policy makers with a targeted indicator of the level of financial risk faced by Americans due to medical care costs.


Contract Charge to the Panel

The U.S. Department of Health and Human Services (HHS) is responsible for carrying out the provisions of the ACA. To monitor the effectiveness of health care reform in providing coverage for low-income families and children, a new SPM became available to HHS in fall 2011; the new measure subtracts health insurance premiums and other out-of-pocket expenses for medical care from income in determining a family’s resources for basic needs (see Short, 2011). To the extent that provisions of the ACA or changes in other health care programs affect premiums and other out-of-pocket expenses, the SPM poverty rate will be higher or lower than otherwise. However, the SPM will not directly assess the extent to which population groups are likely to incur medical care needs that put them at financial risk.

HHS would also find useful a companion measure of medical care economic risk, which estimates the proportion of families and children who are at risk of incurring high out-of-pocket medical care expenses, including health insurance premiums, in relation to their resources, for monitoring the effectiveness of health care reform. Such a measure would enable HHS to answer such questions as which groups face a greater likelihood of economic insecurity due to lack of or inadequate health insurance coverage.

In fall 2010, the Office of the Assistant Secretary for Planning and Evaluation in HHS requested the NRC and the Institute of Medicine (IOM) to convene an ad hoc panel of experts to

organize, commission papers for, and conduct a public workshop to critically examine the state of the science in the development and implementation of a new measure of medical care risk as a companion measure to the new Supplemental Poverty Measure. An agenda for the workshop will be developed by the panel to examine retrospective and prospective measures of medical care risk, defined as the risk of incurring high out-of-pocket medical care expenses (including insurance premiums) relative to income. It will consider the variability of risk across populations and the vulnerability of population groups, including the insured, underinsured, and uninsured and those with chronic health conditions, acute but not catastrophic conditions, catastrophic conditions, and other relevant issues. Based on the workshop and its deliberations, the panel will prepare a report with findings and recommendations that will help the field to move forward to implement a new measure of medical care risk that will

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