In a major victory for President Obama and congressional Democrats, the House has approved a landmark measure that would expand healthcare to over 30 million uninsured Americans while forcing millions to purchase health insurance. The 219-to-212 vote late Sunday night came nearly three months after the Senate’s approval of the bill on Christmas Eve. No Republicans voted with the Democratic majority. The House later approved another package of changes that will now face a testy Senate vote before reaching Obama’s desk. Although the measure marks the largest expansion of health insurance since the founding of Medicare and Medicaid in the mid-1960s, it’s been criticized for further entrenching the for-profit healthcare system that rations care based on wealth. In a national address, Obama acknowledged the bill falls short of radical reform but said it marked a “victory” for the American people.

President Obama: “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. In the end, what this day represents is another stone laid firmly in the foundation of the American Dream. Tonight we answered the call of history as so many generations of Americans have before us. When faced with crisis, we did not shrink from our challenge; we overcame it.”

The passage followed weeks of intense negotiations to secure the needed votes. Democratic leaders obtained the backing of progressive lawmakers despite excluding a public option. And several anti-abortion lawmakers signed on after President Obama agreed to issue an executive order reasserting that no federal money in the bill would be used to fund abortions. In a statement, Terry O’Neill of the National Organization for Women said, “The message we have received today is that it is acceptable to negotiate healthcare on the backs of women, and we couldn’t disagree more.”