Controversial plans to overhaul the NHS came one step closer to becoming reality after MPs voted through the latest draft.
They gave their backing to the "third reading" of the Health and Social Care Bill which means it passes from the Commons to the Lords.
The Government had feared a rebellion from Liberal Democrat MPs but instead won with a healthy majority of 65.
Sky sources said four Lib Dems voted against the Government with up to 10 abstaining.
The rebels are understood to be Julian Huppert, Greg Mulholland, Andrew George and Adrian Sanders.
A total of 316 MPs voted for the Coalition's position, with 251 against.
Labour have indicated they will still try to wreck the Bill in the House of Lords.
They could have allies in senior Liberal Democrats. Baroness Williams has already signalled her concerns.
After a second day of debate, Health Secretary Andrew Lansley told the Commons his "only motivation" was safeguarding the NHS.
But critics, mainly on the Labour benches, said they feared the changes would see the NHS "destroyed".
Shadow health secretary John Healey called the reforms the wrong policy, based on the "wrong ideology".
He warned the Bill would see power to direct the health service transferred from the Secretary of State to hundreds of devolved bodies.
The change "betrays the founding principles" of the health service, he said.
But Conservative MP Stephen Dorrell, who chairs the influential health committee, said the Bill had been substantially changed and improved.
Earlier this year opposition to the reforms prompted the Government to "pause" its passage through Parliament to try to address concerns among the medical profession.
Mr Dorrell said the new version was different in "important respects".
Mr Lansley's flagship plans involve handing a commissioning budget worth £60bn to groups of local GPs.
It will also see Primary Care Trusts scrapped, administration costs reduced and a bigger role for private sector providers.
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