After an emotional debate, capping a Saturday night session that dragged into Sunday, the House voted 231-192 to add a one-year delay of Obamacare to the short-term funding bill that would keep the government open through mid-December.
Two Democrats -- Jim Matheson of Utah and Mike McIntyre of North Carolina -- voted with Republicans to add the provision. Two GOP representatives, Chris Gibson and Richard Hanna, both from New York, voted against the measure.
"Now that the House has again acted, it's up to the Senate to pass this bill without delay to stop a government shutdown," House Speaker John Boehner said after the vote. "Let's get this done."
Earlier, the House voted 248-174 to add a repeal of an unpopular medical device tax to the continuing resolution. In that vote, 17 Democrats joined with every Republican.
In the final vote of the nights, the House voted unanimously (423-0) to ensure that paychecks go to uniformed and civilian employees of the Defense Department in the event of a government shutdown.
With the evening's votes, it now seems fairly likely one will happen.
The signs were there all day Saturday that federal government was inching closer to its first shutdown in nearly two decades, with House Republicans taking a hard line in their push for a one-year delay of President Obama's health care law as a condition to keep the government running after the fiscal year ends on Monday.
The House was escalating an already-bitter confrontation with the Senate and the White House. The finger-pointing in the budget debate quickly moved to a fight over who should bear the blame for a government shutdown.
"The American people don't want a government shutdown, and they don't want Obamacare," Boehner and other Republican leaders said in a statement. "We will do our job and send this bill over and then it's up to the Senate to pass it and stop a government shutdown."
The Senate, controlled by Democrats, has repeatedly pledged to reject any budget plan that delays or defunds the Affordable Care Act.
The decision by House Republicans makes it increasingly more likely the government would shut down Tuesday -- at least for a short time -- unless lawmakers agree on a short-term emergency spending bill while trying to resolve their differences.
House Republicans gathered behind closed doors today in the basement of the Capitol for a rare Saturday strategy session. Booming applause and at least one lawmaker shouting, "Let's Roll," seemed to underscore the party's unified front.
"It has united us around a couple of very important principles," said Rep. Hal Rogers, R-Ky., chairman of the Appropriations Committee, adding that it was important for House members to take another stand against the health care law.
When asked whether he agreed that a government shutdown was unavoidable, he replied, "Not necessarily."
"They can make this work if they really put their mind to it and work hard," Rogers said.
But there was also an air of anxiety, particularly among some senior House Republicans, who worry about the repercussions of a government shutdown when the plan is almost certainly rejected by Senate Democrats.
The Senate is scheduled to be out of session until Monday at 2 p.m., and aides said Saturday it remained an open question whether senators would return to Washington sooner to deal with the House bill.