The Urban Institute (UI), an independent non-partisan policy institute, created in the 1960s to examine the problems facing American cities, released a paper in October 2009, entitled, “The Cost of Failure to Enact Health Reform: Implications for States”.  The report looks at three scenarios: worst, intermediate and best case. The results are sobering.

According to the report, if health care reform fails in this country, the middle class would be the hardest hit. Within 10 years, the UI estimates that:

• In 29 states, the number of people without insurance would increase by more than 30 percent.

• Under this worst-case scenario, the number of uninsured could grow by at least 10 percent in every state. All told, the number of uninsured Americans would reach 65.7 million.  
• Even in the best case scenario, 46 states would see employer premium costs increase by more than 60 percent.  
• Half of the states would see the number of people with ESI coverage fall by more than 10 percent.
• Half the states would face cost increases of more than 100 percent.
• Even in the best case, uncompensated care would increase by more than 50 percent in 48 states.
• The amount of uncompensated care in the health system would more than double in 45 states.
• Every state would see its Medicaid/CHIP spending rise by more than 75 percent by 2019.
• Every state would see a smaller share of its population with employer-sponsored insurance (ESI).
• Businesses would see their premiums continue to increase—more than doubling in 27 states.

So what is meant by worst, intermediate and best case scneario? The institue defines it as follows:

1. Worst case – slow growth in incomes and continuing high growth rates for health care costs
2. Intermediate case – somewhat fast growth in incomes, but a lower growth rate for health care costs
3. Best case – full employment, faster income growth and even slower growth in health care costs.

In other words, worst case scenario is what we’ve experienced in  the last however-many-years and  in all likelihood, what we’ll continue to see. Who among us actually believes  health care costs will go down without some sort of intervention?

So why is  health care reform such a contentious issue? Because middle class people believe that their health insurance benefits will erode  if the bill is passed. With health care costs rising two percentage points faster than the gross domestic product, the cost for insurance premiums will continue to rise. Businesses in an attempt to keep costs lower for their employees will be forced to pass some (if not all) of the increased costs on to its employees and/or be forced to select a plan that offers fewer services and higher out-of-pocket expenses for the employee for diagnostics, office visits, referrals to specialists and cost of medications.

As more people become uninsured due to rising unemployment or because they simply can’t afford the cost of health care premiums, the numbers of people on Medicaid/Medicare will swell. Those who wouldn’t qualify for  public assistance will simply burden the already over-burdened hospitals whose EDs are swelling with the uninsured.

Case in point are the six hospitals in Massachusetts which have filed a joint lawsuit  for insufficient reimbursement for care to Medicaid patients. These six hospitals, known as “disproportionate-share hospitals” are called this because at least 63% of its revenue come from public payors.

Because they serve a disproportionate share of un- or underinsured people and actually lose money in taking care of them, these hospitals run the risk of closing their doors. Holyoke Medical Center, one of the six hospitals has estimated a $10.04 million shortfall in the past 6 years. Who will provide the care for these people then?

Should I agree with Jacob Weisberg of Slate.com who believes that our political and economic problems are the fault of “the childish, ignorant American public – not politicians“? I’ve been sorely tempted to especially when I hear educated middle-class people state they voted for Scott Brown, the Republican winner of Ted Kennedy’s senate seat, because they believed their own health care coverage would deteriorate if Obama’s health care reform bill passed. 

Alert: It’s already deteriorated and will only get worse if there is no health care reform.