This was ostensibly a vote on a motion to table (kill) an amendment by Sen. Jim Bunning (R-KY) to health care legislation allowing seniors to opt out of Medicare Part A.  (Medicare Part A covers services provided at hospitals and nursing facilities.) The measure Bunning 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.”

Bunning urged the Senate to support it: “My amendment would allow individuals to voluntarily opt out of Medicare Part A benefits….If a senior doesn't want Part A, they shouldn't be forced to take it.…I think this is a fairness issue…”

Sen. Max Baucus (D-MT) made a motion to table (kill) the amendment, saying: “…Since 1965, Medicare has provided security and health to millions of seniors. Along with Social Security, it is one of the two most successful and best social programs this country has adopted. Now, after 45 years of success, what does this amendment seek to do? It seeks to undermine the foundation of our social insurance program.”

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 the amendment by a vote of 61-36. All 58 Democrats present and 3 Republicans voted “yea.” 36 Republicans voted “nay.” As a result, the Senate rejected an amendment  Democratic leaders fearedcould have torpedoed the entire companion health care measure and would have allowed seniors to opt out of Medicare Part A.