Nearly 30,000 more Hawai'i residents could be thrown into the ranks of the uninsured, while employer health insurance premiums and uncompensated care costs could more than double in the state over the next decade if health care reform isn't enacted.

Those are some of the findings of a study for the Robert Wood Johnson Foundation that examined the costs nationwide of keeping the status quo when it comes to health care over the next 10 years. It projected a worsening of costs, uninsured numbers and coverage in all states.

"The most important take-away is that in every scenario we see really unfortunate developments," said Andrew Hyman, a senior program officer for the foundation in Princeton, N.J.

While much of the health care debate has focused on elements of various proposals, the foundation said it has not seen talk of what would happen if reforms are not enacted. It examined three scenarios of income growth and health care costs and found negative implications for families, businesses, government and providers in even the rosiest of scenarios (high employment, fast income growth and slow health cost increases).

"The report makes clear that the cost of failure would be substantial and felt in every state," the study said.

The worst-case scenario called for slow growth in income and high growth in health care costs. In Hawai'i this would translate into:

• The number of uninsured rising from 123,000, or 10.7 percent of the population, this year to 152,000 or 13 percent, in 2019.

• Employer-sponsored insurance could fall from 755,000 people this year to 703,000 in a decade.

• Medicaid and Children's Health Insurance Program use would rise as those eligible for the programs flee from the escalating costs of private coverage. Spending on these programs would rise by 114 percent to $2.35 billion.

• Employer premium spending would rise from $1.91 billion this year to $4.08 billion, more than doubling.

• Uncompensated care would more than double to $306 million as the ranks of the uninsured grow.

• Individual and family spending on health care would increase by 67 percent to $2.23 billion.

Beth Giesting, executive director of the Hawaii Primary Care Association, said the projections sounded fair, given the rising costs here during the past 10 years. Preferred-provider premiums for small businesses from the Hawaii Medical Service Association have risen about 112 percent during the period.

"Those are very reasonable numbers, given where we've been in the last decade," said Giesting, who supports an overhaul of the U.S. health care system. She said it isn't difficult to project an increase in uninsured people as costs increase and employers look for ways to escape higher premiums.

"I think that people who are currently covered, who think that things are just fine, really have their heads in the sand," Giesting said.

"Our health care system is in pretty bad shape already."