WASHINGTON — In a victory for President Barack Obama, the Democratic-controlled House narrowly passed landmark health care legislation to expand coverage to tens of millions who lack it and place tough new restrictions on the insurance industry. Republican opposition was nearly unanimous.

The 220-215 vote late Saturday night cleared the way for the Senate to begin a long-delayed debate on the issue that has come to overshadow all others in Congress. But the measure faces a tougher battle in the Senate, where more than a simple majority is needed for passage and several moderate Democrats still have reservations.

Obama praised the House in a statement and said he is "absolutely confident" that the Senate will pass its version of the legislation. "I look forward to signing it into law by the end of the year," he said.

The bill is projected to expand coverage to 36 million uninsured, resulting in 96 percent of the United States' eligible population having insurance. The United States is the only developed nation that does not have a comprehensive national health care plan.

House Speaker Nancy Pelosi likened the legislation to the passage of the government's Social Security pension program in 1935 and Medicare health insurance for the elderly 30 years later.

The legislation would require most Americans to carry insurance and provide federal subsidies to those who otherwise could not afford it. Large companies would have to offer coverage to their employees. Both consumers and companies would be slapped with penalties if they defied the government's mandates.

Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned, and insurers would no longer be able to charge higher premiums on the basis of gender or medical history. In a further slap, the industry would lose its exemption from federal antitrust restrictions on price fixing and market allocation.

At its core, the measure would create a federally regulated marketplace where consumers could shop for coverage. In the bill's most controversial provision, the government would sell insurance, although the Congressional Budget Office forecasts that premiums for it would be more expensive than for policies sold by private firms.

A cheer went up from the Democratic side of the House when the bill gained 218 votes, a majority. Moments later, Democrats counted down the final seconds of the voting period in unison, and let loose an even louder roar when Pelosi grabbed the gavel and declared, "the bill is passed."

The bill drew the votes of 219 Democrats and Rep. Joseph Cao, a first-term Republican who holds an overwhelmingly Democratic seat in New Orleans. Opposed were 176 Republicans and 39 Democrats.

From the Senate, Majority Leader Harry Reid issued a statement saying, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."

Senate Democrats will need 60 out of 100 votes to end debate and bring legislation to a final vote, and several moderate Democratic senators still have reservations.

If the Senate does pass a bill, it would have to be reconciled with the House version by a panel of lawmakers from both chambers before the legislation is put up for final approval.

Nearly unanimous in their opposition, minority House Republicans cataloged their objections across hours of debate on the 1,990-page, $1.2 trillion legislation.

"We are going to have a complete government takeover of our health care system faster than you can say, 'this is making me sick,'" jabbed Republican Rep. Candice Miller, adding that Democrats were intent on passing "a jobs-killing, tax-hiking, deficit-exploding" bill.

But with little doubt about the outcome, the rhetoric lacked the fire of last summer's town hall meetings, when some critics accused Democrats of plotting "death panels" to hasten the demise of senior citizens.

In the run-up to a final vote, conservatives from the two political parties joined forces to impose tough new restrictions on abortion coverage in insurance policies to be sold to many individuals and small groups. They prevailed on a roll call of 240-194.

Ironically, that only solidified support for the legislation, clearing the way for conservative Democrats to vote for it.

Over all, the bill envisioned the most sweeping set of changes to the health care system in more than a generation, and Democrats said it marked the culmination of a campaign that Harry Truman began when he sat in the White House 60 years ago.

A Republican alternative to the Democrats' House bill was rejected on a near party line vote of 258-176.

Debate on the House floor had already begun when Obama strode into a closed-door meeting of the Democratic rank and file across the street from the Capitol to make a final personal appeal to them to pass his top domestic priority.

Later, in an appearance at the White House, he said he had told lawmakers, "to rise to this moment. Answer the call of history, and vote yes for health insurance reform for America."

The U.S. government provides coverage for the poor, elderly and military veterans, but most Americans rely on private insurance, usually provided through their employers. But with unemployment climbing above 10 percent, many Americans are losing their health insurance when they lose their jobs. At the same time, the deepening budget deficit has made it difficult for lawmakers to support costly new programs.

Associated Press writers Phil Elliott, Alan Fram and Erica Werner contributed to this report.