urban institute nonprofit social and economic policy research

The Cost of Health Reform Failure

As health care reform comes down to the wire, the nation's leaders need credible facts and analysis to reach consensus and move ahead.  Here Urban Institute researchers explain who stands to be hurt most if reform fails and what costs individuals, families, employers and states can expect. 

The Cost of Failure to Enact Health Reform: 2010 - 2020 (Updated)
Bowen Garrett, Matthew Buettgens, Lan Doan, Irene Headen, John Holahan

This report assesses the changes in coverage patterns and health care costs that will occur nationally if major reforms are not enacted. The authors find that by 2015, there could be 59.7 million people uninsured. The number could swell to 67.6 million by 2020, up from an estimated 49.4 million in 2010. As premiums nearly double, employees in small firms would see offers of health insurance almost cut in half, dropping from 41 percent of firms offering insurance in 2010 to 23 percent in 2020. Individual spending could jump 34 percent by 2015 and 79 percent by 2020.

The Biggest Losers, Health Edition: Who Would Be Hurt the Most by a Failure to Enact Comprehensive Reforms?
Linda J. Blumberg

This brief describes the groups with the most to lose if comprehensive health care reform is not enacted—people who either lack coverage today or who are required to pay the most for health insurance and medical care. Reform's combination of Medicaid expansions, subsidies for exchange-based coverage, broader-based sharing of risk, and administrative economies of scale would make meaningful coverage affordable for the vast majority of individuals disadvantaged by the current system.

The Cost of Failure to Enact Health Reform: Implications for States
Bowen Garrett, John Holahan, Lan Doan, Irene Headen

This report assesses the changes in coverage patterns and health care costs that will occur nationally if major reforms are not enacted. The authors find that by 2015, there could be 59.7 million people uninsured. The number could swell to 67.6 million by 2020, up from an estimated 49.4 million in 2010. As premiums nearly double, employees in small firms would see offers of health insurance almost cut in half, dropping from 41 percent of firms offering insurance in 2010 to 23 percent in 2020. Individual spending could jump 34 percent by 2015 and 79 percent by 2020.

Health Reform: The Cost of Failure
John Holahan, Bowen Garrett, Irene Headen, Aaron Lucas

This report quantifies the intermediate and longer-term implications if America’s health care system is not significantly overhauled. Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted. There would be a dramatic decline in the number of people insured through employers, and millions more could become uninsured. There would be large growth in Medicaid/CHIP enrollment and spending, and increased spending on uncompensated health care. Middle-income working families would be the most affected.

Additional Resources

Variation in Insurance Coverage Across Congressional Districts: New Estimates from 2008
Genevieve M. Kenney, Victoria Lynch, Stephen Zuckerman, Samantha Phong

New data on health insurance coverage from the American Community Survey show extensive variation in rates of private and public coverage and uninsurance across congressional districts in the United States. This analysis identifies the districts in which residents would have the most to gain from health reforms.


More on Health Care Reform from UI's Health Care Policy Center