dar year 2009, had fewer than 15,000 households, whereas the 2011 NHIS was projected to have a final interviewed sample of 35,000 households (U.S. Government Accountability Office, 2012). Like MEPS, the annual sample for the CE quarterly survey is under 15,000 households. The ACS, in contrast, collects data from about 2 million households each year. To put this in perspective, the mean state sample in the ACS is larger than the NHIS national sample (the median ACS state sample is considerably smaller). The ability of the ACS to support estimates for states and large metropolitan areas at levels of precision comparable to some of these national samples is appealing, but as we show, the data elements are too limited for our needs. Of the five surveys, the CPS ASEC has the most timely release, just 6 months after the completion of data collection and 9 months after the end of the survey reference period. The CPS is also the source of both the official poverty measure and the SPM, to which the MCER measure is intended as a companion (Czajka, in Part III). Producing the two measures from the same survey would enable more direct comparisons than if the two were based on different surveys.

Table 5-2 summarizes the collection of variables needed to produce an annual prospective measure of MCER. Measures of medical expenditures are required only for the prior year—where they are used as baseline characteristics. The model will predict medical expenditures during the next year as a function of the baseline characteristics. Although model development will focus on the fullest set of baseline characteristics, the model will have to be reestimated using just those baseline characteristics that are available for a particular survey. Fewer baseline characteristics imply a weaker model unless the baseline characteristics that are omitted have no impact.

Because none of the longitudinal surveys provides detailed information on what is actually included in health insurance coverage, such variables will not be included in the predictive model, so the absence of such variables from all five surveys, although a major limitation for modeling, is beside the point. Only MEPS and the NHIS provide information on functional limitations and chronic medical conditions, which are likely to be important predictors. The NHIS lacks information on prior year premiums or out-of-pocket expenditures, however. What it does include are several questions relating to the financial burden posed by medical care. In 2011, the NHIS added three new questions that asked whether the family had problems paying its medical bills in the past 12 months, whether there were medical bills that were being paid over time, and whether there were medical bills that the family was unable to pay at all. The NHIS is also very weak on resources. MEPS collects much more information on resources but lacks the components that differentiate money income from disposable income.

The CPS ASEC is the only one of the surveys that can estimate disposable income currently, but it lacks a measure of liquid assets. Given that

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