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The US House of Representatives sent a historic health care overhaul to President Barack Obama, bringing the United States closer than ever before to guaranteed coverage for all Americans.

Lawmakers voted 219-212 to approve the Senate-passed legislation and were to move quickly to pass a package of changes sought by Obama, who was to mark the legacy-defining political victory with a public statement at the White House.

Democrats used their majority to muscle the measure through, losing 34 conservative party members who joined the united Republican opposition, worried about paying a political price in November mid-term elections.

"This bill is complicated, but it's also very simple: Illness and infirmity are universal, and we are stronger against them together than we are alone," Democratic House Majority Leader Steny Hoyer said before the vote.

"This trillion-dollar overhaul will take the America we know and love in the wrong direction," said Representative Eric Cantor, the number two House Republican.

With the fixes, the overhaul was estimated to extend coverage to some 32 million Americans who currently lack it, bringing to 95 percent the proportion of under-65 US citizens with private insurance. Related article: History of US health care reform battle

It would ban insurance company practices like denying care for preexisting conditions, imposing lifetime caps on coverage, while providing subsidies to buy private insurance in newly-created marketplaces called "exchanges."

Republicans denounced the plan, and made frequent trips to a Capitol balcony to cheer on hundreds of protesters outside demanding they "kill the bill" and warning "in November, we'll remember."

Inside, Republican Representative Paul Ryan leveled angry charges that the legislation would crush the free market in the heavy hand of government while raising taxes and creating a bevy of inefficient agencies.

"This bill is a fiscal Frankenstein," he said. "It's not too late to get it right, let's start over, let's defeat this bill."

Republicans also vowed to keep up the fight in the Senate -- the next battleground -- and repeal the broadly unpopular bill if they win back majorities in November.

After a year of often bitter debate, Obama cleared the way for his own victory with an 11th-hour deal to sign an executive order reaffirming a longstanding US ban on government funding for abortions, winning support for the bill from a group of conservative Democratic holdouts. Facts: Obama health care plan

"I've always supported health care reform," said the group's leader, Democratic Representative Bart Stupak, flanked by other anti-abortion lawmakers. "This bill is going to go through."

The breakthrough ensured that Obama's Democratic allies could lock down the 216 votes needed to ensure passage of the sweeping legislation, on which Obama had staked much of his future effectiveness and even his political legacy.

The Democratic plan called for the House to approve the Senate version of the legislation, sending it to Obama to sign into law, then pass a package of "fixes" to make it more like the House-passed health care bill.

The Senate was expected this week to take up the changes and approve them separately, under rules that prevent Republicans from using a parliamentary tactic, the filibuster, to indefinitely delay and therefore kill the measure.

But Senate Republicans plan to besiege the legislation with "hundreds of amendments," to "highlight what is in the bill that is bad," one of their leaders, John Cornyn, told Fox News.

Cornyn acknowledged that Vice President Joe Biden, the Senate's presiding officer, could declare the amendments to be purely delaying tactics and call a vote on the legislation.

"I guarantee it will happen on television ... for 300 million people to see and I think there will be a terrible price to be paid for this sort of defying public opinion," said Cornyn.

Recent opinion polls have painted a confusing picture, with respondents expressing strong support for individual elements of the bill, but with large numbers saying they oppose the overall measure.

Democrats have highlighted the independent Congressional Budget Office's estimate that the bill would cost 940 billion dollars over the next 10 years, while cutting 143 billion dollars from the bloated US deficit through 2019 and 1.2 trillion over the following decade.

The House vote on what Obama has called "the toughest insurance reforms in history" would come a century after president Theodore Roosevelt first called for a national approach to US health care.

Before the final showdown, Democrats won a series of procedural votes by margins of 228-195, 230-200, 228-202, and passed a "rule" governing the debate in a 224-206 vote.

AFP