The number of uninsured Americans could grow by 10 million people in just five years, and spending on government health care programs for the poor could more than double by 2020, if there are not significant reforms to the current health care system, according to a new analysis just released from the Robert Wood Johnson Foundation (RWJF).

Urban Institute researchers used their Health Insurance Policy Simulation Model to assess the changes in coverage patterns and health care costs that will occur nationally from 2010 to 2020 if major reforms are not enacted. The authors provide a range of scenarios to assess the effects. In the worst case:

• By 2015, there could be 59.7 million people uninsured. The number could swell to 67.6 million by 2020. An estimated 49.4 million individuals were uninsured in 2010.
• Middle-class households would suffer most without reform, with the percentage of these families without health coverage rising from 19 percent today to 28 percent at decade’s end.
• 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.
• For employers who continued to offer health insurance, more of the costs would likely be passed on to workers. At the same time, individuals and families would face higher out-of-pocket costs for premiums and health care services. Their spending will jump 34 percent by 2015 and 79 percent by 2020.

The analysis is an update of a report prepared by the Urban Institute last year on the economic impact for the nation and individuals if the health reform effort were to fail. The new report presents fresh findings on the composition of the uninsured in 2020 without reform, the offers of health benefits by employers and the increase in costs to different payers.

It is being released today as part of Cover the Uninsured Week (March 14-20), a nonpartisan campaign organized by RWJF to advocate for health coverage for all Americans. Now in its eighth year, it has become the largest, nonpartisan mobilization in history seeking solutions for the millions of Americans who are uninsured.