Vice President Kamala Harris reacts as President Joe Biden and former President Barack Obama shake hands on stage after Obama called Biden "Vice President". Photo / AP
With hugs, laughs and good-natured ribbing, Barack Obama returned to the White House for the first time in more than five years to savour the 12th anniversary of his signature health care law and give a boost to US President Joe Biden's efforts to expand it.
The Affordable Care Act has survived repeated repeal attempts by Republicans.
Biden, who was Obama's No 2 when "Obamacare" became law in March 2010, wants to extend the law's reach to even more than the current millions. He gave all the credit for the original law to the former president.
"It's because of you," Biden said after good-naturedly introducing himself as Obama's vice president. Biden said the law "shows hope leads to change," a play on Obama's "hope and change" campaign slogan.
Obama was last at the White House on January 20, 2017, when he left to escort Donald Trump, the successor bent on overturning the law, to the Capitol to be inaugurated. He spent more than four hours on Wednesday meeting with Biden and greeting White House staff in what was hoped would be a morale boost for the administration.
"It's good to be back in the White House. It's been a while," he said after Vice President Kamala Harris introduced him in the East Room. Obama opened by referring to Biden as "vice president" before acknowledging that was a "set up" joke and embracing his former No 2.
Obama said he and Biden accomplished "a lot" in their eight years but "nothing made me prouder than providing better health care and more protections to millions of people across this country."
"The ACA was an example of why you run for office in the first place," Obama said, calling it the "high point of my time here".
Biden called the Affordable Care Act the most consequential legislation since Medicare and Medicaid were created in 1965, and insisted it must be expanded to more people.
"We can do this. We should do this. We have to do this," Biden said. He said the law has been called a lot of things, "but Obamacare is the most fitting."
Biden and Obama marked the 12th anniversary of the law, which back in 2010 the then-vice president had memorably whispered to Obama was a "big (expletive) deal" - words captured on an open microphone.
At Tuesday's event, Biden signed an executive order directing federal agencies to look for ways to continue to expand the availability and quality of affordable health care. He also highlighted ongoing efforts to close a "family glitch" in the implementation of the 2010 law that his administration believes will help 200,000 more people gain affordable coverage.
Before signing the order, Biden jokingly warned Obama, "Let me remind you, it's a hot mic."
Obama warmed up the crowd with a few deadpan jokes about how things around the White House had changed under Biden, leaning into the current occupant's affinity for sunglasses and ice cream and his taste in pets.
He quipped that Secret Service agents now have to wear aviator sunglasses, the White House mess has been replaced by a Baskin-Robbins and "there's a cat running around".
"I guarantee you Bo and Sunny would have been very unhappy about it," Obama added, referencing his family's dogs.
As for "Obamacare," the law's staying power has been enhanced by three Supreme Court victories and the late Senator John McCain's emphatic thumbs-down vote that took the wind out of then-President Trump's efforts to repeal and replace it.
The law was such a bugaboo in 2010 that Democrats rarely invoked it as they went into a midterm election that turned out to be, in Obama's own words, a "shellacking". Now, Democrats are hoping the political equation will work to their advantage, and that a focus on shoring up the law can help them avoid a debacle at the polls this November.
Harris, in her remarks, called on Congress to allow Medicare to negotiate prescription drug prices and to make permanent subsidies for the Affordable Care Act that were included in Biden's pandemic relief bill. Harris also called out 12 states that have not expanded eligibility for Medicaid.
Obama referred to the health care law as a "starter home" that Americans can build upon, gradually reducing the 9 per cent share of the population that remains uninsured. The rate was nearly 15 per cent in 2013 before the coverage provisions of the law took effect. Between the health law's Medicaid expansion and its health insurance markets, more than 30 million people are now estimated to be getting coverage.
Biden opened up the health insurance markets to anyone seeking coverage during the Covid-19 pandemic, and his coronavirus relief bill provided a significant, though temporary, increase in financial assistance. The result was a record 14.5 million people signing up for subsidised private coverage.
People tripped up by the "family glitch" are dependents of workers who have an offer of employer coverage that the US government interprets as being affordable. As a rule, people with affordable employer coverage are not eligible for taxpayer-subsidised ACA plans.
But the issue with the current interpretation is that affordability is determined by the cost of employee-only coverage, and not more expensive family policies. Workers able to afford their own share may not be able to cover premiums for the entire family. So the family is cut out of ACA coverage.
A Biden administration regulation addressing the issue recently cleared the White House review. The intent of the original policy was to prevent people with employer coverage from going into the health law's subsidised markets, but advocates say it has proven too restrictive.
There are more fundamental issues for the two presidents to consider as well, both policy-wise and politically.
Unless Democrats in Congress finally coalesce around a version of Biden's social legislation, his enhanced financial assistance for millions purchasing ACA plans will expire at the end of this year. A return to higher premiums would likely trigger an increase in the number of uninsured people, a problem for them and a political embarrassment for Democrats committed to expanding coverage.
The Biden legislation, which passed the House but sputtered in the Senate, also includes a mechanism for providing coverage to as many as four million uninsured low-income adults in states that have refused the health law's Medicaid expansion. It would deliver on Biden's campaign promise to build on existing government programmes to move the US Closer to coverage for all.