The House speaker, Nancy Pelosi, has said the House would not just accept the Senate bill. And some Senate Democrats have warned that they could turn against the bill if changes made during negotiations with the House are not to their liking.

Given the late hour, the White House did not immediately issue a statement after the Senate vote.

The health care legislation, which President Obama has called his top domestic priority, seeks to extend health benefits to more than 30 million people who are currently uninsured. The bill would require nearly all Americans to obtain health insurance, or pay financial penalties for failing to do so, and it would provide federal subsidies to help moderate-income Americans buy private coverage.

About half of the people who would gain coverage, some 15 million, would do so through a broad expansion of Medicaid, the federal-state insurance program for low-income Americans, and growth in the Children’s Health Insurance Program.

To pay for the new coverage, the bill would impose an array of fees and taxes, including an increase in the payroll tax for individuals earning more than $200,000 and couples earning more than $250,000 and a new excise tax on high-cost insurance polices. The bill also calls for major reductions in government spending, by slowing the growth of Medicare.

The nonpartisan Congressional Budget Office said that the $871 billion cost of the bill would be more than offset by the new revenues and cuts in spending, so that it would reduce future federal budget deficits by $132 billion between 2010 and 2019.

The outcome of the Monday morning vote was effectively decided on Saturday, when Senator Ben Nelson, Democrat of Nebraska, the last holdout, announced that he would support the bill and Mr. Reid unveiled his final “manager’s” package of changes. Mr. Reid’s amendment included provisions aimed at winning over Mr. Nelson and others. Republicans derided the changes as akin to bribery.

On Sunday, any lingering doubts were put to rest. Senator Jim Webb, Democrat of Virginia, who voted in favor of several Republican amendments to the health care bill, issued a statement saying he would support the measure. And Senator Olympia J. Snowe, Republican of Maine, who had been in intense talks with the White House, issued a statement saying she would vote no.