President Obama: "For years we've been told that this could not be done"
US President Barack Obama has hailed as "historic" the approval of a health bill by the House of Representatives.
He said he was "absolutely confident" the Senate would pass its own version, and that healthcare reforms would become law by the end of the year.
Passed in a narrow 220-215 vote by the House, the bill aims to extend coverage to 36 million more Americans and provide affordable healthcare to 96%.
Mr Obama has made healthcare reform a central plank of his domestic agenda.
Correspondents say the legislation could lead to the biggest changes in American healthcare in decades.
Democratic Senators must now consider their own bill. They need 60 out of 100 votes to bring it to a final vote.
I look forward to signing comprehensive health insurance reform into law by the end of the year
There are only 58 Democrats and two independents in the Senate. Two Republicans have signalled they could approve a compromise health bill.
If it is passed, lawmakers from both houses will try to reconcile the two versions before the programme can be signed into law by the president.
In Saturday's vote, the bill was supported by 219 Democrats and one Republican - Joseph Cao from New Orleans. Opposed were 176 Republicans and 39 Democrats.
Mr Obama said: "Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable healthcare for the American people.
"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."
The debate had sparked strong emotions on both sides.
Democratic Party representative John Dingell said: "[The bill] offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable healthcare when they need it."
KEY BILL PROVISIONS
Aims to provide affordable healthcare to 96% to redress 2008 figure of 47 million uninsured
Individuals must obtain coverage and most firms must provide it to workers
Creates an insurance market for purchase of coverage
One product will be a government health insurance plan
People with pre-existing health problems cannot be denied insurance
Funded by raft of measures, including 5.4% surtax on those earning $500,000 a year or more
Those who earn up to 150% of poverty level to qualify for Medicaid government programme for the poor
But Republican representative Candice Miller said: "We are going to have a complete government takeover of our healthcare system faster than you can say 'this is making me sick'."
Before the vote, Mr Obama had made a rare visit to Congress to try to persuade wavering members of his own Democratic Party to back the bill.
He said such opportunities came around "maybe once in a generation".
After the vote House Speaker Nancy Pelosi said: "I thank the president for his tremendous leadership, because without President Obama in the White House, this victory would not have been possible."
The bill will allow the government to sell insurance in competition with private companies and make insurers offer cover to those with pre-existing conditions.
However, the government-run healthcare programme - the so-called "public option" - was scaled back in the run-up to the vote.
One key concession to get the bill through was to anti-abortion legislators.
An amendment was passed that prohibits coverage for abortion in the government-run programme except for rape, incest or if the mother's life is threatened. Private plans can still offer the cover.
Democrat Bart Stupak, who sponsored the amendment, said: "Let us stand together on principle - no public funding for abortions."
Abortion rights supporters said the amendment was the biggest setback to their cause in decades.
The Senate debate on healthcare reform is expected in the coming days.
Senate majority leader Harry Reid said after the House vote: "We realise the strong will for reform that exists, and we are energised that we stand closer than ever to reforming our broken health insurance system."
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