Protesters gather inside the State Capitol building on Friday, May 19, 2023, in Lincoln, Neb., before lawmakers were scheduled to begin debating a bill that will ban abortions at 12 weeks of pregnancy and also ban gender-affirming care for transgender minors.
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A Nebraska bill combining a ban on most abortions after 12 weeks and restrictions on gender-affirming care for transgender Nebraskans under 19 is poised to become law after the state’s unicameral legislature voted for its passage Friday.

Nebraska’s LB 574, also known as the “Let Them Grow Act” was first introduced to bar health care providers from performing gender transition surgeries and to restrict access to puberty blocking medication and hormone treatments for anyone under 19. It will also severely restrict most abortions at 12 weeks after legislators added a last-minute amendment to the bill on May 17.

Republican Gov. Jim Pillen has said he will sign the bill into law.

“All children deserve a chance to grow and live happy, fruitful lives. This includes pre-born boys and girls, and it includes children struggling with their gender identity,” he said in a statement after the bill’s passage. “These kids deserve the opportunity to grow and explore who they are and want to be, and they can do so without making irreversible decisions that should be made when they are fully grown.”

The measure passed by a vote of 33-15, just meeting the threshold needed, following lengthy debate and multiple efforts by opponents to delay the final vote. The chants of protesters in the halls of the state Capitol could be heard in the chamber as lawmakers spoke, with the Nebraska State Patrol arresting several people during the debate on charges ranging from disturbing the peace to obstructing a government operation.

The bill makes it illegal for medical personnel to perform an abortion after 12 weeks of pregnancy — with exceptions for sexual assault, incest and medical emergencies. The bill does not define “medical emergency.” The legislation includes an emergency clause, meaning the new abortion rules will take effect the day after it is signed by the governor.

The bill also bans a range of treatments that fall under the umbrella of gender affirming care. Some of what it bans, like various gender affirming surgeries, are already extremely rare for minors. Others, like puberty blockers and other hormone treatments, are the standard of care for many trans and nonbinary youth. The bill leaves the governor-appointed chief medical officer with the authority to make rules on access to puberty blocking medication and hormone treatments for Nebraskans under 19.

Unlike the abortion ban, the provisions regarding non-surgical gender-affirming care do not take effect until October 1.

Some Republicans have expressed concern over long-term outcomes of the treatments. But major medical associations say that gender-affirming care is clinically appropriate for children and adults with gender dysphoria –the psychological distress that may result when a person’s gender identity and sex assigned at birth do not align, according to the American Psychiatric Association.

“Senators just voted to deny Nebraskans medically necessary care and to trample their freedom to make decisions about their own lives, families and futures,” American Civil Liberties Union of Nebraska executive director Mindy Rush Chipman said in a written statement following the vote.

State Sen. Ben Hansen introduced his “Preborn Child Protection Act” amendment earlier this month on the heels of the failed LB626, or “The Heartbeat Act,” which would have banned most abortions after six weeks. That bill failed to overcome a filibuster in the legislature.

Hansen said the amended bill was born out of compromises to overcome the filibuster, with a two-thirds vote needed to break that obstacle in Nebraska’s legislature — which consists of a single lawmaking chamber as opposed to the typical House and Senate chambers.

He also said adding the restrictions onto the already existing bill was Republicans’ last shot at passing abortion restrictions in the Cornhusker State, which have been sought by Pillen since the overturning of Roe v. Wade.

“We didn’t shove things down people’s throats like we could have, I think we paused and listened like we should have,” Hansen said, which he said got the Republicans to the 33 votes they needed.

“These are some of the socially and culturally hottest topics that are tough to deal with,” he added. “Some people don’t deal with them. We are.”

Opponents of the bill don’t see the amendment as a compromise at all, with state Sen. Megan Hunt calling the Republicans’ tacking on of the abortion restrictions in a statement “unprecedented procedural maneuvers that eroded the respect for our institution.”

She asked that her Republican colleagues earn back that respect by “heeding the voices of the hundreds of thousands of Nebraskans who are pleading with them to stop this discriminatory and hateful attack on our most inherent rights.”

Under the state’s constitution, legislation proposed in Nebraska is required to be limited to a single topic, though the bill’s advocates say both issues addressed in its language are medical procedures.

This story has been updated with additional information.

CNN’s Andy Rose and Shawna Mizelle contributed to this report.