The US House of Representatives has narrowly backed a healthcare bill in a step towards reforms promised by President Barack Obama.
The BBC reports the bill passed in a narrow 220-215 vote, despite strong opposition.
The legislation aims to extend coverage to 36 million more Americans and provide affordable healthcare to 96% of the population.
The bill now has to be reconciled with a separate Senate draft law.
Mr Obama worked very hard to secure the bill's approval.
Given that there were wavering members of his own Democratic Party there was no guarantee he would succeed.
On the eve of the vote Mr Obama made a rare visit to Congress to urge his fellow Democrats to finish the job and answer the call of history.
Mr Obama says he is absolutely confident the Senate will also approve his proposals and the US is now just steps away from achieving health insurance reform.