A pounded gavel, the votes, then four words: &ldquo;The bill is passed.&rdquo;</p><p>With that, House Speaker Nancy Pelosi announced narrow passage Saturday of historic legislation that would fundamentally change American health care for decades. </p><p>Democrats erupted in weary applause and cheers after a day-long debate. Republicans, equally tired, promised to continue opposing the $1.1 trillion plan.</p><p> The vote was razor close &mdash; 220-215. Thirty-nine Democrats, including Rep. Ike Skelton of Missouri, voted against the measure, while only one Republican, Rep. Anh &ldquo;Joseph&rdquo; Cao of New Orleans, voted for it.</p><p> Every Republican from Kansas and Missouri voted no, while every other Democrat, including Rep. Dennis Moore of Kansas, voted yes.</p><p> &ldquo;Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people,&rdquo; President Barack Obama said in a statement. </p><p>Republicans did not agree.</p><p>&ldquo;Tonight, the Washington Democrats &hellip; (rammed) through a budget-busting, 2,000-plus-page health care plan with bipartisan opposition,&rdquo; said Rep. Roy Blunt, a Missouri Republican, in a statement.</p><p> The nearly 2,000-page bill isn&rsquo;t law yet &mdash; the Senate is struggling with its version, which will have to be merged with the House bill before a final vote.</p><p> But Democrats said a significant hurdle had been overcome.</p><p> &ldquo;There are few moments when we have the opportunity to do so much good with one vote. This is one of those moments,&rdquo; said Rep. Steny Hoyer, a Maryland Democrat.</p><p>The final vote was in doubt for much of the day. It took a visit to Capitol Hill by Obama &mdash; and a last-minute compromise allowing a vote on tougher restrictions on abortion funding &mdash; to persuade enough reluctant conservative Democrats to provide the margin of victory.</p><p> &ldquo;When I sign this in the Rose Garden, each and every one of you will be able to look back and say, &lsquo;This was my finest moment in politics,&rsquo;&ensp;&rdquo; Obama reportedly told Democrats in the private meeting.</p><p> During the sometimes contentious debate, which lasted all of Saturday, GOP members repeatedly complained about the size and complexity of the measure, some feigning injury as they lugged a copy of the massive blueprint to the floor. </p><p>&ldquo;We are going to have a complete government takeover of our health care system faster than you can say, &lsquo;This is making me sick,&rsquo;&ensp;&rdquo; said Rep. Candice Miller, a Michigan Republican.</p><p>The bill <em>is</em> complicated, although many parts are well known. It requires almost everyone to get insurance, and for most employers to provide it. It expands subsidies for people too poor to afford coverage and sets up a public company to compete with private insurers. It raises taxes and cuts Medicare and prohibits insurers from denying coverage because of pre-existing medical conditions.</p><p> It would also provide health insurance to 96 percent of all Americans by 2019, according to the Congressional Budget Office.</p><p> But millions of Americans may soon learn how dramatically other, less familiar parts of the legislation would change virtually every part of the health care system, which now takes up 16 cents of every dollar in the U.S. economy.</p><p> The House bill:</p><p>&bull;Creates a Health Choices Administration to oversee health care reform.</p><p>&bull;Establishes a Health Benefits Advisory Council, chaired by the surgeon general, which will recommend an &ldquo;essential benefits package&rdquo; that people must buy and employers must pay for in part.