A century-old battle for near-universal health coverage in America effectively ended today after politicians agreed to accept President Barack Obama's healthcare reform bill.
The House of Representatives voted the landmark legislation through by 219 votes to 212 --a move that will extend healthcare coverage to 32 million Americans without it and crack down on insurance company abuses.
It caps a year-long quest by Mr Obama and the Democrats to overhaul the country's health system and reshape a sector that represents one sixth of the giant US economy. Mr Obama said afterwards that the vote proved "we can still tackle big things".
He added: "We proved that this government -- a government of the people and by the people -- still works for the people."
The bill's passage marks the most significant victory for his administration since being elected 16 months ago, and the stakes could not have been higher.
By blocking the legislation, Republicans hoped they would be able to thwart the president's ambitious domestic agenda which includes immigration reform and climate change legislation.
Mr Obama watched the vote in the White House's Roosevelt Room with Vice President Joe Biden and about 40 staff aides.
When the crucial 216th vote came in -- the magic number needed for passage -- the room burst into applause and hugs. An elated president then exchanged a high-five with his chief of staff, Rahm Emanuel, while Democrats in the House chamber chanted: "Yes we can."
Under the bill, health insurance will be extended to virtually all Americans, new taxes imposed on the wealthy and restrictive insurance practices such as refusing to cover people with pre-existing medical conditions barred.
The measure represents the biggest expansion of the social safety net since Medicare and Medicaid were enacted in 1965 during President Lyndon Johnson's administration to provide government-funded healthcare coverage to the elderly and poor.
Republicans warned about the burden imposed by more than $900bn (€665bn) in tax increases and Medicare cuts combined. They also argued the legislation would permit the use of federal money to pay for abortions.
But the legislation's advocates made passionate speeches in its favour.
"Healthcare isn't only a civil right, it's a moral issue," said Democratic representative Patrick Kennedy, whose late father, Senator Edward Kennedy, worked his entire career for nationwide health care.
President Obama's healthcare quest seemed at a dead end two months ago, when Republicans won a special election to fill Edward Kennedy's Massachusetts Senate seat, and with it, enough votes to prevent a final vote.
But the White House and Congress allies came up with a rescue plan that required the House to approve the Senate-passed measure despite opposition to many of its provisions, then have both chambers pass a fix-it measure incorporating numerous changes.