The US House of Representatives narrowly voted in favour of Barack Obama's contentious healthcare reform bill.
After a year of heated debate over the policy, which was at the heart of Obama's agenda, the bill was passed by 219 votes to 212.
This followed days of lobbying dissident Democrats to come on board, and hours of heated debate. Every single Republican voted against the bill, as well as 34 Democrats.
Although it does not go as far as originally planned, the bill is the biggest change to the US healthcare system in decades. It will extend coverage to 32 million more Americans.
This will give coverage to 95 per cent of Americans, at a cost of approximately $940bn over 10 years.
Speaking after the vote, Obama said: "Tonight, at a time when the pundits said it was no longer possible, we rose above the weight of our politics.
"This legislation will not fix everything that ails our healthcare system, but it moves us decisively in the right direction. This is what change looks like."
The passing of the bill is a huge turnaround from January, when the Democrats lost their 60 seat majority in the Senate.
This is the biggest success of Obama's 15 month presidency so far, amid slipping poll ratings and criticism that he had failed to deliver on the change he promised.
The Republicans believe that the measures will be unpopular, and plan to use the reform as a rallying point to win votes in November's mid-term elections.
The bill is expected to be signed by Obama and passed into law as early as Tuesday.
However, this is not the end of the road for the reform. The Republicans say they will seek to repeal the measure and block its implementation, claiming that it is unconstitutional.
