It's a huge victory for U-S President Barack Obama.

The Democratic-controlled House narrowly passed landmark health care legislation to expand coverage to tens of millions of Americans who lack it and place tough new restrictions on the insurance industry.

Most Americans would be required to carry insurance and large employers would be obliged to cover their employees.

Republican opposition the legislation was nearly unanimous.

The 220-215 vote clears the way for the Senate to begin debate on the issue that has come to overshadow all others in Congress.

A triumphant Speaker Nancy Pelosi likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later.