President Barack Obama's ambitious healthcare overhaul has crossed the first hurdle. The US House of Representatives has approved the bill. The battle now moves to the Senate, where its fate remains unclear.
Still the House vote should be a matter of great satisfaction to the President who has just suffered some election reverses.
"Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people," Obama said in a statement savoring the political triumph.
"The United States Senate must follow suit and pass its version of the legislation. I am absolutely confident it will, and I look forward to signing comprehensive health insurance reform into law by the end of the year," he said.
After hours of bitter debate and an appeal from Obama to "answer the call of history," lawmakers voted late Saturday 220-215 for a 10-year, trillion-dollar plan to extend health coverage to some 36 million Americans who lack it now.Facts: Health bill
The chamber's Democrats erupted in loud cheers and triumphant applause the moment the bill had the 218 votes needed for passage, about 11:07 pm (0407 GMT), a happy din that grew deafening when a gavel made it official.
The president had paid a rare visit to Congress to lobby for unity among his Democratic allies and reinforced it with a public speech, but 39 still joined 176 of the chamber's Republicans in opposition to the proposal.
One Republican broke ranks, nominally fulfilling, in the barest terms, Obama's vow to secure bipartisan support.
"This is our moment to deliver. I urge members of congress to rise to this moment, answer the call of history and vote yes for health insurance reform for America," Obama said in the White House's Rose Garden hours before the vote.
In the Senate though, there is a raging intra-party dispute among Democrats anchored on what role the US government should play.
Democratic Senate Majority Leader Harry Reid, struggling to pull together the 60 votes needed to ensure passage, has hinted that the chamber may not act until next year.
That would put the issue front-and-center in the 2010 mid-term elections, when one third of the Senate, the entire House of Representatives, and many US governorships are up for grabs.
If, as expected, the two chambers pass rival versions of health care legislation, they will need to thrash out a compromise version and approve it in order to send it to Obama to sign into law.
Final House passage came after a flurry of votes, including a 240-194 vote to sharply tighten restrictions on government monies paying for abortions, seen as critical to cementing support from a group of anti-abortion Democrats.
The House then voted 176-258 to defeat the Republican alternative to the overall plan -- with one lone Republican, Representative Timothy Johnson of Illinois, joining the Democrats in opposition.
The United States is the only industrialized democracy that does not ensure that all of its citizens have health care coverage, with an estimated 36 million Americans uninsured.
And Washington spends vastly more on health care -- both per person and as a share of national income as measured by Gross Domestic Product -- than other industrialized democracies, but with no meaningful edge in quality of care, according to the Organization for Economic Cooperation and Development.
The bill would create a government-backed insurance plan, popularly known as a "public option," to compete with private firms and would end denial of coverage based on preexisting medical problems.
Under the White House-backed bill, Americans would have to buy insurance and most employers would have to offer coverage to their workers -- though some small businesses would be exempt and the government would offer subsidies.