The House gave final approval on Wednesday to a bill extending health insurance to millions of low-income children, and President Obama signed it this afternoon, in the first of what he hopes will be many steps to guarantee coverage for all Americans.

Smiling broadly, Speaker Nancy Pelosi announced the tally, 290 to 135. Forty Republicans voted for the bill, and 2 Democrats voted against it.

The roll call ended a two-year odyssey for the child health legislation, which President George W. Bush adamantly opposed on the ground it would lead to "government-run health care for every American."