ing to combine data from multiple sources, but no one has produced an experimental MCRI. Recently, an interagency working group was established by the U.S. Office of Management and Budget and charged with developing the guidelines under which the Census Bureau would cooperate with the Bureau of Labor Statistics to produce a Supplemental Poverty Measure (SPM) on an annual basis, beginning in 2011. This new measure would not replace the current, official poverty measure, but its release on a formal basis in conjunction with the official measure would ensure that it received greater attention—and use—than previous experimental measures. Also unlike the official measure, the methods used to create the SPM would be modified over time as researchers inside and outside government proposed improvements supported by research or developing consensus.

With the SPM about to become reality, attention has refocused on the MCRI, and the charge to the Panel on Measuring Medical Care Risk in Conjunction with the New Supplemental Income Poverty Measure is to examine the state of the science in developing a measure of medical care risk that is feasible to produce and can be used to track changes in medical care economic risk as the implementation of health care reform progresses.

Data issues loom large, compounded by complex conceptual issues. This paper examines the data sources that might be used to construct a measure of medical care economic risk. Although the design of an MCRI need not be constrained by the data that are available at present, the reality is that, if an MCRI is produced in the next few years, it will have to be based almost exclusively on data that are being collected currently. The addition of a modest number of new items to an existing survey is possible, and the Census Bureau has done exactly that for the SPM. However, none of the federal agencies likely to be involved in the development and production of an MCRI has the budgetary resources to support significant additions to any of the key surveys. The Census Bureau, in fact, has not received the funding that was included in the president’s budget to support production of the SPM. Therefore, the existing data sources will largely define what is possible to include in an MCRI.


Multiple surveys could be considered as candidates to host the MCRI, each of them offering some unique advantage, but the sponsor of the study panel, the Assistant Secretary for Planning and Evaluation (ASPE), has indicated that the MCRI should be constructed from variables that are available in the Census Bureau’s Current Population Survey Annual Social and Economic Supplement (CPS ASEC). This will make it possible to compare a family’s medical care risk with its poverty status as reflected in the new SPM, which is also based on the CPS ASEC. ASPE has also indicated that

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