The biggest overhaul of America's medical system since Medicare passed with a tight vote in the House of Representatives Saturday night.
The bill passed with a vote of 220 to 215, with only one single Republican - Joseph Cao from Louisana - choose "Yea."
The health reform bill included a controversial amendment to restrict coverage of abortion.
House Speaker Nancy Pelosi was forced to bring up the abortion amendment after a deal with conservative Democrats collapsed and they threatened to sink the whole bill.
The move enraged liberals, but most agreed to stay onboard and President Obama traveled to the House to make a personal appeal and seal the deal.
Pelosi hailed the progress as delivering on the promise of Obama's election.
"President Obama's leadership gives our nation hope," she said. "Today, with this legislation, we will give them health."
The bill proposes to spend $1.055 trillion to add 36 million Americans to the insurance rolls, largely paid for with a 5.4% surtax on the top 0.3% of earners and cutting Medicare Advantage programs.
It would create an exchange where small businesses and the uninsured could buy coverage, including a government-run public option. The abortion amendment bars anyone who gets federal subsidies from abortion coverage. The public option plan does not cover elective abortion.
Under the bill, no insurance company could consider preexisting conditions, out-of-pocket expenses would be capped, there would be no co-pays for preventive care, and the so-called donut hole would be closed in Medicare prescription coverage.
"This is the most important legislation I've voted on in my 21 years in Congress," Bronx Rep. Eliot Engel said.
Republicans argued the measure is too expensive, too tax-heavy and a threat to jobs and American freedom.
Liberals savaged the anti-abortion provision. "This amendment threatens the health and rights of women to seek a legal procedure," said Westchester Rep. Nita Lowey, calling it "unnecessary and reprehensible."
But pro-choice Democrats voted for the overall measure nevertheless, helped along by Obama, who implored them to be on the "right side of history" and invoked the shootings at Fort Hood in his emotional appeal.
"He was absolutely inspiring. In a very moving way, he reminded us what sacrifice really is," said Rep. Rob Andrews, a New Jersey Democrat. "It made a lot of people feel a little less sorry for themselves about their political problems."
A $61 billion GOP substitute bill failed after Democrats mocked it, noting that nonpartisan number crunchers found it did little to help people get insurance.
Brooklyn-Queens Rep. Anthony Weiner quipped the uninsured could turn to the "bill fairy" for help affording doctor visits under the GOP plan.
The Senate must also pass its bill, which also is facing trouble from conservative Democrats.
