The US House of Representatives backed amendments by 220 votes to 207. The vote was needed after a number of Republican objections.

The Senate earlier voted for the package by 56-43. Two points, which Democrats say are minor, were deleted.

President Barack Obama has already signed the main bill into law. He will now be able to apply a final signature.

The healthcare reform marks the biggest change to the US healthcare system in decades.

After the main vote on Sunday a package of amendments was sent back to the Senate for a vote, under a process known as budget reconciliation. The amendments have to relate to budgetary rather than policy issues.