Out-of-Pocket Health Care Costs Could Increase More Than 35 Percent in Every State by 2019

Report takes a state-by-state look at the impact that failing to reform health care would have on insurance coverage, government, employer and family spending.

    • September 30, 2009

As policymakers continue to debate comprehensive reform of the nation’s health care system, a new report commissioned by the Robert Wood Johnson Foundation (RWJF) projects that if federal reform efforts are not enacted, the cost of failure would be substantial. In every state, the number of uninsured will increase, employer-sponsored insurance (ESI) coverage will continue to erode, spending on public programs will balloon and out-of-pocket health care costs for individuals and families could increase by more than 35 percent over the next decade. While all income levels would be affected, middle-class working families would be hardest hit.

“We hear a lot about the political toll of health reform, but the cost of failing to reform our health care system will be felt most strongly by our state governments, our communities, and most importantly, our families and neighbors,” said Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation. “Now is the time to act, because delaying reform makes the problem worse. In just 10 years, the cost to American businesses for their workers’ health care could double. The number of uninsured Americans could reach almost 66 million. Individual and family spending on health care would jump 46 to 68 percent, with middle-class families hardest hit. The consequences would be blind to politics and felt by Democrats, Republicans and Independents alike. The only ‘universal’ thing to come from inaction would be the pain.”

Researchers from the Urban Institute used their Health Insurance Policy Simulation Model to estimate how coverage and cost trends would change between now and 2019 if the health system is not reformed. The analysis examines three scenarios:

  • Worst case—assuming slow growth in incomes and high growth rates for health care costs;
  • Intermediate case—assumes faster growth in incomes but a lower growth rate for health care costs;
  • Best case—assumes full employment, faster income growth and even slower growth in health costs

The report shows that under the worst-case scenario, within 10 years:

  • In 29 states, the number of people without insurance would increase by more than 30 percent.
    The number of uninsured could grow by at least 10 percent in every state under the worst-case scenario. All told, the number of uninsured Americans would reach 65.7 million.
  • Businesses would see their premiums continue to increase—more than doubling in 27 states.
    Even in the best case scenario, 46 states would see employer premium costs increase by more than 60 percent.
  • Every state would see a smaller share of its population getting health care through their job.
    Half of the states would see the number of people with employer-sponsored insurance (ESI) fall by more than 10 percent.
  • Every state would see their Medicaid/Children's Health Insurance Program (CHIP) spending rise by more than 75 percent.
    Half the states would see their costs more than double.
  • The amount of uncompensated care in the health system would more than double in 45 states.
    Even in the best case, uncompensated care would increase by more than 50 percent in 48 states.

“While enacting health reform will be difficult and expensive, the cost of failure would be considerable for every state in the union, and affect every community,” said John Holahan, Ph.D., director of the Health Policy Center at the Urban Institute and one of the report’s authors. “Even in the best scenario, the cost of state-funded programs will grow considerably. Without reform, taxes will likely have to increase significantly to pay for higher Medicaid costs and care for the additional uninsured.”


Robert Wood Johnson Foundation
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime.

Urban Institute
The Urban Institute gathers data, conducts research, evaluates programs, offers technical assistance overseas, and educates Americans on social and economic issues—to foster sound public policy and effective government.