This was a vote on a motion to table (kill) a "motion to commit" (i.e. an amendment) by Sen. Pat Roberts (R-KS) that would have repealed four provisions in major health care legislation. (If passed, a motion to commit sends the legislation back to committee with instructions to amend the legislation as specified.) The measure Roberts 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 amendment was ostensibly intended to repeal provisions of the health care law that Roberts believed would lead to the rationing of health care. 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.”

Roberts’ amendment would have repealed the Independent Payment Advisory Board. The health care reform bill signed into law by President Obama created this independent board to make cuts in Medicare spending (although Congress could act to block the cuts). The amendment would also have repealed a provision providing for the Patient Center Outcomes Research Institute, which provides data to doctors on which treatments result in the best clinical outcomes for patients. The amendment also would have repealed a provision creating an “innovation center” within the Centers for Medicare and Medicaid Services. This center conducts research on ways to improve the quality of care for patients enrolled in Medicare and Medicaid and reduces the cost of those programs. Finally, the amendment would have repealed a provision empowering the U.S. Preventive Services Task Force to set standards for preventive health care services that insurance plans must cover at no cost to patients.

Roberts contended his amendment would “repeal `the four rationers' of health care reform. These four horsemen of the rationing apocalypse are the Patient Center Outcomes Research Institute…the CMS Innovation Center, which will grant new powers to CMS--that should be a pleasant thought by any beleaguered hospital administrator--the U.S. Preventive Services Task Force…and the Independent Payment Advisory Board…These rationers comprise the infrastructure for the `Brave New World' of big government intrusion into health care decisions of all Americans, and they must be repealed.”

Sen. Max Baucus (D-MT) contended Roberts had mischaracterized the provisions he sought to repeal, and made a motion to table (kill) Roberts’ motion to commit: “…Saying it doesn't make it so. It is not at all as it has been described. We very much in this country have to work to control health care costs. Doctors and hospitals--especially doctors--want to practice evidence-based medicine, even more than they do now. They want the evidence…if we really want to do something about health care costs in this country, this is a start.”

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 tabled (killed) Roberts’ motion to commit by a vote of 59-37. All 57 Democrats present and 2 Republicans voted “yea.” 37 Republicans voted “nay.” As a result, the Senate effectively rejected an amendment Democratic leaders feared could have torpedoed the entire companion health care measure and would have repealed four provisions in health care reform legislation signed into law by President Obama that were intended to reduce health care costs, including a new Independent Payment Advisory Board and the Patient Center Outcomes Research Institute.