The 220-215 vote late Saturday night cleared the way for the Senate to begin debate on the issue that has come to overshadow all others in Congress. But it will be tougher to get Senate approval because Democrats will need 60 out of 100 votes to end debate and bring legislation to a final vote, and several moderate Democratic senators still have reservations.
House Speaker Nancy Pelosi likened the legislation to the passage of the government's Social Security pension program in 1935 and Medicare health insurance for the elderly 30 years later.
"It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it," said Rep. John Dingell, an 83-year-old Democratic lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.
In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.
Ironically, that only solidified support for the legislation, clearing the way for conservative Democrats to vote for it.
The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.
Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging and market allocation.
A cheer went up from the Democratic side of the House when the bill gained 218 votes, a majority. Moments later, Democrats counted down the final seconds of the voting period in unison, and let loose an even louder roar when Pelosi grabbed the gavel and declared, "the bill is passed."
From the Senate, Majority Leader Harry Reid issued a statement saying, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."
If the Senate does pass a bill, it would have to be reconciled with the House version by a panel of lawmakers from both chambers before the legislation is put up for final approval.
The House bill drew the votes of 219 Democrats and Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans. Opposed were 176 Republicans and 39 Democrats.
Nearly unanimous in their opposition, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.