ONE CHAMBER DOWN, ONE TO GO…. It wasn’t easy, but last night, for the first time, the House of Representatives approved legislation to reform the nation’s dysfunctional health care system.

By the time House Speaker Nancy Pelosi banged the gavel, the final tally was 220 to 215. In all, 39 Democrats — some who thought the bill was too liberal, some who found it too conservative — joined with Republicans to oppose the legislation. One House Republican, Rep. Anh “Joseph” Cao of Louisiana, joined with the majority.

Now, given the narrow margin — the bill needed to 218 to pass, and 220 was obviously cutting it close — it might seem as if the House leadership struggled to keep the caucus together. From what I hear, that’s not what happened. Pelosi recognized which House Dems from “red” districts were under the most pressure to oppose the bill, and once she had the majority she needed, the leadership effectively told the center-right Dems they could go ahead and break ranks.

As for the bigger picture, there’s quite a bit of work to do before reform becomes law, but it’s worth pausing to appreciate the historic significance of last night’s accomplishment. A lot of presidents have pushed health care reform initiatives before this year, and a lot of lawmakers have tried to get to this point. When it comes to domestic policy legislation, health care reform has been something of a holy grail — but before nine hours ago, the House had never even voted on, better yet passed, a bill of this significance.

And yet, here we are.

President Obama, who helped secure a majority by appearing on the Hill yesterday morning, issued a statement last night heralding the milestone.

“Tonight, in an historic vote, the House of Representatives passed a bill that would finally make real the promise of quality, affordable health care for the American people.

“The Affordable Health Care for America Act is a piece of legislation that will provide stability and security for Americans who have insurance; quality affordable options for those who don’t; and bring down the cost of health care for families, businesses, and the government while strengthening the financial health of Medicare. And it is legislation that is fully paid for and will reduce our long-term federal deficit.

“Thanks to the hard work of the House, we are just two steps away from achieving health insurance reform in America. 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.”

The Senate still has heavy lifting to do, and unlike the House, Majority Leader Harry Reid (D-Nev.) has to figure out how to generate a supermajority to support reform without a single defection from the Democratic caucus. The upper chamber will have to address the question of the public option, financing, subsidy rates, and what to do with the odious Stupak amendment (which passed last night, 240 to 194).

But in the meantime, there’s cause for some preliminary rejoicing. There are all kinds of hurdles between the status quo and much-needed reforms, and last night was a big one. We’re this close.

Steve Benen

Follow Steve on Twitter @stevebenen. Steve Benen is a producer at MSNBC's The Rachel Maddow Show. He was the principal contributor to the Washington Monthly's Political Animal blog from August 2008 until January 2012.