This vote was on an amendment by Charles Grassley, R-Iowa, that would have replaced Medicaid's medical assistance percentage formula contained in an economic stimulus bill with a flat increase of 9.5 percent.  The amendment was offered to a bill that is intended to help stimulate the flagging U.S. economy with a $900 billion cash infusion. 

Grassley said the stimulus bill as written would give states $87 billion in Medicaid-related funding, but the formula included in the bill isn't fair to certain states (including his) because it allocates based on how low unemployment rates are at the time the bill is enacted, and does not provide any mechanism to adjust that funding if unemployment rates change.

"It is not fair to States with low unemployment rates or States that have not seen the recession hit full force yet, and for those States where the recession hasn’t hit, it is just around the corner. For instance, in the Midwest agricultural areas, we tend to be countercyclical. We tend to be lagging when we hit recession. Yet we will be coming along into recession when the other parts of the country are recovering," Grassley said

Amy Klobuchar, D-Minn., said the stimulus bill as written would allocate based on need, and that the formula should stay this way because for every percentage increase in unemployment, states see an additional one million people who seek Medicaid assistance.

"By eliminating the portion of assistance that is targeted based on States’ unemployment rates, Senator Grassley’s amendment would significantly reduce assistance for States facing the largest increases in their unemployment rates and the largest budget deficits.  Instead of providing aid to those who need it most, his amendment provides relief for States that are, in some cases, even enjoying a budget surplus," Klobuchar said.  " This is about targeted assistance. We have heard a lot about targeting spending, putting spending where we need it. This is also about targeted assistance to the States that need it most."

By a vote of 47-49, the amendment was rejected.  All but three Republicans present voted for the amendment.  Of Democrats present, 11 voted for the amendment and 44 voted against it (including the most progressive members).  The end result is that the measure went forward with language establishing a need-based formula for $87 billion in additional Medicare funding intact.