The biggest US health reforms in recent history have been approved in a landmark victory for President Barack Obama. Skip related content
The sweeping reforms will see healthcare coverage extended to 36 million more Americans.
The bill was passed by the US House of Representatives and Barack Obama immediately hailed it "an historic vote".
And the changes - passed on a narrow 220-215 vote - are the most significant for four decades.
As well as extending affordable healthcare to nearly all Americans, the bill bars insurance practices such as refusing to cover people with pre-existing medical conditions.
Mr Obama's top domestic priority now moves to the US Senate, where work on its own version has stalled for weeks.
Any differences between the Senate and the House bills will have to be reconciled, and a final bill passed again by both before going to Mr Obama for his signature.
The President said: "Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people.
"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, and I look forward to signing comprehensive health insurance reform into law by the end of the year."
House speaker Nancy Pelosi was cheered by Democrats as she announced the vote.
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