US President Barack Obama has welcomed the passage of his healthcare bill through the Senate, saying it paves the way for "real" reform.
The bill, which passed with 60 to 39 votes, aims to cover 31 million uninsured Americans. "This will be the most important piece of social legislation since Social Security passed in the 1930s," he said.
It must still be reconciled with similar legislation passed by the House of Representatives.
Mr Obama said: "We are now finally poised to deliver on the promise of real, meaningful health insurance reform that will bring additional security and stability to the American people."
He described the measures as "the toughest measures ever taken to hold the insurance industry accountable".
Among various reforms, Mr Obama said the insurance companies will no longer be able to deny coverage with a pre-existing condition nor end coverage when a person becomes ill.
"With today's vote, we are now incredibly close to making health insurance reform a reality in this country," the president said.
But he said it would be a challenge to "finish the job" of reform.
"For the sake of our citizens, our economy and our future, let's make 2010 the year we finally reform healthcare in the United States of America."
The process of reconciling the two bills is expected to begin in January and will require further tough negotiations.
Once that has been done - and the process could still be derailed by last-minute changes of heart among senators - Mr Obama will be able to sign the measure into law.
The bill's passage in an early morning vote on Christmas Eve follows months of political wrangling and 24 days of debate in the Senate chamber.
Opposition Republicans say the legislation is expensive, authoritarian and a threat to civil liberties, and accuse the Democrats of rushing it through.
 | MARDELL'S AMERICA   I suspect it is all over bar the shouting, but there will be an awful lot of shouting before we're done  Mark Mardell, BBC North America editor  |
"The most obvious problem with the bill before us is that it doesn't do what it was supposed to do. The one test for any bill was whether it would lower costs. This bill fails that test.
"It's also clear that even many of the people on this side who are going to support this bill don't like it - otherwise Democratic leaders wouldn't have had such a tough time rounding up the votes."
The non-partisan Congressional Budget Office estimates that efficiency savings made as a result of the Senate healthcare reform bill will cut the federal deficit by $132bn (£83bn) over 10 years, but critics say the predicted savings may never materialise.
As a nation, the US spent some $2.2tn (£1.36tn) on healthcare in 2007. That amounts to 16.2% of GDP, nearly twice the average of other rich, industrialised countries.
As costs have spiralled, millions of Americans have found themselves unable to afford health insurance and the cost to the government of providing care for the poor and elderly has risen hugely.
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