Measuring Medical Care Economic Burden
The panel proposes that a measure of medical care economic burden be estimated by the U.S. Census Bureau in conjunction with estimating the SPM. This would be done by comparing a family or individual’s actual out-of-pocket medical spending with resources available for medical care. (Chapter 2 provides details of the calculation, which involves taking a family’s SPM measure of resources, adding back its out-of-pocket medical spending, and subtracting its nonmedical needs as represented by the SPM poverty threshold for the family.) The difference would be expressed by the extent to which families and individuals who are already poor in terms of having insufficient resources for their nonmedical needs are moved deeper into poverty because of their medical costs and the extent to which those who are not poor are moved into poverty or below a low multiple of poverty, such as 100 percent or 250 percent. Estimates of these effects should be provided separately for health insurance premiums and other expenses for medical care and should also take account of important features of the new national health care policy, which include a major role for states going forward, premium subsidies and other features of affordability that are linked explicitly to multiples of the poverty thresholds, and continued policy differences by age. To inform policy, it is important that the SPM and the measure of medical care economic burden reflect trends in actual spending—not hypothetical spending. Thus, there should be no adjustment for underutilization of medical care in the definition of resources.
Recommendation 2-1: The panel recommends that the U.S. Census Bureau refine its Supplemental Poverty Measure (SPM) reports and tables to include the estimated effects of medical care economic burden on poverty by component, showing the effects of premiums separately from other out-of-pocket expenses. It further recommends that the SPM reports and tables include the estimated effects of medical care economic burden by region or state, recognizing that aggregation over time or by groups of states may be necessary to obtain reliable estimates.
Recommendation 2-2: The panel recommends that the U.S. Census Bureau examine medical care economic burden in its Supplemental Poverty Measure (SPM) reports and tables by providing estimates of the number of people who move from higher to lower multiples of the SPM poverty thresholds—including thresholds above and below the poverty level—because of their health insurance premiums and other out-of-pocket medical care costs.