This vote was on an amendment offered by Rep. Stupak (D-MI) to a major health care bill the House was considering. The amendment prohibited any health insurance plan offered by the federal government (the so-called “public option”) from covering abortions; it also prohibited insurance subsidies, which the health care legislation provided to help low and middle-income Americans purchase insurance, from going toward the purchase of any policy that covered abortions. An exception was made to both prohibitions for the coverage of abortions to terminate pregnancies resulting from rape or incest.

Most of the Members of the Democratic majority supported the health care legislation. Almost every Republican opposed it. However, a number of anti-abortion Democrats had said they would not vote for the bill unless language, such as that in the Stupak amendment, was added to it. The House Democratic leadership determined that it could not pass the bill without the votes of these anti-abortion Democrats. In addition, the U.S. Conference of Catholic Bishops, a strong supporter of the overall health care bill, had said that it would not support passage without the inclusion of the kind of language that was in the Stupak amendment.

Existing law prohibited federal funds from paying for abortions. Democratic congressional leaders had argued that the bill, even without the amendment, would not direct any taxpayer fund to pay for abortions. However, Republicans and anti-abortion Democrats claimed the language of the bill, without the amendment, could circumvent the existing prohibition and effectively allow for federal abortion funding.

The amendment was very controversial. Speaking on its behalf, Rep. Stupak said that the provisions of the bill without his amendment would be a "direct assault" on the existing abortion funding prohibition. Pro-choice Democrats argued that the amendment could deprive women of abortion coverage because insurers who wanted to sell their policies in the new market created by the bill would have to drop that coverage from their policies. Rep. Schakowsky (D-Ill) referred to the language of the amendment as "an insult to millions of American women". Rep. DeGette (D-Colo), another amendment opponent, argued that its passage “will be the greatest restriction on a woman's right to choose in our careers."

A number of other Democratic Members took the position that, regardless of whether the bill as written would actually allow for federal abortion funding, approving the amendment was politically necessary to gain the votes of several moderate and conservative Democrats for its final passage.
 
The amendment passed by a vote of 240-194.  All one hundred and seventy-six Republicans, joined by sixty-four Democrats, voted “aye”. All one hundred and ninety-four “nay” votes were cast by Democrats, including a majority of the most progressive House Members. As a result, language was added to the major health care bill prohibiting abortion coverage in any health insurance plan offered by the federal government, and also prohibiting any federal subsidies going to pay for insurance policies that provide abortion coverage.