WASHINGTON — The House of Representatives Saturday passed, by a vote of 220 to 215, historic health care legislation that would require virtually all Americans to obtain health insurance and create a government-run health insurance plan to help them do so.

If passed by the Senate, the bill would bring about the most sweeping change in the American health care system since Medicare was created 44 years ago.

Supporters of the measure burst into cheers and applause on the House floor as it became clear the measure had won, but the vote was excruciatingly close, just two more than the bare minimum needed. One Republican, Joseph Cao of Louisiana, voted for the bill; 39 Democrats voted against.

President Barack Obama made a personal plea for passage before the all-day debate began.

"Now is the time to finish the job," Obama said in brief remarks in the White House Rose Garden after meeting with House Democrats.

The job is far from finished. The Senate hopes to act by the end of the year, and if successful, the two Houses would then craft a compromise that would need approval of each chamber.

The House vote came with a warning: Getting enough votes later this year or early in 2010 will not be easy. Thirty-nine Democrats, most from conservative districts or freshmen who narrowly won their 2008 elections, voted against the House bill, joining 176 Republicans. In the Senate, eight to 12 moderates have expressed reservations about that chamber's proposal.

In addition to creating the so-called public option government run insurance program, the House-passed bill would bar insurers from denying people coverage because of pre-existing conditions and set up health care "exchanges," or marketplaces, where consumers could easily shop for coverage.

The changes are expected to mean that by 2019, 96 percent of eligible Americans would have health insurance, up from the current 83 percent.

During his half hour appearance on Capitol Hill Saturday, Obama took no questions from lawmakers, but his presence was a vivid reminder that the president has put health care overhaul at the top of his domestic agenda — a change that has eluded presidents for nearly a century.

"He came here to say, 'This is what we said we would do in the campaign. Let's do it,' " said House Majority Leader Steny Hoyer, D-Md.

On the House floor, Democratic leaders appealed to members' sense of history, reminding them this was one of the most significant votes, short of war, that they were likely to take.

"There are few moments when we have the opportunity to do so much good with one vote. This is one of those moments," said Majority Leader Steny Hoyer, D-Md.

Republicans countered with arguments that the health care plan did little to improve coverage or affordability.

"Astoundingly, Democrats are bringing to the floor a bill today that will not reduce the costs of health insurance, it will grow the size of government," said GOP Conference Chairman Mike Pence, R-Ind..

Democratic leaders said that they doubted Obama changed many votes, but "the energy he brought to this debate will be helpful," said Majority Whip Jim Clyburn, D-S.C.

A bigger boost may have come from a deal to bar coverage by government-subsidized insurance policies of elective abortions.

As originally written, the measure would have required insurers to separate public and private money, so that only private funds could be used for elective abortions. Abortion opponents were concerned that such a policy would effectively expand the government's role in improving access to abortion, and as many as 40 Democrats threatened to withhold support from the health care bill unless changes were made.

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