United States senators have passed the final Senate version of a healthcare reform bill.
The bill aims to cover 31 million uninsured people and could lead to the biggest change in US healthcare in decades.
President Barack Obama described it the most important piece of social legislation since the 1930s.
However, it must still be reconciled with more expansive legislation passed in November by the House of Representatives.
The process of reconciling the two bills is expected to begin in January and will require further tough negotiations.
The Senate bill was adopted by 60 votes to 39 at 7.30am on Christmas Eve, with senators voting along party lines.
Fifty-eight Democrats and two independents backed the legislation, while Republicans voted unanimously against it.
The vote follows months of political wrangling and 24 days of debate in the Senate chamber.
Republicans say the legislation is expensive, authoritarian and a threat to civil liberties and accuse the Democrats of rushing it through.
The BBC reports healthcare reform has dominated American politics all year and it has poisoned the political atmosphere in Washington.
Even many of the president's own party are unsure about the bill, its cost and its implications.