Updated at 11:38 p.m.

By a razor thin margin of 219-212, the House of Representatives tonight passed far-reaching legislation that will lead to near-universal health care coverage in the United States — a goal that has eluded Presidents and Congresses for a century.

The vote on the Senate bill concluded at 10:48 p.m., almost 10 hours after Democrats gavelled the chamber into session, confident the vote would be there. Within an hour, the House also passed the “fix” to the Senate bill, on a 220-211 vote. The separate, smaller reconciliation package will go to the Senate, where Democrats are expected to muster the 51 votes needed to pass it.

With two minutes left to vote on the Senate bill, the 216th vote was cast, leading to scattered applause in the visitors’ viewing gallery gallery, and loud chants on the Democratic side of the aisle of Obama’s campaign mantra “yes we can.” As the 15 minutes allotted for the vote wound down, Democratic representatives counted down the clock: “3, 2, 1 …” The time for voting didn’t close immediately after the 15 minutes elapsed.

Rep. Loretta Sanchez (D-CA), whose vote was very much in doubt, was the 219th and final yes vote. She received a big hug from Rep. Doris Matsui (D-CA). Rep. Rick Boucher (D-VA), another whose vote was undeclared, ended up voting against the bill.

When the vote concluded, Rep. Rosa DeLauro (D-CT) was seen hugging everyone around her on the House floor and clapping and jumping up and down. Rep. Alan Grayson (D-FL), wearing a tie with the American flag printed on it, waved both of his hands in the air as the vote passed. Rep. Steve Cohen (D-TN) pumped his fist in the air.

At the White House, the President watched the vote in the Roosevelt Room with staff. When the vote total hit the magic 216, there were “cheers and clapping … high five for Rahm, hugs all around,” according to press secretary Robert Gibbs.

Shortly after the vote, Senate Majority Leader Harry Reid (d-NV) issued a statement lauding the result in the House and saying that the Senate will “complete our work on this historic effort.”

The scene on the floor before the key vote was impassioned on both sides. In his final remarks, House Minority Leader John Boehner became so agitated that Democrats had to muffle awkward laughter. Pelosi received a huge, sustained standing ovation from her caucus, and during the vote, autographed copies of the bill for members of her caucus.

Tonight’s historic vote was supposed to happen nine months ago, on the heels of the stimulus bill, with more than a year until midterm elections and President Obama’s popularity still high enough to push Democrats straight through to the next big initiative. That snowball effect never materialized, and Democrats have watched their popularity fade and their majority shrink. After Republican Scott Brown won election to Ted Kennedy’s old Senate seat in January, depriving Democrats of a 60th vote in the Senate, they nearly lost the nerve to pass health reform altogether.

But this morning, Democratic aides were confident. By noon, the whip’s office had informed members that the vote tally was at 217: one above the magic 216 needed for passage. And that was the absolute minimum House Speaker Nancy Pelosi would accept: by surpassing the 216-mark by at least one vote, she blunted the Republicans’ ability to characterize individual members as the deciding vote for the still-controversial bill.

The precision was vintage Pelosi, who has passed practically the entire Democratic platform by intentionally narrow margins, allowing members in vulnerable districts to keep a safe distance from the President and his agenda, both of which have agitated the Republican base.

But her success this time was not assured. Over the past year, a number of setbacks, and disappointments have piled up, fatiguing and embittering dozens of rank-and-file members whose votes were, as recently as two weeks ago, anything but assured. Tonight’s achievement required a tirelessness whip operation, and significant involvement from President Obama himself, when key members continued to insist they would vote against the legislation, even if it meant the whole project would collapse.

The cracks in the Democratic coalition appeared early, and are no doubt familiar to anybody who followed the debate closely. Last spring and summer, House progressives banded together to insist that the final health care reform bill contain a public option. As time went on, and that goal appeared more and more elusive, dozens of them had to walk back their demands, and erase the lines they’d drawn in the sand as part of the process of accepting defeat.

But that episode left progressives raw and less willing to compromise over a controversial tax on insurance benefits, supported by the White House, but broadly opposed by members and unions. Ultimately the White House, Congress and unions came to an agreement on scaling back the measure. But that deal–and indeed the entire push–hit a wall when Brown won. With his victory, the prospect of a true conference between the House and Senate evaporated. Demoralized House Democrats toyed for weeks with the idea of dropping the initiative altogether. And Obama was nearly forced to accept a legislative defeat worse than Clinton-care in 1994.

And that’s to say nothing of abortion, which loomed over the entire legislative process–from the early days on committee, to the final hours, when, once again, pro-life Democrats threatened to tank the bill. No less than four times in the past year did the tug-of-war between pro-choice and anti-abortion Democrats threatened to leave the entire party in the mud. But this afternoon, the White House brokered a compromise that brought pro-choice and pro-life Democrats into agreement, if not harmony. The result was meant Pelosi had a surplus to work with.

That’s all behind them now. Health care reform, writ large, is a done deal. Democrats now have two separate, but important, responsibilities. First, the Senate must pass a small, but significant, reconciliation bill, changing several of the health care bill’s more controversial provisions. Then Democrats need to run–hard–on their achievement for the next six months.

Additional reporting by Christina Bellantoni.

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