide the services in question — not ideology.”

Collins emphasized to reporters that the rule as drafted was in compliance with the Hyde amendment, meaning the Title X dollars were not to flow to abortion services anyway.

“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,” the Maine Republican said. “I don’t think, as long as it’s federal funds we’re talking about, that these kinds of restrictions should be placed on their use.”

Isakson, who flew up from Atlanta on Thursday morning, said he would return to vote as frequently as possible, “which will be often.”

While he said he was taking the process week by week, he signaled he could be available for key votes next Thursday if Majority Leader Mitch McConnell moves forward, as expected, on changing Senate precedent to ensure that Judge Neil Gorsuch is confirmed to the Supreme Court by a simple majority if a Democratic filibuster holds.

“My option is always to be the team player, and I’m on the team, and I’ll be doing what Mitch needs me to do,” Isakson said.

The Georgia Republican also told reporters he had kept tabs on Capitol Hill from home, including last week’s developments in the House where GOP leadership there pulled a health care reconciliation bill off the floor Friday without a vote. Had that not happened, Isakson’s return this week might have been for a Senate health care vote-a-rama.

“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 said. “I suspected everything was going to be happening this week and none of it happened.”

Andrew Siddons contributed to this report.