As Congress debates the details of health reform, it may be valuable to recap the high cost of doing nothing. 

A new Urban Institute report examines the likely impact of another health reform failure on insurance coverage and government, employer, and family spending in all 50 states. In The Cost of Failure to Enact Health Reform: Implications for States, the Urban Institute uses the Health Insurance Policy Simulation Model (HIPSM) to project cost and coverage implications for the worst case, intermediate case and best case scenarios.

As you might expect, even the "best" case scenario is none too good. Under any scenario, the status quo would significantly add to the financial burdens of Americans of all income levels. Middle-class families would fare the worst.

Let's take a look at a reform-less United States of America in 2019:

• In a worst case scenario, the number of uninsured Americans would increase to 65.7 million. In a best case scenario, the number of uninsured would grow "only" to 57.0 million.
• In all three scenarios, we would see a decline in employer-sponsored insurance rates. In a worst case scenario, the rate would fall from 56.1 percent in 2009 to 49.2 percent in 2019. In a best case scenario, the ESI rate would fall to 53.9 percent.
• Under all three scenarios, employer premiums would rise. The Urban Institute estimates that in the worst case scenario, employer premiums would roughly double from $429.8 billion in 2009 to $885.1 billion in 2019.
• Individual and family spending would increase substantially. In a worst case scenario, it would increase from $326.4 billion in 2009 to $548.4 billion. In a best case scenario, it would reach $476.2 billion.
• The cost of uncompensated care would grow by as much as 128 percent in the worst case scenario and by 72 percent in the best case scenario. This (as well as an increase in both Medicaid and CHIP spending) would lead to higher taxes even without health reform.
• Medicaid and CHIP spending would grow significantly as a result of higher enrollment and escalating health care costs. In the worst case scenario, Medicaid and CHIP spending for the non-elderly would increase from $251.1 billion to $519.7 billion.
• Even in a best case scenario, enrollment in public programs would increase from 16.5 percent of the population to 18.3 percent.

The outlook for individual states will vary depending on their individual employment and demographic landscape.

For instance:

• New York, Maine and Vermont would experience large increases in their Medicaid/CHIP enrollments because these states extend program eligibility to higher income levels.
• As Iowa, Minnesota and North Dakota generally have large percentages of their populations working in medium to large sized firms, they would experience only a small decrease in employer-sponsored coverage.
• Due to population and uninsurance growth, Florida, Nevada and New Hampshire would face significant increases in uncompensated care costs.

So while we know all too well that health reform is difficult and expensive, the consequences of doing nothing to improve the system will be detrimental on both the state and national level. Click here to check out state-by-state projections.