The US House of Representatives has approved the broadest overhaul of US health care in four decades, handing President Barack Obama a hard-fought victory for his top domestic priority.
Heeding Obama's appeal to "answer the call of history," lawmakers late Saturday capped 12 hours of bitter debate with a 220-215 vote.
The bill amounts to a 10-year, trillion-dollar plan to extend health coverage to some 36 million Americans who lack it now.
"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.
The fight to remake health care in the world's richest country shifted to the US Senate, where its fate remained unclear amid a tense intra-party dispute among Democrats anchored on what role the US government should play.Facts: Health bill
Obama said he was "absolutely confident" the Senate would pass its own bill, stressing: "I look forward to signing comprehensive health insurance reform into law by the end of the year."
House Speaker Nancy Pelosi, who has faced tough criticism from Republicans over the proposal, said the health care bill "improves quality, lowers cost, expands coverage to 36 million more people and retains choice."
If, as expected, the House and Senate 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, a frequently tough process.
Obama and Democratic House leaders had invested heavy political capital in what they knew would be a close contest sure to shape his legacy and the fate of his ambitious plan to remake US health care if the bill went down to defeat.
The president telephoned wavering members on Friday and paid a rare visit to Congress on Saturday, buttressed with a speech from the White House Rose Garden, but still 39 Democrats joined 176 Republicans to oppose the plan.
One Republican -- Joseph Cao of Louisiana -- broke ranks, nominally fulfilling, in the barest terms, Obama's vow to secure bipartisan support.
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).
Final House passage came after a flurry of votes, including a 240-194 vote to sharply tighten restrictions on government funds for abortions, vital to cementing support from a platoon 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.
Republicans appealed to swing-vote Democrats from battleground districts to reject what they warned would end up being a costly government takeover of health care, stoking traditionally American suspicions of the public sector.
"This bill bulldozes individual liberty and puts the government just where it doesn't belong," said Republican Representative Sam Johnson.
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.
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.
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