Xavier Becerra, California’s attorney general and former congressman, was confirmed Thursday by the Senate as secretary of the Department of Health and Human Services.

The narrow confirmation vote of 50-49 took place mostly along party lines, with Democrats in support and Sen. Susan Collins of Maine being the only Republican to cross the aisle and support Becerra's confirmation. Sen. Mazie Hirono (D-Hawaii) did not vote.

Becerra wrote on Twitter that he is “honored and humbled” by his confirmation, and he is “ready to get to work.”

Becerra was one of Biden’s most controversial nominations due to his previous positions on abortion and conscience protections. The Senate Finance Committee was ultimately deadlocked on a favorable recommendation for his confirmation, forcing Senate Majority Leader Chuck Schumer to file a discharge petition for the whole chamber to vote to advance the confirmation.

He will take the helm of the health agency amid the ongoing COVID-19 pandemic with legal experience - but critics have pointed to his lack of public health experience.

Pro-life advocates from both parties expressed alarm at Becerra’s confirmation, pointing to his previous defense of coercive state abortion coverage and abortion advertising mandates.

In a statement, Democrats for Life of America said Becerra’s record on abortion “should shock and horrify every American.”

Becerra as health secretary will be “a clear and present danger for Catholics and all people of faith,” said CatholicVote.org president Brian Burch.

Jeanne Mancini, president of March for Life, said in a statement that Becerra’s confirmation “is alarming given the fact that he has spent his career expanding pro-abortion policies and persecuting pro-life groups and individuals.”

Thomas Glessner, president of the National Institute of Family and Life Advocates (NIFLA), said in a statement that the institute was “disheartened by the confirmation of anti-life extremist Xavier Becerra” during March, Women’s History Month.

NIFLA sued the state of California over its Reproductive FACT Act, which required pro-life pregnancy centers to post signs advertising where free or low-cost abortion procedures could be obtained. Becerra defended that law in court, and lost at the Supreme Court in 2018 in the case of NIFLA v. Becerra.

Mancini added that Becerra “utilized his power as Attorney General of California to punish groups like the Little Sisters of the Poor for their faith as well as the journalists who exposed Planned Parenthood's trafficking in baby body parts.”

Becerra continued the state’s prosecution of pro-life activist David Daleiden for his undercover videos claiming that Planned Parenthood illegally profited from the sale of fetal tissue of aborted babies. He also sued the Trump administration in order to take away broad religious and moral exemptions to the HHS contraceptive mandate - exemptions which included the Little Sisters of the Poor.

Lawsuits by Becerra and Pennsylvania’s attorney general Josh Shapiro forced the sisters to go back to court to defend their religious exemptions, and the Supreme Court sided with the Little Sisters in July.

Mancini said that “If his record is any indication, Becerra will weaponize the more than trillion-dollar budget of the Department of Health and Human Services to attack or disadvantage those with whom he disagrees, and advance unpopular pro-abortion policies.”

“From his new role, we expect Mr. Becerra will continue his attack on the civil liberties of those with whom he disagrees,” said Kristin Waggoner, general counsel with the group Alliance Defending Freedom.

Pro-life groups on Thursday also stated their disappointment that no Democrats opposed Becerra’s nomination - including Sen. Joe Manchin (D-W.Va.) who was endorsed by Democrats for Life.

“We are deeply disappointed in @Sen_JoeManchin and @SenBobCasey for their votes today,” Democrats for Life tweeted.

“Becerra is infamous in the pro-life movement, well known for his record of attacking pro-life policies protecting unborn life, as well as assaulting the conscience rights of pro-life Americans,” said Marjorie Dannenfelser, president of the pro-life group Susan B. Anthony List, in a statement. “President Biden could not have picked a more eager and enthusiastic partner to destroy pro-life policy and expand abortion on demand.”

Meanwhile, Alexis McGill Johnson, President and CEO of both Planned Parenthood and its lobbying arm, tweeted she “[c]ouldn’t be more excited” to have Becerra lead HHS.

During his Senate confirmation hearings, Becerra wouldn’t name a single abortion restriction he supported and claimed “I have never sued any nuns,” despite his lawsuit that ultimately drove the Little Sisters of the Poor to return to court.

He also defended his push for the abortion pill regimen to be prescribed and dispensed remotely, saying remote health care practice is “something that we should really build on” in response to a question about federal restrictions on the abortion pill regimen.

Supporters of Becerra’s nomination pointed to his advocacy for the Affordable Care Act. He also received unlikely support from Republican attorneys general Jeff Landry of Louisiana and Herbert Slatery of Tennessee. Both officials hailed Becerra’s work on combatting the opioid crisis.