More than 1 million uninsured and self-insured Hoosiers could get affordable coverage through health care reforms being debated in Congress, according to a report released Monday by the U.S. Department of Health and Human Services.

In Illinois, more than 2.4 million people in those two groups could gain affordable access to health insurance.

"Families, seniors and businesses all are suffering under the health care status quo," said U.S. Health Secretary Kathleen Sebelius. "Our new reports demonstrate how health insurance reform will improve health care for all Americans."

The Democratic-controlled Senate voted 60-39 along party lines Saturday to begin floor debate next month on a health care plan that would extend coverage to roughly 31 million Americans. If the Senate passes the bill, negotiations will begin with the House, which approved a competing proposal earlier this month.

"This is just the beginning of what will be a long process and debate," Sen. Evan Bayh, D-Ind., said in a statement last week.

Once a compromise is reached, the House and Senate will vote separately on the unified plan. If both chambers approve the measure, it will go to President Obama, who could veto the legislation or sign it into law.

"It's still unclear entirely what shape (the final legislation) will take," said Dr. Jonathan Javors, chief of orthopedics at Medical Specialists of Indiana, which has nine offices in Northwest Indiana. "It's hard to know what it will look like."

The Health and Human Services report released Monday bases its state estimates on general provisions included in both the House and Senate proposals. On topics in which the House and Senate bills differ, the report focuses more on the Senate version.

Without health care reform, the report claims within 10 years the number of uninsured will grow by at least 10 percent in every state. The amount of uncompensated care provided by doctors and hospitals will more than double in 45 states, the report projects, and many businesses will see insurance premiums more than double.

If the legislation becomes law, insurance companies will not be able to place lifetime limits on coverage and will face restrictions on the use of annual limits.

Doctors and hospitals currently give $1 billion in annual uncompensated care in Indiana and $2.2 billion in Illinois. States often end up subsidizing those costs, the report said. Health care reform would reduce the number of uninsured and, in turn, reduce the amount of uncompensated care.

Preventive services would be free through the health plans, according to the report, and investments would be made in prevention and public health funds to encourage wellness programs.

Javors said he supports reform that makes it easier for people to get health insurance and preventive care.

"Essentially, in the long-term that would go a long way to lower health care costs," Javors said.

But he argued some of the versions of health care reform could come at the expense of constitutional freedoms. He points to provisions that would force tax penalties on Americans who choose to remain uninsured and the debate over whether states should be allowed to opt out of a so-called public option, which would create a new government-run insurance program.

"I think that there's going to be constitutional issues that come up, if in fact the government forces someone to have health insurance against their will," Javors said. "There are people out there who don't want health insurance or don't need health insurance. I don't think they should have it shoved down their throats."

The 10th Amendment states that powers not granted to the federal government are left to the states. Javors said health care reform could challenge that amendment if it does not give states the opportunity to opt out.

"There's nothing in the Constitution that says a state has to have an insurance plan and has to offer health insurance to everybody," he said.

Javors said he is concerned about where the money will come from to finance the reforms. The Senate version is expected to cost $979 billion over a decade.

Javors also is hopeful there will be a provision in the final bill to allow interstate competition between insurance companies.

"Right now insurance companies cannot sell across state lines, so that prevents competition," he said. "When there's an increase in competition, prices usually go down and quality usually goes up."

Health care reform by the numbers

Indiana

Out of a population of more than 6.35 million

820,000 Hoosiers who do not currently have insurance could get affordable coverage.

279,000 Hoosiers who are self-insured could get affordable coverage.

508,000 residents could qualify for tax credits to help them purchase health coverage.

958,000 seniors would receive free preventive care.

170,000 seniors would have their brand-name drug costs in the Medicare Part D "doughnut hole" cut in half.

76,800 small businesses could be helped by a tax credit to make premiums more affordable.

Sources: U.S. Census Bureau, U.S. Department of Health and Human Services