The US House of Representatives has voted in favour of Barack Obama's healthcare reform bill by a slim margin.
The bill was passed by 219 votes to 212, after a fiery debate.
It extends state-aided healthcare coverage to 32m more Americans and is a flagship policy for the US president.
Obama said: "We proved that we are still a people capable of doing big things.
"This legislation will not fix everything that ails our healthcare system, but it moves us decisively in the right direction."
The reforms extend insurance coverage through tax credits for the middle class and expansion of the Medicaid programme for the poorest citizens.