The 220-215 vote cleared the way for the Senate to begin debate on the issue that has come to overshadow all others in Congress.

A triumphant Speaker Nancy Pelosi likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later.

"It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it," said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.

In the run-up to a final vote, conservatives from both parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.

That move solidified support for the legislation, clearing the way for conservative Democrats to vote for it.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance-industry practices such as denying coverage on the basis of preexisting medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price gouging, bid rigging, and market allocation.

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage.

In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.

The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the nation's eligible population having insurance.

To pay for the expansion of coverage, the bill would cut Medicare's projected spending by more than $400 billion over a decade. It also would impose a tax surcharge of 5.4 percent on income over $500,000 for individuals and $1 million for families.

The bill was estimated to reduce federal deficits by about $104 billion over a decade, although it lacked two of the key cost-cutting provisions under consideration in the Senate, and its longer-term impact on government red ink was far from clear.

Shortly before beginning its vote on a Democratic plan, the chamber voted 258-176, largely on party lines, against a GOP version that would have lowered costs for people with insurance but done little or nothing to expand coverage to those without any.

The GOP relied largely on loosening regulations on private insurers to reduce costs for the insured by as much as 10 percent. Congressional budget analysts said the plan would make no dent in the ranks of the uninsured.

United in opposition, minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

"We are going to have a complete government takeover of our health-care system faster than you can say, 'This is making me sick,' " jabbed Rep. Candice Miller (R., Mich.), adding that Democrats were intent on passing "a jobs-killing, tax-hiking, deficit-exploding" bill.

But with little or no doubt about the outcome, the rhetoric lacked the fire of last summer's town-hall meetings.

Democrats lined up a range of outside groups behind their legislation, none more important than the AARP, whose support promises political cover against the cuts to Medicare in next year's congressional elections.

Passage cleared the way for a Senate debate expected to begin in several days.

Debate on the House floor had already begun when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority.

While the session was private, he later said he had told the rank and file "that opportunities like this come around maybe once in a generation. . . . This is their moment, this is our moment, to live up to the trust that the American people have placed in us."

Participants said Obama had referred to Thursday's shooting rampage at Fort Hood, Texas, in which 13 people were killed. His remarks put in perspective that the hardships soldiers endure for the country are "what sacrifice really is," as opposed to "casting a vote that might lose an election for you," said Rep. Robert E. Andrews (D., N.J.).

In a statement last night, Rep. Joe Sestak (D., Pa.) said: "I am honored to have had the opportunity to vote for the Affordable Health Care for America Act. Today, we are a significant step closer to achieving this critical goal" of expanding health care.

Republicans had circulated a list of 34 Democrats in opposition earlier in the day but made no claims they could block the legislation's passage.

Health-Coverage Makeover

A look at some ways in which the House measure would change how health insurance operates nationwide. The bill would:

Create a government-run plan, or "public option," to offer insurance coverage. It would compete with the private sector.

Set up "exchanges," or marketplaces, where consumers could easily compare coverage and rates.

Require nearly everyone to obtain health-insurance coverage starting in 2013.

Require health plans to allow young adults to remain on their parents' policies until their 27th birthday.

Provide federal financial help for lower- and middle-income consumers so they can obtain coverage.

Bar insurers from denying or limiting coverage because of preexisting conditions.

Bar insurers from imposing lifetime limits on coverage.

Expand Medicaid coverage to more people.

Impose a 5.4 percent surcharge on adjusted gross incomes of more than $500,000 for individuals and $1 million for joint filers.

Impose penalties on people and businesses who fail to comply with the new law.

- McClatchy Newspapers