Without Republican votes, the House voted late Sunday night to approve a healthcare reform package passed by the Senate on Christmas Eve.
The bill, approved by a vote of 219-212, could be signed into law as early as Tuesday. No Republicans voted in support of the bill, while 34 Democrats voted against it.
According to House Speaker Nancy Pelosi (D-Calif.), the new law will make healthcare coverage available to 32 million uninsured Americans and establish healthcare exchanges where consumers can purchase healthcare insurance at a lower rate. She also said the new law would "hold health insurance companies accountable."
The House also adopted a package of changes to the Senate bill, by a vote of 220-211. That package, which was hammered out in negotiations between Senate and House Democrats and the White House, now goes to the Senate for a vote as soon as this week.
Sunday's vote means that the bill will become law once President Barack Obama signs it, regardless of the outcome of the package of changes being returned to the Senate. Senate Majority Leader Harry Reid of Nevada has said he has the votes in the Senate to pass those changes. In addition, the Senate will consider the package under a parlamentary procedure that allows for passage by a simple majority, thus preventing Republicans from killing the vote through a filibuster.
Oponents to the bill, meanwhile, say there is no guarantee that the Senate will approve the changes, and that Senate Republicans may try to use hundreds of amendments to stop them.
The House package of changes stripped the law of deals cut in the Senate that would give some states more Medicaid funding than others.
Estimates made by the Congressional Budget Office last week said the bill would reduce the federal deficit by $143 billion through 2019.
"This is what change looks like," Obama said shortly after the vote. He called the new law major reform, not radical reform.
"Tonight's vote is not a victory for any one party," he said. "It's a victory for the American people and for common sense."
The president is expected to launch a nationwide tour soon to educate Americans about the reform.
Republicans said the plan would saddle the nation with unaffordable levels of debt, leave states with expensive new obligations, weaken Medicare and give the government a huge new role in the healthcare system. The House Republican leader, Rep. John Boehner of Ohio, said the vote defies the wishes of Americans who "are angry" with Congress.
The turning point came Sunday as House leaders found a way to quell conservative Democrats' fears over federal spending on abortion. Obama announced Sunday that he would be issue an executive order after passage of the bill to reaffirm its consistency with longstanding restrictions on the use of federal funds for abortion.
Republicans argued that the executive order would not be enough to ensure that federal funding will not be used for abortion.
Provider organizations weighed in after the vote, praising the reform.
Richard Umbdenstock, president and CEO of the American Hospital Association, called the vote "a historic and long overdue step" that will make "a real difference in lives of millions of Americans."
"Healthcare is at a tipping point and the shortcomings within our health care system can no longer be ignored," Umbdenstock said.
Mandy Krauthamer Cohen, executive director of Doctors for America, said the new law would expand the coordination of care and strengthen the physician workforce. "While no bill is perfect, I am hopeful today for the future of medicine because of the many ways this bill will improve healthcare in America," she said.
Along with Doctors for America, other groups supporting the bill included the American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, American Medical Student Association, American Medical Women's Association, American Muslim Health Professionals, Association of Clinicians for the Underserved, Committee of Interns and Residents/SEIU Healthcare, Doctors Council SEIU, Association of Physicians of Pakistani Descent of North America, HIV Medicine Association, National Medical Association, National Physicians Alliance, National Physicians Alliance-New York, National Doctors Alliance/SEIU Healthcare, Nurse Alliance/SEIU Healthcare, Student National Medical Association and United Nurses of America-AFSCME.
The American Medical Association called the new law "a step toward providing coverage to all Americans and improving our nation's health system."
"By extending health coverage to the vast majority of the uninsured, improving competition and choice in the insurance marketplace, promoting prevention and wellness, reducing administrative burdens and promoting clinical comparative effectiveness research, this bill will help patients and their physicians," said J. James Rohack, MD, the AMA's president.
America's Health Insurance Plans President and CEO Karen Ignagni issued a warning.
"The access expansions are a significant step forward, but this legislation will exacerbate the healthcare costs crisis facing many working families and small businesses," she said.