components of disposable income are or were previously imputed in the CPS ASEC to create a number of alternative poverty measures (taxes and commuting expenses are currently simulated or imputed, and child care expenses and child support payments were previously imputed), similar imputations could be performed with MEPS as well—or the additional variables could be added to the MEPS questionnaire in the future.
Both the ACS and the CE fall short in a number of other ways. The ACS collects only limited measures of health, and the CE collects none. The ACS collects no medical expenditure data, nor does it collect from persons unrelated to the householder the relationship information needed to construct health insurance units or families. The CE does collect expenditure data, but this is done for “consumer units,” and when these do not align with health insurance units or families, the latter cannot be constructed.
Given the data limitations shown here and the possibility that the research to develop a prospective measure may show little gain over a retrospective measure, production of a retrospective measure of MCER remains an option. Ideally, such a measure would take account of measures of chronic health conditions and functional limitations, which are available in MEPS and the NHIS, and it would also take account of features of health insurance coverage, which are not available in any federal household survey. Minimally, however, it would require only measures of prior year premiums and out-of-pocket expenditures, along with prior year measures of all of the resources that would be needed for a prospective measure, assuming that disposable income as defined for the SPM, plus a portion of liquid assets, would be used as the measure of resources. In essence, a retrospective measure of medical care economic risk of this kind would be similar to a retrospective measure of financial burden, as described in Chapter 2, with the exception of including a portion of liquid assets in the former measure. The CPS ASEC falls short only on liquid assets although it relies on simulation and imputation for a number of the components that distinguish disposable income from Census money income. MEPS has liquid assets, but for only half the sample, and it lacks most of the components that distinguish disposable income from Census money income. MEPS also lacks prior year insurance premiums for Medicare, but otherwise meets the minimal requirements for a retrospective measure.
CONCLUSIONS AND RECOMMENDATIONS
Although the panel favors a prospective measure of MCER over a retrospective measure, the more substantial data requirements for developing a model with which to estimate the prospective measure cannot be fully met with an existing survey. The MEPS longitudinal file comes closest to meeting these requirements.