(The Hill) — Nebraska lawmakers on Friday gave final approval to legislation that bans gender-affirming health care for transgender minors and prohibits abortion after 12 weeks of pregnancy, sending the measure to Republican Gov. Jim Pillen.

Pillen is expected to sign the bill — which state lawmakers passed by a 33-15 party-line vote — into law on an emergency clause, which means the measure will take effect immediately.

Abortion and medical care for transgender youth are two of the most hot-button issues in state legislatures this year, and conservative lawmakers in the unicameral legislature merged both into a single bill.

The abortion ban was added as an amendment to Legislative Bill 574, a bill that would restrict access to gender-affirming medical care for transgender young people, in the final days of Nebraska’s legislative session.

Democrats were rejoicing late last month when a bill to ban abortion after six weeks failed by a single vote. Abortion in Nebraska is currently legal up to 20 weeks of pregnancy.

Sen. Merv Riepe, an 80-year-old longtime Republican, abstained from a vote to end debate and advance the legislation. Riepe introduced an amendment that would ban abortions after 12 weeks, but it wasn’t given a vote.

That defeat changed the approach of legislators, who then pivoted to legislation that Riepe would support. This week, he voted in favor of adding the abortion language to the transgender care bill. 

While Republicans called it a compromise, Democrats and abortion rights advocates decried the provision as extreme.

“A ban is a ban, whether it prohibits abortion after six, 12, or 15 weeks,” the Planned Parenthood Action Fund said in a recent memo. “Any ban that takes away a person’s ability to make their own medical decisions is unacceptable.”

Still, the legislation stops short of imposing the most stringent bans on abortion that have passed in other states. It reflects the difficult calculus from Republicans who are attempting to thread a political needle between their hardline base and the rest of the electorate.

The original bill, titled the “Let Them Grow Act,” seeks to authorize the state’s chief medical officer to adopt a set of rules that will restrict access to gender-affirming medical care for transgender children and adolescents younger than 19.

The bill’s introduction early this year kicked off a marathon 12-week filibuster led by state Sen. Macheala Cavanaugh, one of just 16 Democrats in the legislature.

“If you want to inflict pain upon our children, I am going to inflict pain upon this body,” Cavanaugh said in February.

Nebraska lawmakers passed their first bill, a measure on liquor taxation, on April 17, 64 days into the legislative session.

“Today is the day,” Cavanaugh said Friday. “It’s going to be a long day. It’s going to be a hard day.”

Cavanaugh and other Democrats slammed Republicans during Friday’s session for fast-tracking the measure. In the rotunda, hundreds of demonstrators gathered to protest the bill. Chants of “Keep kids alive!” and “Kill this bill!” echoed through the chamber.

The body briefly stood at ease after shouts from the gallery drowned out debate on the floor.

“You 33 members do not represent the will of Nebraskans,” state Sen. Megan Hunt (D) said Friday in comments directed toward her Republican colleagues. “You are more radical than Nebraskans.”

Hunt, the mother of a transgender child, announced last month that she is under investigation for a potential conflict of interest after she opposed Legislative Bill 574 in an earlier procedural vote. An ethics complaint against Hunt alleges she could benefit financially from the measure’s failure.

“You should know that there’s going to be a lawsuit if you pass this bill, with numerous plaintiffs, and the taxpayers are going to pay for that,” Hunt said Friday.

Gender-affirming health care bans adopted by at least nine states have been challenged in court, according to the Movement Advancement Project, which tracks state-level laws and policies that impact LGBTQ people.

“I lost so much this session in terms of relationships with all of you,” Hunt continued. “But I gained a hundred-fold in relationships with the people I know who support me and my family—the people who I found out have the back of the LGBTQ community and women in Nebraska.”

Democrats on Friday also circulated an open letter signed by more than 1,200 Nebraska medical professionals opposing the bill, which they said “puts patients’ lives at risk.”

Republicans, meanwhile, argued that the bill’s primary purpose is to protect young children from making health care decisions they may later regret. The bill’s designation as an anti-LGBTQ measure is a mischaracterization, they said.

“You can portray this bill any way you want. But for me, this bill is simply about protecting innocent life and protecting our kids,” Republican state Sen. Tom Briese said Friday. “And this represents a reasonable place to land in that effort.”

“You can describe it any way you want,” Briese added. “I’ve heard words like ‘hateful’ and ‘anti-trans,’ ‘homophobic,’ things like that. And that’s baloney.”

If the bill is signed by Pillen, Nebraska will be the 19th state to ban gender-affirming health care for transgender young people and the 20th to restrict access to abortion.

More than 100 Nebraska businesses and nonprofit leaders in a letter to Pillen this month warned the bill could hurt job recruitment and retention, the Nebraska Examiner reported.

“There are people planning now to leave Nebraska because of this,” Hunt said Friday, adding “me included.”