This was ostensibly a vote on a motion to table (kill) an amendment by Sen. Lisa Murkowski (R-AK) to tie an increase in Medicare taxes on high-income individuals to inflation. Specifically, the amendment would raise the income thresholds at which new taxes would be imposed at a rate equal to inflation. The amendment would only apply to those individuals subjected to an increase in Medicare taxes under health care legislation signed into law by President Obama – namely, individuals making more than $200,000 a year and married couples making more than $250,000 a year. The measure Murkowski 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.”

Murkowski urged support for her amendment: “What we are doing is indexing for inflation the Medicare tax increase the majority has levied on the American people through this health care bill. Under the bill that is now law, Medicare taxes are going to jump .9 percent for certain income groups. This is about an $86 billion tax hike. My amendment aim is to contain the damage by indexing for inflation the wage thresholds for those subject to the tax increase.” To offset lost tax revenue, Murkowski’s amendment would have used funds contained in the economic stimulus law signed into law by President Obama in 2009 in response to the economic crisis.

Sen. Max Baucus (D-MT) urged opposition to the amendment: “Unemployment is still hovering close to 10 percent. There is growing evidence the recovery package is working. I don't think we want to stifle the stimulus now. Over the last 6 months of 2009, the economy grew at an annual rate of 4 percent. The fourth quarter grew at a higher rate, but that was due to an inventory situation. By and large, it is not proper to offset this with stimulus dollars.” Baucus also argued the amendment violated Senate budget rules, because the committees responsible for drafting the companion bill had no authority over the stimulus legislation. Murkowski then made a motion to waive the budget rules. Motions to waive those rules require 60 votes for passage.

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 its budget rules by a vote of 42-57. All 40 Republicans present voted “yea.” 57 Democrats voted “nay.” As a result, the Senate effectively rejected an amendment Democratic leaders believed could have torpedoed the entire companion health care measure and would have tied an increase in Medicare taxes on high-income individuals to inflation.