VOLUNTARY PUBLIC-HEALTH INSURANCE FOR LOW-INCOME FAMILIES - THE DECISION TO ENROLL

A dominant issue in the health reform debate is whether insurance cove rage should be voluntary or mandatory. Clearly, the factors that deter mine who will seek voluntary coverage are relevant to this policy issu e. This article uses experience from Washington State's Basic Health P lan to examine the enrollment choices of low-income families in a stat e-subsidized voluntary insurance plan offered through managed carl org anizations. We hypothesize that the decision to enroll, which encompas ses the decisions to purchase insurance coverage and to select a parti cular plan, is influenced by four factors: the family's financial vuln erability, their risk perception, the price of coverage, and the trans ition costs of enrolling. Our enrollment model is supported by the dat a and has important implications for the design of voluntary programs. Families who choose to enroll are more likely to have a female head o f household, young children, and a family member who has a part-time j ob and some college education. Higher premiums and availability of oth er insurance coverage decrease the probability of enrolling.