President Obama urged Congress on Monday to both preserve and build on his health care legacy, saying insurance remains out of reach for millions despite the lofty goals of his signature domestic achievement.

Mr. Obama, in an article published in the Journal of the American Medical Association, took credit for slashing the uninsured rate from 16 percent in 2010 — the year Democrats muscled the Affordable Care Act to passage — to 9.1 percent in 2015.

“I will repeat what I said four years ago when the Supreme Court upheld the ACA: I am as confident as ever that looking back 20 years from now, the nation will be better off because of having the courage to pass this law and persevere,” he wrote.

Yet 29 million people are uninsured today, he noted, and “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.”

Mr. Obama said areas with limited competition should have access to government-run plan that competes with private insurance companies, since 12 percent of customers on Obamacare’s web-based exchanges can only choose from one or two insurers.

The so-called “public option” didn’t make it into his signature bill during the health care debate of 2009 and 2010, yet Democratic nominee Hillary Clinton embraced it over the weekend.

While the plan stops far short of the Medicare-for-all system that her main primary adversary, Sen. Bernie of Vermont, had envisioned, it goes further than Mrs. Clinton had gone previously in the Democratic campaign.

Mr. Obama also said Congress should consider ways to make financial assistance through his web-based exchanges more generous, citing congressional budget projections that say his law is costing less than expected so far.

And he urged holdout states to embrace the part of Obamacare that calls on state to expand Medicaid to those making 138 percent of the federal poverty level.

The Supreme Court in 2012 made expansion optional, so many Republican-led states bucked the president, saying their budgets were already stretched thin by the government-run health program for the poor.

Mr. Obama also said prescription drugs cost too much for many Americans, so Congress should give the federal government the authority to negotiate prices for certain high-cost drugs.

House Republicans have signaled they’re not interested in preserving Mr. Obama’s health legacy. Instead, they want to start over with a GOP president in 2017.

Last month, they unveiled a long-awaited replacement plan that would end the heavy mandates and government-run exchanges of Obamacare in favor of incentives designed to entice customers into private market plans.

The plan also embraces long-time GOP favorites such as allowing insurance companies to sell policies across state lines — a key part of presumptive Republican presidential nominee Donald Trump’s health care plan — and calls for high-risk pools to provide coverage for sick Americans who are priced out of the private market.

The crux of the proposal is a tax credit intended to help offset the costs of buying insurance for those who don’t get coverage through their job or through a government program.

Speaker Paul D. Ryan released it as a blueprint rather than an actual bill, so it is unclear whether it would provide coverage to as many Americans as Mr. Obama’s law, or what the cost to taxpayers would be.

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