Federal health care reform could save Maryland roughly $829 million in health care costs until 2020, but drive up costs thereafter -- to the tune of $46 million in fiscal 2020 -- as the federal government begins shifting more expensesonto states.

The state is expecting about 400,000 uninsured Marylanders to enroll for coverage by 2017, according to the report by Maryland's Health Care Reform Coordinating Council.

Expanding coverage will increase state contributions to Medicaid, but savings and new revenue will far outweigh any added costs for the first decade, the council concluded.

The state's estimated savings peak in 2016 at $250 million and begin tapering off the next fiscal year until 2020, when the state will pay $46 million more on health care than the previous year, according to the report. Council co-chairman John Colmers said he expects savings to continue to drop in the following years, though the council did not report beyond 2020.

"Because of declining savings at the end of the decade, it is essential to immediately begin serious and sustained efforts to bend the cost curve," the report says.

The council recommends increasing access to primary care, establishing a system of electronic patient records and reducing hospital-acquired infections to curb growing costs.

"Our health care system will soon be unsustainable, regardless of these savings, unless we succeed in improving quality while reining in the runaway growth in costs," the council warned.

Colmers also cautioned that the report can only be used as a guideline, because it relies on many "assumptions."

"We expect that those assumptions will change over time," said Colmers, who is secretary of Maryland's Department of Health and Mental Hygiene. "The message we are coming out with is, this should not make us complacent."

Gov. Martin O'Malley created the health care council in March to study how federal health care reform would affect the state. The council plans to continue holding meetings and following up on federal health reform implementation through its work groups.