Time to Reassess the "Sub26ers": Converting to a Range

Over the months, I've made numerous changes to my methodology and calculations of some of the "fuzzier" numbers which aren't locked down precisely in the HHS, CMS or state-run Exchange reports. For the most part, this refers to the Medicaid/CHIP enrollments, which are difficult to define since there's a lot of variables involved (including the "motive" of the enrollee in the case of "woodworkers").

• On the Private QHP side, you have Paid QHPs (or Unpaid for Legit Reasons); Unpaid QHPs; SHOP Enrollments; and Off-Exchange QHPs.
• On the Medicaid side, you have "Strict Expansion" and "Woodworkers" (which both count) as well as "Redeterminations (renewals)" and "Baseline Churn" (neither of which is counted, though the "churn" is very difficult to pinpoint).

However, there's one number which I've pretty much left alone throughout this process: The 3.1 million "Sub26ers"...that is, the 19-25-year olds who are now (and have been, for up to the past 3 years) included on their parents policies specifically due to the provision in the ACA which requires all policies to allow for this.

I discussed this a few times back in late December and early January. At the time I assumed, based on a casual analysis of the multiple studies I was reading, that the true number of sub-26'ers on their parents policies due to the ACA was actuall somewhat higher than 3.1 million; the 3.1M seemed to be based on a 6.6M number from a Commonwealth Fund study in 2012; a similar study by the Commonwealth Fund a year later had the same measurement at 7.8 million, which suggested (to me, at least) that a higher number, around 3.7 million, might be more appropriate.

However, I assumed that there was a good reason for the HHS Dept. to stick with the 3.1M figure, and more pressing issues presented themselves, so I left it alone...until a few days ago.

On Monday, in a "Fact Check" piece in the Washington Post, Glenn Kessler (who I've actually butted heads with a couple of times, but nothing too serious) brought up the 3.1M Sub26er issue as an aside to his debunking of John Boehner's absurd claim that there's been a net loss of people covered since the ACA exchanges went live.

Mr. Kessler didn't spend too much time on the Sub26er number, since his larger point was that no matter how you slice it, a lot more people have gained insurance when you total everything up (QHPs, Medicaid, Sub26ers, Off-Exchange, SHOP, etc) than have lost it (and technically, even most of those people didn't lose insurance anyway; they just replaced a non-compliant policy with a compliant one, as I did).

However, he did spend a bit of time on it, and presented an interesting finding. By his reckoning, the 3.1 million figure was actually based on studies by the Centers for Disease Control, which basically involves converting a percentage drop of uninsured 19-25 year olds from the 3rd quarter of 2010 over the following years into an actual hard number based on that percent. However, Kessler noted that while the number may have dropped by 3.1 million at one point, the drop seems to have shrunk a bit since then. He also feels that due to fluctuations from one quarter to the next, it should be more accurate to take the average of every year.

It gets a bit into the weeds, but the bottom line is that Kessler feels that instead of a flat 3.1 million, a more accurate estimate of the current number of 19-25 year olds, on their parents' healthcare plans specifically due to the ACA provisions would be a range from 2.2 million (if you go with an average per year) to 2.8 million (if you use just the 3rd quarter of 2010 to the first half of 2013).

The Fact Checker dug into the more recent reports and found that it was based on a single quarterly figure that was not sustained in later quarters. (That might be why the report was never updated.) However, the overall increase in the percentage of insured young adults suggests a gain of about 2.8 million from the third quarter of 2010 to the first half of 2013. Given quarterly fluctuations, a more conservative approach would be to use the average figure for 2010 as the base; that would reduce the increase to 2.2 million people. That is still substantial.

I haven't had a chance to analyze these reports, and frankly some of it goes a bit above my skill set anyway, but I'm willing to give him (most) of the benefit of the doubt. The sub26er issue has bothered me for awhile for several reasons:

• it's 2 years out of date
• Those who were at the top end of the age range in 2010 (25 years old) are 28-29 now, meaning they're no longer covered
• However, they've presumably been replaced by more kids growing into the age range (17-18 year olds turning 19) since then
• Some have moved onto their own policies via (hopefully) getting a private sector job with coverage, etc.
• Some have moved onto Medicaid or other coverage (joining the military, etc.)

So...what I'm going to do is this: I'm keeping the 3.1 million figure as the top end, but taking the average of Mr. Kessler's range as the low end of the range. Thus, instead of 3.1 million flat, I'm changing this to a range from 2.5 million - 3.1 million going forward.