Otherwise, every Democrat voted in favor and every Republican against. The final vote was 220-215 (with 39 Democrats opposed) underscoring the difficulty ahead for Democrats and President Obama as the debate moves to the Senate.

Tampa Democrat Kathy Castor, who played a role in expanding medical school residencies for Florida and better consumer protections against Medicare Advantage marketing, said it was historic, "along the lines of Social Security and Medicare. This is the next step, the one that has been missing for decades."

Rep. Gus Bilirakis, R-Palm Harbor, bemoaned the $1.1 trillion price tag and said measures would hurt small businesses by requiring more coverage. "I'm worried about the loss of jobs." He also faulted cuts to Medicare Advantage, which is subsidized at a higher rate than Medicare. Bilirakis said his office phones had been ringing all day and five out of six constituents opposed the plan.

Democratic leaders pressed well into Saturday night for more party support. Obama's campaign arm, Organizing for America, even tried to gain Republican support by sending e-mail to voters in districts that voted for Obama over John McCain last year. "With the big vote happening in as little as a few hours, there's not a moment to lose," read the e-mail.

Rep. C.W. Bill Young, R-Indian Shores, was among the targets but it did not resonate with him.

-- Alex Leary, Times staff writer