A century-old battle for near-universal health coverage in America has effectively ended after US politicians agreed to accept President Barack Obama's healthcare reform bill.
The House of Representatives voted the landmark legislation through by 219 votes to 212, a move that will extend healthcare coverage to 32 million Americans without it and crack down on insurance company abuses.
It caps a year-long quest by President Obama and the Democrats to overhaul the country's health system and reshape a sector that represents one sixth of the giant US economy.
President Obama, who is expected to sign the Bill later, said afterwards that the vote proved "we can still tackle big things".
He added: "We proved that this government - a government of the people and by the people - still works for the people."
Under the Bill, health insurance will be extended to virtually all Americans, new taxes imposed on the wealthy and restrictive insurance practices such as refusing to cover people with pre-existing medical conditions barred.