66 Million Could be Uninsured in a Decade Without Healthcare Reform

Janice Simmons, for HealthLeaders Media , May 26, 2009

If current federal healthcare reform efforts fall flat in Congress, businesses in 2019 could find their health costs doubled and 65.7 million people could end up uninsured under a worst-case scenario, according to projections from researchers at the Urban Institute in Washington.

The researchers, using their Health Insurance Policy Simulation Model, estimated how coverage and cost trends could change between now and 2019. They looked at three scenarios: worst case where growth is slow for incomes but high for healthcare costs; intermediate case where incomes grow somewhat faster, but healthcare costs remain slower; and best case where there is full employment and faster income growth but slower growth in healthcare costs.

However, no matter which scenario occurs, business owners likely will face huge strains and millions would end up losing their insurance, according to the analysis, which is included in the report, Health Reform: The Price of Failure, published by the Robert Wood Johnson Foundation. Even under the intermediate case scenario, 62.2 million individuals could be uninsured, and 53.1 million could be uninsured under the best case scenario.

Individuals and families would see healthcare costs dramatically jump. In addition, total individual and family spending on premiums and out-of-pocket costs could increase 68% by 2019 in the worst-case scenario. Even under the best case scenario, healthcare costs still could increase at least 46%.

Businesses could see their healthcare costs double within 10 years. The amount that employers pay for premiums could more than double--from $429.8 billion in 2009 to $885.1 billion in 2019. Even with the best-case economic conditions, employer spending on health insurance premiums would increase 72%. The percentage of individuals covered by employer insurance could drop from 56.1% in 2009, to as low as 49.2% by 2019.

Spending on government insurance programs could double. In the worst case scenario, spending on Medicaid and the state Children's Health Insurance Program (SCHIP) could increase from $251.2 billion this year to $519.7 billion in 2019, as more people are priced out of private insurance and become eligible for government programs.

At the same time, public programs could be hit hard. For instance, Medicaid and the SCHIP "would increase substantially" from the current rate of 16.5% of the population to 20.3% by 2019.

John Holahan, PhD, director of the Health Policy Research Center at the Urban Institute, wrote in his blog about the projections that "it seems to me that while enacting reform in a bad economy will be politically tough, it’s the cost of failure that the nation really can’t afford."

Janice Simmons is a senior editor and Washington, DC, correspondent for HealthLeaders Media Online. She can be reached at jsimmons@healthleadersmedia.com.

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