Thirteen years ago Thursday, then-Vice President Joe Biden was introducing President Barack Obama at a White House event marking the passage of the Affordable Care Act, often dubbed Obamacare.

As the president took the podium, Biden whispered into Obama’s ear what he assumed was a private aside, but was instead caught on a hot mic telling his then-boss it was a "big f****** deal."

“I remember three words I used at the time. I thought it was a big deal,” Biden said Thursday, drawing laughs at an event celebrating the 13th anniversary of the health care law. “I stand by the fact that it was a big deal.”

Roughly 200 people attended the celebration in the White House’s East Room, including former Obama administration staffers and members of Congress. Among those attending was former House Speaker Nancy Pelosi, D-Calif., who played a leading role in passing the legislation in 2010.

The law, fully enacted in 2014, bars insurance companies from denying coverage on the basis of preexisting conditions, created a mandate that required every American to have health insurance or be fined, created subsidies for insurance premiums, and expanded Medicaid eligibility for people in states enrolled in the program, among other insurance industry reforms.

Children were also allowed to stay on their parents’ insurance plan until they turned 26 under the law.

Since 2014, 39 states have signed up for the Medicaid expansion, increasing coverage for low-income adults. On Thursday, lawmakers in North Carolina sent a bill to Gov. Roy Cooper’s desk that would make their state the 40th.

The president said he spoke with Obama on Wednesday, reminiscing about the law’s passage.

“The night the ACA passed was incredibly meaningful, because we knew the law would have a profound impact on the lives of millions of people,” Obama tweeted Thursday. “And it has.”

Enrollment in coverage through the federal and state marketplaces has doubled since 2014, according to the Department of Health and Human Services, rising to nearly 16.4 million people after the 2023 open enrollment period — an increase of 1.8 million since 2022. 

“Thirteen years later, it’s easy to forget what life was like for hard-working families before the Affordable Care Act,” Biden said, recalling the stress when his family lost their health insurance when he was a teenager, and later thinking about how devastating it would be had his son Beau Biden, who died of brain cancer, did not have insurance to cover the high costs of treatment.

“Remember when a parent with a heart disease or diabetes or a child with asthma couldn't get coverage because of a pre existing condition? Remember when women had to pay more for insurance, because they had a pre existing condition: they were a woman," the president added.

Prior to the law, some insurance companies would charge women more than men for the same procedures or not cover maternity care at all. A 2009 report from the National Women’s Law Center examined best-selling health insurance plans in states that allowed companies to take into account gender in their pricing. They found 61% of plans charged a 40-year-old woman who didn’t smoke more than a 40-year-old man who did.

“Not a joke,” Biden added. “Say it today to people and they look at you like ‘you’re kidding me?’”

Biden used the occasion to revisit the health care achievements of his administration so far, pitch his budget, and attack congressional Republicans for their lack of a formal budget proposal and desire among some members to repeal or gut health care laws and programs.

The Inflation Reduction Act, passed last summer, capped insulin prices at $35 a month for Medicare beneficiaries beginning in January. On Thursday, Biden touted the achievement and renewed his call for insulin-makers to lower prices for all Americans.

So far, three of the country’s top producers have.

The IRA also will allow Medicare to negotiate prices on over 10 drugs with pharmaceutical companies beginning this fall, including anticoagulants, treatments for serious fungal infections, and cancer treatments.

As for what’s next, Biden’s proposed budget — a largely ceremonial document and opening salvo in negotiations with congressional Republicans — would solidify funding for Medicare through at least 2032 and possibly into the 2050s, according to modeling by the chief actuary at the Centers for Medicare & Medicaid Services. Currently, Medicare is set to run out of money by 2028 if nothing is done.

While House Speaker Kevin McCarthy, R-Calif., has yet to propose a budget of his own and ruled out cuts to Social Security and Medicare, Biden and administration officials have taken to highlighting individual Congress members’ plans to repeal or significantly cut portions of the IRA, the Affordable Care Act, Medicaid and Medicare.

“Even now, MAGA Republicans in Congress are intent on repealing the Affordable Care Act when it’s clear it would have a devastating impact on the American people,” Biden said Thursday, adding “this ain’t your father’s Republican party.”

Republicans attempted to repeal Obamacare dozens of times since it was passed, culminating in a 2017 effort to repeal and replace it when the GOP controlled the House, the Senate and the White House. A handful of moderate Republican senators opposed the replacement bill, killing its chances of passing in the narrowly divided Senate.

Before the midterms last year, many Republicans abandoned the hope of repealing it altogether, though some still expressed desire to modify the law.

“13 years of higher healthcare costs under Obamacare,” Rep. Jim Banks, R-Ind., wrote on Twitter Thursday. “Socialism doesn’t work.”