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This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if Americas 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.