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US President Joe Biden tripped twice on Tuesday as he boarded Air Force One for a flight to California. Although the White House has insisted he is in excellent health, the 81-year-old Democrat has persistently refused to take a cognitive test during his annual health exams.

Cameras at Andrews Air Force Base in Maryland captured Biden stumbling while going up the steps to the presidential jet, barely avoiding a fall. The latest incident comes as the president faces public demands to have his mental acuity checked.

Biden "should come out and debate and to show the American public that he has the cognitive capacity to do this very, very difficult job," his former challenger for the Democratic nomination Robert F. Kennedy Jr., now an independent candidate, said last week.


Meanwhile, 84 House Republicans wrote an open letter demanding that the commander-in-chief submit to a cognitive test, or face being replaced under the 25th Amendment.

"If you are too mentally impaired to stand trial, as your own Department of Justice claims, then we are concerned that your mental state is not at a competent level to serve as the leader of the free world," said the letter, written by former White House physician Ronny Jackson, who treated presidents Barack Obama and Donald Trump before becoming a congressman from Texas.

The letter came after special counsel Robert Hur, who was investigating Biden's improper handling of classified documents, concluded that the president should not be charged because it would be difficult to persuade a jury that an "elderly man with a poor memory" could have committed a serious felony.

Biden is due for his annual physical, though the White House has not revealed the date of the examination. Following his last physical, in mid-February 2023, Dr. Kevin O'Connor declared Biden "healthy, vigorous" and "fit to successfully execute the duties of the presidency."

Biden had two brain surgeries in 1988, to deal with life-threatening aneurysms. Dr. O'Connor's report said that "an extremely detailed neurologic exam" found no indication of stroke, multiple sclerosis or Parkinson's disease, but noted that the president did not take a cognitive test.

Under the 2011 Affordable Care Act - passed when Biden was Barack Obama's vice president - Americans 65 and older who are on Medicare are required to take a "cognitive assessment" as part of their annual "wellness visit."