President Barack Obama expressed his frustration with states that chose not to expand Medicaid "for no other reason than political spite" against him, saying that decision has been hurtful to millions.
"You have 5 million people who could be having health insurance right now at no cost to these states, zero cost to these states, other than ideological reasons, they have chosen not to provide health insurance for their citizens," Obama said during a press conference Thursday. "That's wrong. It should stop. Those folks should be able to get health insurance like everybody else."
The president said he's "still puzzled" why Republicans are making Obamacare "their sole agenda item," and said "Democrats should forcefully defend and be proud" of the law.
"We've been having a political fight about this for 5 years," Obama said. "We need to move on to something else."
The criticism came after Obama announced 8 million people signed up for private health insurance through exchanges created by the Affordable Care Act. Obama noted about 35 percent of people who signed up during the open enrollment period were under the age of 35.
Below, more from the AP:
WASHINGTON (AP) — President Barack Obama's full-throated defense of his health care overhaul seems perfectly timed for Democrats who want their party to embrace the law more enthusiastically.
At a White House news conference Thursday, Obama noted that health insurance enrollments under the new law are higher than expected, and costs are lower. If Republicans carried out their pledge to repeal the law, he said, it "would increase the deficit, raise premiums for millions of Americans and take insurance away from millions more."
Republicans, Obama said, "can't bring themselves to admit that the Affordable Care Act is working." That's precisely the message many liberals have been awaiting.
For their part, Republicans practically dare Democrats to embrace "Obamacare," the GOP's favorite target in most congressional campaigns.
Yet pro-Democratic activists in Alaska are doing just that, and a number of strategists elsewhere hope it will spread.
Obama said Thursday that 8 million Americans have signed up for health coverage under the new law, exceeding expectations. And the Congressional Budget Office — the government's fiscal scorekeeper — said it expects only a minimal increase in customers' costs for 2015. Over the next decade, the CBO said the new law will cost taxpayers $100 billion less than previously estimated.
Republicans already were pushing their luck by vowing to "repeal and replace" the health care law without having a viable replacement in mind, said Thomas Mills, a Democratic consultant and blogger in North Carolina. Now, he said, Democrats have even more reasons to rise from their defensive crouch on this topic.
"Democrats need to start making the case for Obamacare," Mills said. "They all voted for it, they all own it, so they can't get away from it. So they'd better start defending it."
Even some professionals who have criticized the health care law say the political climate has changed.
"I think Democrats have the ability to steal the health care issue back from Republicans," health care industry consultant said Bob Laszewski said. "The Democratic Party can become the party of fixing Obamacare."
In truth, some Democratic lawmakers often talk of "fixing" the 2010 health care law. But it's usually in response to critics or in a manner meant to show their willingness to challenge Obama.
For instance, Sen. Mary Landrieu, D-La., who faces a tough re-election bid, used her first TV ad of the campaign to highlight her demand that Obama let people keep insurance policies they like.
But Landrieu and other hard-pressed Democrats have not gone as far as a pro-Democratic group in Alaska that is unabashedly highlighting the health law's strongest points.
The independent group Put Alaska First is airing a TV ad that praises Democratic Sen. Mark Begich for helping people obtain insurance even if they have "pre-existing conditions," such as cancer. The ad doesn't mention Obama or his health care law by name, but it focuses on one of the law's most popular features.
Other Democrats should consider such tactics, political consultant David DiMartino said.
"There is still time to tell the story of Obamacare to voters," he said. Democratic candidates don't want to be defined entirely by the health law, he said, "but now they can point to its successes to fend off the inevitable distortions."
GOP strategists don't agree. The recent upbeat reports might help Democrats temporarily, but "the negative opinion of Americans toward Obamacare is baked in," Texas-based Republican consultant Matt Mackowiak said. "If Obamacare was truly trending positively," he said, "Sebelius would have stayed, and Democrats in tough races would be picking a fight on Obamacare, instead of mostly hiding from it."
Kathleen Sebelius, the health and human services secretary closely associated with the health care law, is stepping down. Democrats say it's a sign that the biggest problems are past, but Senate Republicans vow to use her successor's confirmation hearings as another forum for criticizing the law.
Democrats hardest hit by anti-Obamacare ads — including Sens. Kay Hagan of North Carolina and Mark Pryor of Arkansas — continue to defend the health law when asked, but they generally focus on other topics, campaign aides say.
Polls don't suggest public sentiment is shifting toward Democrats, said Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health. But with at least 7.5 million people enrolled despite last fall's disastrous rollout of insurance markets, Blendon said, Democrats have some strong new material to use.
"Each of the Democratic candidates is going to have to make a calculation on whether or not they can motivate Democrats," Blendon said. "For Democrats to get an advantage out of the law, they have to convince people they have something to lose if the Senate changes hands."
Republicans need to gain six seats to control the 100-member Senate.
New political problems might arise for the health care law before the Nov. 4 election. For instance, the individual requirement to carry health insurance remains generally unpopular, and now penalties may apply to millions of people who remain uninsured.
So far, Republicans have had an edge in public opinion, particularly when those with strong sentiments about the law are considered. A recent AP-GfK poll found that strong opponents outnumber strong supporters, 31 percent to 13 percent. And motivated voters often make the difference in low-turnout nonpresidential elections. But the poll also found that most Americans expect the health law to be changed, not repealed.
That puts Republicans in a tricky situation: GOP primary voters demand repeal, but general election voters in November are looking for fixes.
"It's not a cheap and easy political target anymore," Laszewski said. "Republicans are going to have to tell us what they would do different."
Democrats deride GOP proposals to "replace" the 2010 health care law, saying they collapse under close scrutiny. Since they generally contemplate a smaller federal government role, many of the GOP ideas are likely to leave more people uninsured. Some approaches do not completely prohibit insurers from turning away people with pre-existing medical conditions.
Economist Douglas Holtz-Eakin, who advises many top Republicans, said the emerging GOP plans aren't tied to the ups and downs of Obama's law but look ahead to the 2016 presidential election, when the party will need alternatives.
Ultimately, he said, "there can't be a Republican 'replace.' ... There needs to be a bipartisan reform." That doesn't seem likely, but Holtz-Eakin said it was the only kind of change that will prove durable.
Democrats can cheer the latest statistics, "but they are not out of the woods yet," he said. "They have waived and deferred a million things they knew were unpopular, and those are still out there."
AP Director of Polling Jennifer Agiesta contributed to this report.
This story has been updated with more from the AP.