The US House of Representatives has backed a healthcare bill in a step towards reforms promised by President Obama, despite strong opposition.
Passed in a narrow 220-215 vote, the bill aims to extend coverage to 36 million more Americans and provide affordable healthcare to 96%.
The Senate now has to pass its own bill and the two must then be reconciled before the programme can become law.
Mr Obama has made healthcare reform a central plank of his domestic agenda.
He described Saturday's vote in the House as "historic", saying he was "absolutely confident" the Senate would follow suit.
Correspondents say the legislation could lead to the biggest changes in American healthcare in decades.
Concessions
The bill was supported by 219 Democrats and one Republican - Joseph Cao from New Orleans. Opposed were 176 Republicans and 39 Democrats.
Mr Obama said: "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."
The debate had sparked strong emotions on both sides.
Democratic Party representative John Dingell said: "[The bill] offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable healthcare when they need it."
But Republican representative Candice Miller said: "We are going to have a complete government takeover of our healthcare system faster than you can say `this is making me sick'."
Before Saturday's vote, Mr Obama had made a rare visit to Congress to try to persuade wavering members of his own Democratic Party to back the bill.
He said such opportunities came around "maybe once in a generation".
After the vote, the speaker of the House, Nancy Pelosi, said: "I thank the president for his tremendous leadership, because without President Obama in the White House, this victory would not have been possible."
The bill will allow the government to sell insurance in competition with private companies and make insurers offer cover to those with pre-existing conditions.
However, the government-run healthcare programme - the so-called "public option" - was scaled back in the run-up to the vote.
One key concession to get the bill through was to anti-abortion legislators.
An amendment was passed that prohibits coverage for abortion in the government-run programme except for rape, incest or if the mother's life is threatened. Private plans can still offer the cover.
Republican Bart Stupak, who sponsored the amendment, said: "Let us stand together on principle - no public funding for abortions."
Abortion rights supporters said the amendment was the biggest setback to their cause in decades.
A Senate debate on healthcare reform is expected in the coming days.
Senate majority leader Harry Reid said after the House vote: "We realise the strong will for reform that exists, and we are energised that we stand closer than ever to reforming our broken health insurance system."
The debate had sparked strong emotions on both sides.
Democratic Party representative John Dingell said: "[The bill] offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable healthcare when they need it."
But Republican representative Candice Miller said: "We are going to have a complete government takeover of our healthcare system faster than you can say `this is making me sick'."
Before Saturday's vote, Mr Obama had made a rare visit to Congress to try to persuade wavering members of his own Democratic Party to back the bill.
He said such opportunities came around "maybe once in a generation".
After the vote, the speaker of the House, Nancy Pelosi, said: "I thank the president for his tremendous leadership, because without President Obama in the White House, this victory would not have been possible."
The bill will allow the government to sell insurance in competition with private companies and make insurers offer cover to those with pre-existing conditions.
However, the government-run healthcare programme - the so-called "public option" - was scaled back in the run-up to the vote.
One key concession to get the bill through was to anti-abortion legislators.
An amendment was passed that prohibits coverage for abortion in the government-run programme except for rape, incest or if the mother's life is threatened. Private plans can still offer the cover.
Republican Bart Stupak, who sponsored the amendment, said: "Let us stand together on principle - no public funding for abortions."
Abortion rights supporters said the amendment was the biggest setback to their cause in decades.
A Senate debate on healthcare reform is expected in the coming days.
Senate majority leader Harry Reid said after the House vote: "We realise the strong will for reform that exists, and we are energised that we stand closer than ever to reforming our broken health insurance system."
