Making the nation's medical system work better and cover Americans was the signature issue of President Obama's campaign. In his second year, he has won a historic reform that some rank with such milestone achievements as civil rights acts and the creation of Social Security.
"This is what change looks like," a triumphant Obama said from the White House, minutes before midnight.
"We proved that we are still a people capable of doing big things," the President said. "Tonight's vote answers the prayers of every American who has hoped deeply for something to be done about a health care system that works for insurance companies but not for ordinary people."
As the deciding vote was cast, an exuberant Obama high-fived White House Chief of Staff Rahm Emanuel.
Democrats roared in delight on the House floor as the main bill squeaked through 219 to 212, four months after it had passed the Senate. Republicans were unanimously opposed, joined by 34 Democrats. Fixes to the Senate bill were approved separately, 220 to 211.
The health care push has been as divisive for Obama as the Iraq War was for President George W. Bush. Angry mobs disrupted town hall meetings around the nation last summer. Even last night, protesters swarmed Capitol Hill, chanting, "Kill the bill!"
Republicans to the end called it a big-spending folly that would send the nation's health care into decline.
"Shame on each and every one of you who substitutes your will for the will of your countrymen," House Minority Leader John Boehner (R-Ohio) thundered.
House Speaker Nancy Pelosi (D-Calif.) responded by invoking the Declaration of Independence: "This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people."
The $940 billion bill marks the greatest overhaul of how Americans get medical care in two generations. The changes are not as radical as some liberals wanted, but they are profound.
In six months, people with pre-existing conditions will have better access to insurance. Kids can stay on parents' plans until age 27. Retroactive cancellations of policies will be illegal. And seniors on Medicare won't face a prescription drug "doughnut hole."
Over the next four years, new exchanges will be created through which individuals and small businesses will be able to buy insurance at group rates, and there will be subsidies and tax breaks to help.