WASHINGTON — A federal appeals court in Cincinnati handed a stinging setback to supporters of abortion rights Tuesday when it upheld an Ohio law that cuts off state dollars to Planned Parenthood of Ohio because it offers abortion services or refers women to clinics that perform abortions.

By an 11-6 vote, the 6th U.S. Circuit Court of Appeals reversed a ruling last year by a three-judge panel of the same court that the law violated the Constitution. The law, signed in 2016 by then-Gov. John Kasich, would slash $1.5 million to Planned Parenthood even though the state money financed women’s health programs, not abortions.

“Today’s ruling is a direct attack on health care access for Ohio’s most at-risk communities,” said Iris E. Harvey, president and chief executive officer of Planned Parenthood Advocates of Ohio.

She said it was “shameful that politicians” like Gov. Mike DeWine and Kasich “insist on blocking people from accessing essential reproductive health care and education in our state."

DeWine, who last year as Ohio attorney general appealed the ruling to the full appellate court, said in a telephone interview from Youngstown that “we’ve always felt the state had the right to set policy on who is funded and who is not funded,” adding he was “pleased with the decision.”

Officials for Planned Parenthood declined to say whether they would appeal the decision to the U.S. Supreme Court.

Last December, the high court declined to hear appeals from Kansas and Louisiana after federal judges ruled against their laws that deny Medicaid payments to Planned Parenthood. Chief Justice John Roberts and Justice Brett Kavanaugh joined the court's four liberals in refusing to review the cases.

The 6th Circuit ruling was written by Judge Jeffrey Sutton, a conservative and former Ohio solicitor. Sutton concluded the Ohio law does “not violate a woman’s right to obtain an abortion. It does not condition a woman’s access to any of these public health programs on refusing to obtain an abortion.”

“It makes these programs available to every woman, whether she seeks an abortion or not,” Sutton wrote. “Nor, on this record, has there been any showing that the Ohio law will limit the number of clinics that offer abortions in the state.”

Referring to the 1992 U.S. Supreme Court decision that states cannot place an "undue burden" on a woman’s right to seek an abortion, Sutton wrote that Planned Parenthood had to demonstrate the Ohio law would impose an "undue burden" on a woman’s choice.

“Its vow to keep performing abortions sinks any pre-enforcement action, and any speculation about what would happen if it changed its mind is just that,” Sutton wrote.

But critics warned the court had expanded the state’s authority to restrict abortions in an indirect fashion. Planned Parenthood, which operates 26 facilities in Ohio, said it has used the state money to finance the costs of pregnancy tests, Pap tests, and contraception for more than 60,000 women in the state.

Only three Planned Parenthood centers — including one in Columbus — provide abortion services. But Planned Parenthood can refer women to clinics that offer abortion services.

Writing for the minority, Judge Helene White asserted the U.S. Supreme Court “has never suggested that a party that could prevail in challenging a direct regulation is nevertheless powerless to challenge a law that attempts to achieve the same result by imposing a condition on unrelated funding.”

U.S. Sen. Sherrod Brown, D-Ohio, criticized the ruling, saying it “rewards a political stunt by state lawmakers that has real consequences for Ohio women and families.”

“By blocking funding for women to access potentially lifesaving health care — including breast and cervical cancer screenings and infant mortality prevention programs — Ohio lawmakers are putting politics over the health and safety of their constituents,” Brown said.

But those opposed to abortion rights were cheered.

“Thanks to this very encouraging decision, Ohioans of conscience won't have to worry about whether their tax dollars are going towards abortions," said Michael Gonidakis, president of Ohio Right to Life.