public understanding. Our panel thinks that a subcabinet-level coordinating group would help to ensure that a measure of MCER does not flounder in its development and launch.
Recommendation 6-1: Because technical and cross-departmental efforts such as the construction and maintenance of a measure of medical care economic risk (MCER) require both political and resource support, the panel recommends that the secretaries at the U.S. Departments of Health and Human Services and Commerce be jointly responsible for developing and reporting measures of MCER (and burden) on an annual basis with involvement of the Office of Management and Budget chief statistician. This effort should coincide with the production and release schedule for the Supplemental Poverty Measure.
Recommendation 6-2: The panel further recommends the creation of a medical care economic risk coordinating group composed of senior officials from the U.S. Department of Health and Human Services, the U.S. Census Bureau, and the U.S. Office of Management and Budget to provide oversight and make suggestions for needed improvements.
The coordinating group would provide guidance to the agencies producing the measure and suggest changes in methodology and appropriate data sets as required. The leadership of agencies with contributions to make to the construction and implementation of the measure could constitute such a group. For example, the coordinating group might include the assistant secretary for planning and evaluation in HHS, who plays a comparable role in the development of the Annual Trustees Reports for both Medicare and Social Security and on the 5-year technical review panel of the Medicare Trustees modeling and methodology; the director of the Census Bureau, given that the Census Bureau would presumably play the primary role in producing the MCER, as it does for the official poverty measure and the SPM; and the chief statistician from OMB, given OMB’s role in coordinating statistical and data policy across the entire federal government. OMB would also be in a position to take a policy lead in dealing with other offices within the White House if changes need to be made in the MCER in years to come.
The panel also suggests that one or two members of the coordinating group be chosen from outside government. These outside members would have a role similar to the public trustees who serve on both the Medicare and Social Security Board of Trustees. Having one or more outside members would enhance the transparency and credibility of the process as well as provide the government with the latest thinking from the scholarly community outside the government. The outside members should possess relevant