By a 220-215 vote, including the support of one Republican, the House backed a bill that would expand coverage to nearly all Americans and bar insurance practices such as refusing to cover people with pre-existing conditions.
But in the Senate, work on a healthcare bill — Obama’s top domestic priority — has stalled for weeks as Democratic leader Harry Reid searches for an approach that can win the 60 votes he needs.
Any differences between the Senate and House bills ultimately will have to be reconciled, and a final bill passed again by both before going to Obama for his signature.
House Democrats cheered and hugged when the 218th vote was recorded, and again when House Speaker Nancy Pelosi pounded the gavel and announced the results.
Most Republicans criticized the measure’s $1 trillion price tag, new taxes on the wealthy and what they said was excessive government interference in the private health sector.
"Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. Now the United States Senate must follow suit and pass its version of the legislation. I am absolutely confident it will," Obama said in a statement after the vote.
Reid has been awaiting cost estimates from the Congressional Budget Office before unveiling a Senate bill. But he already made one of his toughest decisions by including a national government-run insurance plan.
"We hope to receive CBO scores back on our draft proposals in the coming days, and look forward to bringing a final bill to the Senate floor as soon as possible," Reid said in a statement shortly after the House vote.
BIGGEST CHANGE SINCE MEDICARE
The overhaul would spark the biggest changes in the $2.5 trillion U.S. healthcare system since the creation of the Medicare government health program for the elderly in 1965.
The vote followed days of heavy lobbying of undecided Democrats by Obama, his top aides and House leaders. The narrow victory was clinched early on Saturday by a deal designed to mollify Democratic opponents of abortion rights.
Democrats had a cushion of 40 of their 258 House members they could afford to lose and still pass the bill. In the end, 39 Democrats sided with Republicans against it.
First-term Representative Anh Cao of Louisiana was the lone Republican supporter.
The landmark vote was a huge step for Obama, who has staked much of his political capital on the healthcare battle. A loss in the House would have ended the fight, impaired the rest of his legislative agenda and left Democrats vulnerable to big losses in next year’s congressional elections.
Obama traveled to Capitol Hill on Saturday morning to meet with House Democrats and emphasize the need for the healthcare reform bill.
Republicans and Democrats battled in sometimes testy debate through the day and into the night on Saturday over the bill, which would require individuals to have insurance and all but the smallest employers to offer health coverage to workers.
"We can’t afford this bill," said Republican Representative Roy Blunt. "It’s a 2,000-page road map to a government takeover of healthcare."
The bill would set up exchanges where people could choose to purchase private plans or a government-run insurance option bitterly opposed by the insurance industry, and it would offer subsidies to help low-income Americans buy insurance.
Congressional budget analysts say it would extend coverage to 36 million uninsured people living in the United States, covering about 96 percent of the population, and would reduce the budget deficit by about $100 billion over 10 years.
The House approved on a 240-194 vote an amendment that would impose tighter restrictions on using federal funds to pay for abortions.
House Democratic leaders agreed to allow a vote on the amendment to mollify about 40 moderate House Democrats who threatened to oppose the overhaul without changes to ensure federal subsidies in the bill for insurance purchases were not used on abortion.
The move enraged Democratic abortions rights supporters, but they voted largely in favor of the bill in hopes they can remove the language later in the legislative process.