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.

By dividing the population into poverty-related groups up to 400 percent of poverty, the Census Bureau could use estimates of spending on premiums and medical care to assess whether such expenses are moving families into or nearer to poverty or are moving already-poor families into deeper poverty. For example, after accounting for medical care expenses, how many households move from above 200 percent of poverty to below 150 percent or below 100 percent of poverty? How many already-poor families (considering their disposable income before subtracting medical care costs) are moved below 75 percent or 50 percent of poverty?5

Recommendation 2-3: The panel recommends that the U.S. Census Bureau report findings on medical care economic burden in its Supplemental Poverty Measure reports and tables separately for the populations under age 65 and ages 65 and older.

Very different health insurance coverage policies currently apply for those reaching age 65 and eligible for Medicare compared with the population under 65. Because of this difference, it would be useful to report all measures of economic burden and risk separately for the populations under age 65 and ages 65 and older. Another reason to show estimates separately for the two age groups concerns differences in asset holdings. There is substantial evidence (see Table 2-3) that people under age 65 with incomes at or below 300 percent of poverty have few resources (including assets) to draw on in the event of a health episode that leads to medical care costs that are high relative to their incomes (see Banthin and Bernard, in Part III of this volume). The elderly tend to have greater assets than those under age 65, although, as illustrated in Table 2-3, for those near poverty (income below 200 percent of poverty), assets, including the net value of homes, are often meager to last a lifetime. Half of the elderly in the near-poverty range have less than $77,300 in total assets. Banthin and Bernard (Table A-2, in Part III of this volume) provide a full distribution. (See Chapter 3 for a discussion of the potential role of assets in measuring medical care economic risk.)

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5 The Census Bureau in November 2011 prepared a special tabulation for the New York Times that is a limited example of what the panel has in mind. See http://www.census.gov/hhes/povmeas/methodology/supplemental/research/SpecialTabulation.pdf.



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