The US House of Representatives has narrowly voted to pass a landmark healthcare reform bill at the heart of President Barack Obama's agenda.
The bill was passed by 219 votes to 212, with no Republican backing, after hours of fierce argument and debate.
It extends coverage to 32 million more Americans, and marks the biggest change to the US healthcare system in decades.
"We proved that we are still a people capable of doing big things," Mr Obama said in remarks after the vote.
"This legislation will not fix everything that ails our healthcare system, but it moves us decisively in the right direction," he said.
Mr Obama is expected to sign the legislation into law shortly.
But a new challenge is expected in the Senate, where Democrats hope amendments to the bill will be enacted by a simple majority. Opposition Republicans have vowed to repeal the measure they argue is unconstitutional.
Historic vote
The president has pulled off the most significant victory since his election 16 months ago, the BBC's Paul Adams reports from Washington.
When the vote count hit the magic number of 216 - the minimum needed to pass the bill - Democrats hugged and cheered in celebration and chanted: "Yes we can!"
Under the legislation, health insurance will be extended to nearly all Americans, new taxes imposed on the wealthy, and restrictive insurance practices such as refusing to cover people with pre-existing medical conditions will be outlawed.
The Republicans have vowed to continue resisting it.
They say the measures are unaffordable and represent a government takeover of the health industry.
"We have failed to listen to America," said Republican party leader John Boehner.
Speaking moments before the vote, House Speaker Nancy Pelosi said the health care reform honoured the nation's traditions.
"We will be joining those who established Social Security, Medicare and now, tonight, healthcare for all Americans," she said, referring to the government's pension program and health insurance for the elderly established nearly 50 years ago.
Although Democrats pushed the measure through with three votes to spare, 34 members joined Republicans in voting against the bill, worried about paying a political price in the November mid-term elections.
In a last-minute move designed to win the support of a bloc of anti-abortion lawmakers, Mr Obama earlier on Sunday announced plans to issue an executive order assuring that healthcare reform will not change the restrictions barring federal money for abortion.
Next steps
The bill's final approval represented a stunning turnaround from January, when it was considered dead after Democrats lost their 60-seaty majority in the Senate, which is required to defeat a filibuster.
To avoid a second Senate vote, the House also approved on Sunday evening a package of reconciliation "fixes" - agreed beforehand between House and Senate Democrats and the White House - amending the bill that senators adopted in December.
