Sen. Susan Collins’ most famous vote on a judicial nominee was her 2018 decision to confirm U.S. Supreme Court Justice Brett Kavanaugh, whose appointment changed the makeup of the nation’s highest court and helped open the door to the overturning of Roe v. Wade.

Less than a year later, Collins was the sole Republican to vote against the confirmation of Matthew Kacsmaryk, former President Donald Trump’s nominee for federal district judge in Texas. That vote attracted far less attention. It also didn’t affect the outcome – Kacsmaryk was confirmed by all the other Republican senators.

Now Kacsmaryk is in the national spotlight as he prepares to rule on a case that could limit abortion services nationwide, including in Maine and other states where abortion remains legal. Collins is among those expecting Kacsmaryk to order that the most commonly used abortion medication be removed from the market nationwide.

“Maybe I’ll be surprised and he will vote in the way that I would like to see him vote,” Collins said. “I don’t think it’s a coincidence that individuals who are trying to restrict access to medication abortion have brought their case to his court.”

When she voted for Kavanaugh in 2018, Collins said the Supreme Court nominee told her during a private meeting that he considered Roe v. Wade, which was still in place at the time, to be settled law. Collins had said she wouldn’t vote for a nominee who would overturn Roe, the landmark decision that established a constitutional right to abortion nationwide.

Eight months later, Collins said she would oppose the confirmation of Kacsmaryk. He also said that he would respect the Roe precedent, but Collins said at the time that he displayed “alarming bias” against LGBTQ people and abortion rights in published writings and interviews.

Kacsmaryk had dismissed abortion rights advocates as “sexual revolutionaries,” criticized the legal foundations of Roe v. Wade, described the national campaign for same-sex marriage as “typified by lawlessness” and derided the Supreme Court’s landmark same-sex marriage ruling, Collins argued.

“Such extreme statements reflect poorly on Mr. Kacsmaryk’s temperament and suggest an inability to respect precedent and to apply the law fairly and impartially,” Collins said in a statement issued one week in advance of her no vote. The Senate confirmed Kacsmaryk 52-46 in June 2019. Maine’s junior senator, independent Angus King, also voted against confirming Kacsmaryk.

Since his appointment, Kacsmaryk has issued a string of divisive rulings, defending the “remain in Mexico” immigration policy, overturning federal guidelines protecting trans people from workplace discrimination, and requiring federal clinics to get parental approval to give contraceptives to minors.

Now he is presiding over a critical legal battle over medication abortion.

The Alliance for Hippocratic Medicine, a group backed by the same conservative attorneys behind the Mississippi state law that toppled Roe, filed a lawsuit to overturn the U.S. Food and Drug Administration’s approval of mifepristone, a key element in the most common abortion medication.

Before he was confirmed, Kacsmaryk also told senators he knew he’d have to follow Roe as a federal judge, but Collins said she didn’t believe him.

“It was evident from his briefs, the organization for which he worked, and the extreme statements he made that he vehemently disagreed with Roe,” Collins said Thursday. “That raised to my mind serious doubts about whether he could set aside his personal views and bias and rule fairly on cases.”

Collins’ critics point out that Kacsmaryk would still be a relatively obscure federal judge if not for the confirmation of Kavanaugh and other justices who overturned Roe.

“By installing extreme judges like Brett Kavanaugh on the Supreme Court, Susan Collins and her Republican friends are ultimately responsible for the current assault on reproductive rights,” said Jacob Stern, communications director for the Maine Democratic Party. “Had Roe v. Wade never been overturned, this case would never have been allowed to come forward and the rights of millions of Americans would not be at risk today.”

The Senate confirmed Kavanaugh by a 50-48 vote, and Collins was one of the final senators to announce key support for his confirmation.

“My fervent hope is that Brett Kavanaugh will work to lessen the divisions in the Supreme Court so we have far fewer 5-4 decisions and so that public confidence in our judiciary and our highest court is restored,” Collins said in a 45-minute Senate speech leading up to the announcement of her yea vote.

The vote exposed Collins to immense criticism, especially among moderates and women’s groups. Despite the blowback over the Kavanaugh vote, Collins easily won reelection to a fifth term in 2020. However, that was a full two years before Kavanaugh and another Supreme Court judge that Collins confirmed, Neil Gorsuch, tipped the court and led to the overturning of Roe.

“This decision is inconsistent with what Justices Gorsuch and Kavanaugh said in their testimony and their meetings with me, where they both were insistent on the importance of supporting long-standing precedents that the country has relied upon,” Collins said of the court’s overturning of Roe.

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