so there is progress in that dimension. Income data collection in the CPS is not as detailed, especially the transfers going forward. But it seems that the CPS ASEC does have most of what is needed to move forward in developing the new measure.

GENERAL DISCUSSION AND COMMENTS

Most of the discussion centered on the benefits, or lack thereof, of requiring everyone to purchase health insurance, as called for in the ACA. Many views were expressed.

Emmett Keeler (RAND) opened the discussion with the observation that one of the main purposes of the measure of MCER is to evaluate the ACA. But he wanted to make sure that it is an honest evaluation.

Although it is clear to him that giving people insurance is a good deal for them, it is not clear that forcing people to buy insurance is a good deal for them. It depends on the price and what the benefits are. Somehow this measure has to take account of that. To the extent that making people buy insurance is a burden, something in this measure needs to that show that economic reality. In the current context, if it were a good deal for uninsured people to have insurance, they would have it. Basically uninsured people are saying they would rather have the money to spend on food or shelter, than to have the money to spend on an insurance premium, and the markets do not work very well for them. There are many reasons why uninsured people do not have insurance; it is a choice that they make. Subsidies can make it a good deal for them. Somehow the measure must include an honest evaluation of the value of that insurance.

Constance Citro (National Research Council) commented that it is very important to compare apples with apples, which is why one would like to compare not only the SPM pre- and post-ACA, but whatever this measure of MCER is pre- and post-ACA. The SPM may show that some people are worse off, in the sense that the money they have available for the basics that are in that measure, but the MCER may show that on that dimension they are benefiting from the insurance. Of course it is a judgment as to what people think of the different values of the different costs—the higher out-of-pocket costs on one hand and the greater insurance against risk on the other hand. But it would be really too bad if all there was at the time that the ACA is implemented is a measure comparing the effects of health care reform on just the SPM.

Keeler commented that he was trying to think of benefits of reducing risks that do not apply to reducing burden. After people have been sick and have had to pay a lot of money for it, they are in a bad situation. But why would they want to reduce risk? He thought of two reasons: one is peace of mind—maybe buying insurance also buys peace of mind. The other reason



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