Major health care challenges plague Michigan even as reform is on the way, a report by the Center for Healthcare Research and Transformation found.

Almost 40 percent of Michigan residents either lack health insurance or rely on the state for assistance, according to the CHRT study. Coverage through employers has also declined faster than the national average in the state.

Stress on the state budget for health care is expected to rise. Over a million people are projected to obtain coverage through state-run programs in 2014, the study found. Hospitals have been increasingly left uncompensated for the care they provide.

These findings represent upcoming challenges for the state.

"Michigan's safety net system is overloaded and shows no signs of abating in the near term even with health care reform," says CHRT director Marianne Udow-Phillips. "Michigan has far fewer federally funded health care centers than other states. The enormous strain on the state's health care system is growing as more people lose employer-based coverage."

Health care costs in the U.S. are some of the steepest out of all the industrialized countries, says the Kaiser Family Foundation, growing faster than inflation and income levels.