The US House of Representatives has narrowly voted to pass a landmark healthcare reform bill at the heart of President Barack Obama's agenda.
The bill was passed by 219 votes to 212, with no Republican backing, after hours of fierce argument and debate.
It extends coverage to 32 million more Americans, and marks the biggest change to the US healthcare system in decades.
"We proved that we are still a people capable of doing big things," Mr Obama said in remarks after the vote.
"This legislation will not fix everything that ails our healthcare system, but it moves us decisively in the right direction," he said.
Mr Obama is expected to sign the legislation into law shortly.