House Democrats narrowly clinched a landmark victory on a sweeping health care overhaul Saturday night, voting 220-215 to deliver President Barack Obama a key win on his No. 1 domestic priority.

The measure, which passed with only one Republican vote, represented six months of hard-fought compromises and deal-making among Democratic lawmakers.

Rep. Anh “Joseph— Cao (R-La.) was the sole Republican to vote in favor of the legislation. By voting for the bill, Cao denied Minority Whip Eric Cantor (R-Va.) the unanimous GOP vote he had sought against the bill.

Thirty-nine Democrats voted against the bill.

Obama issued a statement late Saturday praising the House for passing the health care bill.

“Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America,— Obama said. “Now the United States Senate must follow suit and pass its version of the legislation. I am absolutely confident it will, and I look forward to signing comprehensive health insurance reform into law by the end of the year.—

Leaders continued high-stakes negotiations late into Friday night to break a potentially ruinous deadlock over abortion language and spent Saturday putting the finishing touches on locking down a bare majority of support for the package.

Two social policy disputes — over abortion and immigration — that emerged in recent weeks as major hang-ups for the majority lingered into Saturday evening, providing a final burst of drama in a debate that never lacked for it as Democrats struggled among themselves to craft the most ambitious remake of the health care system in a generation.

In the end, on abortion, anti-abortion Democrats won out against their majority of pro-abortion-rights colleagues when Republicans joined them to approve a change tightly restricting access to the procedure under new health care programs. That the amendment got a vote at all was a major victory for a small clutch of anti-abortion Democrats.

Rep. Bart Stupak (D-Mich.), the architect of the anti-abortion push, said a compromise had been negotiated with Speaker Nancy Pelosi (D-Calif.) on the abortion issue, but it fell apart Friday night after Pelosi said she could not get Pro-Choice Caucus Democrats to endorse it. Stupak said the compromise would have included a permanent ban on the public insurance option providing abortion coverage. But the compromise would have had just an annual ban that would have to be renewed on the private plans offered in the new national exchange, instead of the permanent ban lawmakers ended up endorsing.

The deal enraged abortion-rights supporters, who spent Saturday trying to find the votes to sink it. “The Pro-Choice Caucus is furious and is going to do everything we can to defeat the Stupak amendment,— Rep. Diana DeGette (D-Colo.) said, adding that Pelosi herself was “furious, too.— DeGette blasted the amendment as probably the biggest limitation on a woman’s right to have an abortion that she has seen in her career. “This happened last night in the dead of night,— she said.

But those lawmakers ultimately lined up behind the bill on final passage, reasoning that the broader package was too important to oppose and that they could fight to strip the language in conference negotiations with the Senate.

Democratic leaders also struggled behind the scenes to deal with the immigration issue, with the White House and Senate Democrats backing a ban on illegal immigrants entering the national insurance exchange, while members of the Congressional Hispanic Caucus warned they could vote down the bill if the ban was included.

Rep. Luis Gutierrez (D-Ill.) blamed the White House for going too far in trying to refute Rep. Joe Wilson’s (R-S.C.) accusation that the president was lying about subsidies being provided to illegal immigrants.

“What the president did was he ginned this up to the point where he has a problem,— Gutierrez said

However Republicans instead chose to offer a provision limiting medical malpractice lawsuits to $250,000 in noneconomic damages, which would save an estimated $54 billion over the next decade.

Despite passage of the bill, both issues could potentially bedevil final passage of a conference report.

Rep. Jan Schakowsky (D-Ill.) was among Democrats who said they would vote down a conference report containing the Stupak language, while Gutierrez said he would vote against a conference report that contained the ban on illegal immigrants in the exchange.

Leaders had a more pressing concern on Saturday: last-minute checking and rechecking of their whip lists to protect against flyaway votes. Those efforts were visible on the House floor, with some apparent horse-trading going on in the chamber. Pelosi sat with Rep. Marion Berry (D-Ark.), buttonholing him for about five minutes, while Rep. Jason Altmire (D-Pa.) got the full treatment, bouncing from Pelosi to House Majority Leader Steny Hoyer (D-Md.), Appropriations Chairman David Obey (D-Wis.) and Appropriations Subcommittee on Defense Chairman John Murtha (D-Pa.) — and back.

Democrat also had to beat back brushfires — including a last-minute objection from some lawmakers to a $24 billion tax provision banning “black liquor— generated by paper plants from qualifying ethanol subsidies.

Setting the tone for leaders’ last pitch was an appeal from the closer-in-chief, President Barack Obama, who gave what attendees called a somber but inspirational call to arms for his cornerstone priority. In the midday address, delivered to a packed huddle in the Cannon House Office Building Caucus Room, Obama exhorted Members to seize a historic opportunity by passing the bill.

Speaking off the cuff, the president opened by pointing to the killing spree at Fort Hood, Texas, earlier this week that left 13 dead and more than 30 wounded as an example of true sacrifice that puts in perspective the political heartburn the vote is causing some lawmakers. “I think it made a lot of people feel a little less sorry for themselves about their political problems,— Rep. Robert Andrews (D-N.J.) said afterward.

And the president congratulated Democrats for their successes this year while holding out the pending health care vote as the one that would stand as the proudest of their careers.

House Democrats hailed Obama’s appearance as a key rallying moment, but the day belonged to a giant closer to home. Rep. John Dingell (D-Mich.), the dean of the House and a lifelong champion of universal health care, presided over the opening debate on the rule — his first turn as Speaker Pro Tem since he wielded the gavel during passage of Medicare in 1965. In one of the rare bipartisan moments of the day, he received a standing ovation from both sides of the aisle at the conclusion of that debate. Hours later, he closed debate on the bill itself.

Republicans spent the day blasting what they termed a government takeover of health care, with a tea party protest outside the Capitol and plenty of vitriol inside it. House Minority Leader John Boehner (R-Ohio) repeatedly complained that Democratic leaders refused to guarantee that abortion restrictions would stay in the bill through a conference with the Senate. And early in the day, Republicans objected to a series of Democratic women offering up garden-variety unanimous consent requests highlighting the bill’s benefits to women.

The 2,000-plus-page bill would give an estimated 36 million more Americans health insurance via an expansion of Medicaid and the creation of a national insurance exchange starting in 2013. The bill also imposes new regulations on the private insurance industry, outlawing discrimination based on pre-existing conditions and gender.

The $1.2 trillion, 10-year package will cut the deficit by more than $100 billion in the first decade, according to the Congressional Budget Office, funded by cuts to the growth of Medicare and more than $700 billion in tax hikes, including a surtax on millionaires and new taxes on businesses that do not offer health care insurance to their employees and on individuals who choose not to buy it.