This was a procedural vote determining whether the House would begin consideration of a resolution setting a time limit for debate and prohibiting amendments to major health care legislation. Rep. Paul Ryan (R-WI), raised a point of order against the resolution, claiming it contained “unfunded mandates”, which violate the Congressional Budget Act. An unfunded mandate is a provision requiring states to spend money on a program without providing federal money to pay for the program.  In order to defeat this point of order against the resolution, the Democrats needed to vote on a "question of consideration" -- which essentially determined whether the House would consider the resolution. If the House voted in favor considering the resolution, the point of order would be defeated.

Ryan said: "This bill is the mother of all unfunded mandates. There are mandates on states….There is an individual mandate. It mandates individuals purchase government-approved health insurance or face a fine to be collected by the IRS…There is a business mandate. It mandates businesses provide government-approved health insurance or face penalties….There's a health plan mandate. There are mandates on health plans to comply with new federal benefits, mandates without any funds to meet these new requirements…."

Rep. Louise Slaughter (D-NY) denounced Ryan's point of order as an effort to kill health care reform legislation: "Technically, this point of order is about whether or not to consider this rule and, ultimately, the underlying legislation. In reality, it's about blocking much-needed health care reform in this Nation. Those who oppose the process don't want any debate or votes on health care itself. They just want to make reform go away. I know my colleagues on our side will vote ``yes'' so we can consider this important legislation on its merits and not stop it on a procedural motion"

By a vote of 228-195, the House voted in favor of considering the resolution allowing for debate on health care legislation -- and, in effect, voted down Ryan's point of order. 228 Democrats – including all of the most progressive members present -- voted "yea." All 176 Republicans present and 19 Democrats voted "nay." As a result, the House was able to bring up a health care resolution setting a time limit for debate and a prohibition on amendments.