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WASHINGTON (AP) — The Democratic-controlled House has narrowly passed landmark health care reform legislation, handing President Barack Obama a hard won victory on his signature domestic priority.

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Speaker Nancy Pelosi, center, is joined by (L-R) House Majority Leader Steny Hoyer and Rep. George Miller, D-Calif. during a press conference at the U.S. Capitol, Saturday, Nov. 7, 2009 in Washington after the passage in the house of the health care reform bill. at the U.S. Capitol, Saturday, Nov. 7, 2009 in Washington. (AP Photo/Alex Brandon)

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House Majority Leader Steny Hoyer and Speaker Nancy Pelosi arrive for a press conference after the passage in the house of the health care reform bill at the U.S. Capitol, Saturday, Nov. 7, 2009 in Washington. (AP Photo/J. David Ake)

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Republicans were nearly unanimous in opposing the plan that would expand coverage to tens of millions of Americans who lack it and place tough new restrictions on the insurance industry.

The 220-215 vote late Saturday cleared the way for the Senate to begin a long-delayed debate on the issue that has come to overshadow all others in Congress.

A triumphant Speaker Nancy Pelosi compared the legislation to the passage of Social Security in 1935 and Medicare 30 years later.

Obama, who went to Capitol Hill earlier on Saturday to lobby wavering Democrats, said in a statement after the vote, "I look forward to signing it into law by the end of the year."

"It provides coverage for 96 percent of Americans. It offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it," said Rep. John Dingell, the 83-year-old Michigan lawmaker who has introduced national health insurance in every Congress since succeeding his father in 1955.

But minority Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

"We are going to have a complete government takeover of our health care system faster than you can say, 'this is making me sick,'" said Rep. Candice Miller, R-Mich.

In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance industry practices such as denying coverage because of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. The industry would also lose its exemption from federal antitrust restrictions on price fixing and market allocation.

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private companies.

The bill drew the votes of 219 Democrats and Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans. Opposed were 176 Republicans and 39 Democrats.

From the Senate, Majority Leader Harry Reid of Nevada issued a statement saying, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."

To pay for the expansion of coverage, the bill cuts Medicare's projected spending by more than $400 billion over a decade. It also imposes a tax surcharge of 5.4 percent on income over $500,000 in the case of individuals and $1 million for families.

3:41 a.m.

WASHINGTON — With a personal push from President Barack Obama, the House of Representatives Saturday inched closer to passing historic health care legislation that would guarantee virtually all Americans access to care.

Two key votes pointed to its passage: one, 242-192, authorized the bill to be debated, a key test of Democratic strength, and a second one that banned government-subsidized health insurance from covering elective abortions.

That vote was 240-194, with most Democrats opposing what opponents of the abortion limits called the greatest restriction on health care imposed on women in a generation. Republicans, however, overwhelmingly backed the amendment.

Passage of the amendment, however, was considered critical to win the support of anti-abortion Democrats for passage of the final health-care proposal, which needs 218 votes.

As the debate began, Obama visited Capitol Hill to meet for half an hour with House Democrats as the all-day debate was starting Saturday morning, and compared the health care effort to Democrats’ championing of Social Security and Medicare.

"Now is the time to finish the job," Obama said later in brief remarks in the White House Rose Garden.

On the House floor, Democratic leaders appealed to members’ sense of history, reminding them this is one of the most significant votes, short of war, they are likely to take.

"There are few moments when we have the opportunity to do so much good with one vote. This is one of those moments," said Majority Leader Steny Hoyer, D-Md.

Republicans countered with arguments that the health care plan did little to improve coverage or affordability.

"Astoundingly, Democrats are bringing to the floor a bill today that will not reduce the costs of health insurance. It will grow the size of government," said GOP Conference Chairman Mike Pence, R-Ind.

Democratic leaders scheduled a final vote on the bill late Saturday night, and were confident they had enough for passage after a last-minute abortion deal.

The House bill would make the biggest changes in the nation’s health care system since Medicare was created 44 years ago to provide coverage for seniors and the disabled.

Passage of the bill by the House would be the first crucial step to overhauling health care; the Senate hopes to act by the end of the year, and the two Houses would then craft a compromise that would need the approval of each chamber.

The House measure would create a government-run health-care plan to compete with the private sector, bar insurers from denying coverage because of pre-existing conditions and set up health care "exchanges," or marketplaces where consumers could easily shop for coverage.

The changes are expected to mean that by 2019, 96 percent of eligible Americans would have health insurance, up from the current 83 percent.

Obama took no questions from lawmakers, but his presence was a vivid, and highly partisan, reminder that the president has put health care overhaul at the top of his domestic agenda — a change that has eluded presidents for nearly a century.

"He came here to say, ’This is what we said we would do in the campaign. Let’s do it,’ " Hoyer said.

Democratic leaders said that they doubted many votes would change as a result of the Obama appearance, but that "the energy he brought to this debate will be helpful," said Majority Whip Jim Clyburn, D-S.C.

A bigger boost likely came from the abortion deal.

As originally written, the House bill would have required insurers to separate public and private money, so that only private funds could be used for elective abortions. Abortion opponents were concerned that such a policy would effectively expand the government’s role in improving access to abortion, and as many as 40 Democrats threatened to withhold support from the health care bill unless changes were made.

The change would permit abortion coverage for people receiving federal aid for their insurance only in the case of rape or incest.