This was ostensibly a vote on a motion to table (kill) an amendment by Sen. Charles Grassley (R-IA) that would have repealed a provision of health care reform legislation signed into law by President Obama that increased Medicare’s reimbursement rates for medical services in North Dakota, South Dakota, Montana, Utah, and Wyoming. The measure Grassley 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.”

Grassley argued that raising reimbursement rates for those states was unfair to the rest of the country: “…This is about geographical equity for all States. The Senate health reform bill just signed into law includes a frontier sweetheart deal that improves Medicare payments for five rural states at the expense of the other 45. The special deal is for North Dakota, South Dakota, Montana, Utah, and Wyoming. The Washington Post calls these deals the ``Candy Land'' of the health care bill.

Sen. Max Baucus (D-MT) made a motion to table (kill) the amendment, saying: “We want to make sure our states are fully incorporated, involved in the national health care delivery system; that is, rural states. We also want a balance between urban and rural. It is the only fair solution. This bill has that balance.”

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 voted to table (kill) the Grassley amendment by a vote of 53-45. 53 Democrats voted “yea.” All 40 Republicans present and 5 Democrats voted “nay.” As a result, the Senate voted to table (kill) an amendment Democratic leaders feared could have torpedoed the companion health care bill and would have repealed a provision of health care reform legislation signed into law by President Obama that increased Medicare’s reimbursement rates for medical services in North Dakota, South Dakota, Montana, Utah, and Wyoming.