Summoned to success by President Barack Obama, the Democratic-controlled Congress approved historic legislation Sunday night extending health care to tens of millions of uninsured Americans and cracking down on insurance company abuses, a climactic chapter in the century-long quest for near universal coverage.
Widely viewed as dead two months ago, the Senate-passed bill cleared the House on a 219-212 vote, with Republicans unanimous in opposition.
Congressional officials said they expected Obama to sign the bill as early as Tuesday.
A second measure -- making changes in the first -- was lined up for passage later in the evening. That measure would go to the Senate, where Democratic leaders said they had the votes to pass it.
Crowds of protesters outside the Capitol shouted "just vote no" in a futile attempt to stop the historic vote taking place inside a House packed with lawmakers and ringed with spectators in the galleries above.
Across hours of debate, House Democrats predicted the central bill, costing $940 billion over a decade, would rank with other great social legislation of recent decades.
"We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans, said Speaker Nancy Pelosi, partner to Obama and Senate Majority Leader Harry Reid in the grueling campaign to pass the legislation.
"This is the civil rights act of the 21st century," added Rep. Jim Clyburn of South Carolina, the top-ranking black member of the House.