This was ostensibly a vote on a motion to waive the Senate's budget rules with respect to an amendment by Sen. John Thune (R-SD) to eliminate a provision in health care reform legislation creating a insurance program providing long-term care (such as nursing home care) for the elderly and the disabled. The measure Thune sought to amend was a “companion bill” making a number of changes to health care reform legislation already signed into law by President Obama. The underlying context was that Republicans were trying to attach amendments to the companion bill in order to send it back the House, where it had passed by a narrow margin. CNN reported that Republicans had chosen to offer a slew of amendments in order to “undermine the measure,” while the Associated Press characterized the amendments as “a final drive to thwart President Barack Obama's health care remake.”

The Senate's budget rules prohibit amendments from being adopted to a bill considered under the reconciliation process if those amendments are not strictly relevant to budgetary matters. Sen. Tom Harkin (D-IA) argued that the amendment violated the Senate's budget rules. Thune then made a motion to waive the budget rules. Motions to waive the budget rules require 60 votes for passage.

Thune said: "We have two entitlement programs [referring to Social Security and Medicare] that are already destined to be bankrupt that have unfunded liabilities in the neighborhood of $60 trillion. It does not make a lot of sense to add a third one."

Harkin responded: "…[This program] is a voluntary, self-funded insurance program, with enrollment for people who are presently employed. There are no taxpayer dollars involved whatsoever….By letting people put some money aside, so if they become disabled they can stay at home rather than going to a nursing home, we save Medicaid dollars. This saves taxpayer dollars from paying more into Medicaid in the future."

After the House and Senate both passed their respective health care reform bills, the two chambers had intended to reconcile those two bills into a final package. After the House and Senate passed that final package, it would have been sent to President Obama, who would have signed it into law. Sen. Scott Brown (R-MA), however, won a special election to replace the late Sen. Ted Kennedy (D-MA) before the final health care bill could be brought up for a vote. Brown's victory gave Republicans 41 votes in the Senate, leaving Democrats with 59 members – one vote short of the 60 votes they needed to defeat a unanimous Republican filibuster against the final health care bill. 

In order to pass comprehensive health care legislation without a 60-vote majority in the Senate, Democratic leaders devised a plan in which the House would pass the Senate health care bill (H.R. 3590), thereby enabling the president to sign it into law. The House would then pass a separate companion bill (H.R. 4872) to make changes to the Senate health measure under a process known as "budget reconciliation." Bills considered under budget reconciliation cannot be filibustered under Senate rules. This process allowed the House to make changes to Senate-passed health care legislation without sending the entire health bill back to the Senate, where it could have been filibustered indefinitely.   The companion bill incorporated changes to the Senate health care legislation desired by House Democrats. The House passed the companion measure, and sent it to the Senate, where Democratic leaders hoped to defeat all amendments -- thereby avoiding a second vote in the House on a substantively changed bill; a vote that Democrats might have lost given the already tight margin when it was voted on the previous week.

The Senate rejected the motion to waive the budget rules by a vote of 43-55. All 40 Republicans present and 3 Democrats voted "yea." 55 Democrats voted "nay." As a result, the Senate effectively voted down an amendment Democratic leaders feared could have torpedoed the entire companion health care measure and would have eliminated a provision in health care reform legislation creating an insurance program covering long-term care (such as nursing home care) for the elderly and the disabled.