WASHINGTON - The U.S. House of Representatives approved a sweeping healthcare reform bill on Saturday, backing the biggest health policy changes in four decades and handing President Barack Obama a crucial victory.

On a narrow 220-215 vote, the House endorsed a bill that would expand coverage to nearly all Americans and bar insurance practices such as refusing to cover people with pre-existing medical conditions.

One Republican supported the measure, but most criticized its US$1 trillion (S$1.4 trillion) price tag, new taxes on the wealthy and what they said was excessive government interference in the private health sector.

The battle over Obama's top domestic priority now moves to the U.S. Senate, where work on its own version has stalled for weeks as Senate Democratic leader Harry Reid searches for an approach that can win the 60 votes he needs.

Any differences between the Senate and House bills ultimately will have to be reconciled, and a final bill passed again by both before going to Obama for his signature.

The overhaul would spark the biggest changes in the $2.5 trillion U.S. healthcare system, which accounts for one sixth of the U.S. economy, since the creation of the Medicare government health program for the elderly in 1965.

The vote followed days of heavy lobbying of undecided Democrats by Obama, his top aides and House leaders, and a deal designed to mollify about 40 moderate Democrats who are foes of abortion rights.

Democrats could afford to lose 40 of their 258 House members and still pass the bill. In the end, 39 Democrats sided with Republicans against the bill.

The landmark vote was a huge step for Obama, who has staked much of his political capital on the healthcare battle. A loss in the House would have ended the fight, impaired the rest of his legislative agenda and left Democrats vulnerable to big losses in next year's congressional elections.

(Editing by Todd Eastham)