LONDON, July 12 (APM) - President Barack Obama has written a healthcare plan for the next president, including a crackdown on prescription drug prices that may cut pharmaceutical manufacturers' profits if adopted.

In a first for a sitting president, the Journal of the American Medical Association (JAMA) published a scholarly article on Monday by "Barack Obama, J.D." that examines the passage of his landmark health law, the Affordable Care Act (ACA), and proposes future improvements to the U.S. healthcare system.

Obama said in the journal that a government-run insurance plan, the so-called "public option," should be made available to Americans buying coverage in parts of the country where competition is limited, and that subsidies to reduce insurance premiums in Obamacare should be more generous.

Despite the ACA, "too many Americans still strain to pay for their physician visits and prescriptions, cover their deductibles, or pay their monthly insurance bills; struggle to navigate a complex, sometimes bewildering system; and remain uninsured," Obama wrote. "More work to reform the healthcare system is necessary".

Although the ACA included policies to help address prescription drug costs, as with more substantial Medicaid rebates and the creation of a pathway for approval of biosimilars, "those costs remain a concern for Americans, employers, and taxpayers alike-particularly in light of the 12% increase in prescription drug spending that occurred in 2014", Obama said.

In addition to administrative actions like testing new ways to pay for drugs, legislative action is needed.

He said: "Congress should act on proposals like those included in my fiscal year 2017 budget to increase transparency around manufacturers' actual production and development costs, to increase the rebates manufacturers are required to pay for drugs prescribed to certain Medicare and Medicaid beneficiaries, and to give the federal government the authority to negotiate prices for certain high-priced drugs."

The priorities Obama set in his article have strong support within his party. Presumptive Democratic presidential nominee Hillary Clinton and her rival in the presidential primaries, senator Bernie Sanders of Vermont, both called for the federal government to leverage its buying power to force lower prices from drug companies. Clinton also backs a public option for Obamacare in all states, and Sanders would go further, favouring a government-run universal health insurance program he calls "Medicare for all."

In the article, Obama vigorously defended the ACA's expansion of insurance coverage and said that "trends in healthcare costs and quality" under the law "have been promising." About 20 million Americans have gained coverage since the law was enacted in 2010, he said, and average growth in spending per person in the Medicare programme for the elderly and disabled "has actually been negative" from 2010 to 2014.

Obama went on: "Americans can now count on access to health coverage throughout their lives, and the federal government has an array of tools to bring the rise of healthcare costs under control. However, the work toward a high-quality, affordable, accessible health care system is not over."

Since the law took effect, the portion of non-elderly Americans unable to afford healthcare dropped 5.5 percentage points and the share describing themselves as in poor or fair health dropped 3.4 points, he added.

The ACA has succeeded in sharply increasing insurance coverage, Obama emphasised. Since the ACA became law, the uninsured rate has declined by 43%, from 16.% in 2010 to 9.1% in 2015, with most of that decline occurring after the law's main coverage provisions took effect in 2014.

"The number of uninsured individuals in the U.S. has declined from 49 million in 2010 to 29 million in 2015. This is by far the largest decline in the uninsured rate since the creation of Medicare and Medicaid five decades ago," he said.

However, Obama had a warning for Congress: "it should avoid moving backward on health reform. While I have always been interested in improving the law-and signed 19 bills that do just that-my administration has spent considerable time in the last several years opposing more than 60 attempts to repeal parts or all of the ACA, time that could have been better spent working to improve our health care system and economy."

He advocates greater pragmatism in both legislation and implementation. "Simpler approaches to addressing our healthcare problems exist at both ends of the political spectrum: the single-payer model versus government vouchers for all."

The article includes 68 citations and endnotes, though it was not formally peer-reviewed and JAMA published it as a "special communication."

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