US president says 'this is what change looks like' about reform that ensures coverage for 95% of Americans

Barack Obama last night forced his bitterly fought healthcare reform bill through Congress, bringing near-universal coverage to Americans and delivering the first major triumph of his presidency.

After days of manoeuvring by the Democratic party leadership to bring dissident party legislators on board and an impassioned plea on Saturday by Obama, the speaker of the House of Representatives, Nancy Pelosi, confirmed that the votes were in the bag. She said she would not have decided to take the bill to a vote unless the necessary 216 Democrats had been secured to push the move through. As it was, the bill was passed by 219 votes to 212.

"Tonight, at a time when the pundits said it was no longer possible, we rose above the weight of our politics," Obama said during a late-night appearance at the White House.

"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."

House Democrats hugged and cheered as their vote count hit the magic number of 216, and chanted: "Yes we can."

Every Republican opposed the bill, and 34 Democrats joined them in voting against it.

Pelosi, summing up the debate, described the bill as "the great unfinished business of our society". The bill now goes to Obama to sign into law.

Despite not going as far as many liberals had hoped, the bill will take the US close to universal healthcare coverage and Obama will have achieved the goal that eluded US presidents dating back to Theodore Roosevelt a century ago.

The reform, which will cost an estimated $940bn (£627bn) over 10 years, amounts to a massive change in US healthcare provision, expanding care to 32 million more people, predominantly the poorest, and giving the country 95% coverage.

Obama, whose poll ratings slipped amid criticism that he was a "do-nothing" president, needed at least one major policy success after a series of setbacks in the last 15 months. He told Hispanic members of Congress early last week that the fate of his presidency and their own chances in the mid-term congressional elections in November rested on passage of the bill.

In his final rallying call on Saturday, Obama told his Democratic colleagues: "Every once in a while a moment comes where you have a chance to vindicate all those best hopes that you had about yourself, about this country. This is one of those moments.

"We have been debating healthcare for decades. It has now been debated for a year. It is in your hands."

Given the huge consequences of failure, Obama spent the day on the phone lobbying colleagues.

The vote provided the climax to a year of debate in which the bill at times seemed on the verge of passage and at others about to be scrapped. The issue has divided the country more than any other since the Vietnam war, and led to the rise of the anti-establishment movement the Tea Party.

Thousands of protesters gathered outside Congress at the weekend, shouting "kill the bill". Some directed racist and other derogatory remarks at African-American members of Congress, including John Lewis, one of the veterans of the 1960s civil rights movement. One congressman was spat on.

Another protester shouted "faggot" at Democratic congressman Barney Frank, who later told the Politico website: "It's like the Salem witch trials, and healthcare is the witches. There is mass hysteria."

The 178 Republicans unanimously opposed the bill, as did some Democrats. The balance was held by a bloc of about 10 anti-abortion Democrats, led by Bart Stupak, who were worried that public funds could be used for abortions.

After Obama promised to issue an executive order to prevent cash being used in this way, other than in cases of abortion after incest or rape, Stupak told a press conference that he would support the bill. "We're well past 216," he said.

A vote to set out the procedures for passing the legislation was later passed by 224 to 206. The Republican leader in the House, John Boehner, described the bill as armageddon and predicted the electorate would punish the Democrats for it in the mid-term elections in November.

The House of Representatives was voting on a version of the bill passed by the Senate on Christmas Eve. Obama, who cancelled a trip to Australia and Indonesia in order to be in Washington for the vote, is expected to sign the bill into law within hours.

The House, unhappy with parts of the Senate bill, is to pass a separate bill that contains revisions. The Democratic leader in the Senate, Harry Reid, promised the House Democrats that if they passed the Senate version of the bill, he would repay this by passing their revisions.

The bill with revisions is expected to go to the Senate this week, where procedural wrangling could last days or weeks. But the Democrats, who have a majority of 59 in the 100-member chamber, only need a simple majority to secure its passage.

When the Senate passed Obama's bill on Christmas Eve, success seemed at hand. But the Republican Scott Brown had a surprise win to take Ted Kennedy's former Senate seat in Massachusetts in January, partly because of opposition to the bill, and the Democrats panicked.

After internal debate in which a more modest bill was considered, they recovered their nerve and pushed ahead with comprehensive reform.

Obama's predecessors struggled with healthcare. President Lyndon Johnson made the biggest contribution by creating Medicare in 1965.