This paper analyzes the political process of the introduction and the changes of the out-of-pocket maximum in the Roh Moo-hyun, the Lee Myung-bak, and the Park Geun-hye government. It changed from universal application regardless of income levels to enhancement of income differential coverages. The Roh government accepted civic groups as members of policy governance; the out-of-pocket maximum, a long-standing policy demand from the civil society, was introduced and around the end of Roh’s presidency, the existing compensation system became discarded. During the Lee and the Park administrations, the pan progressive camp strategically insisted on free medical care and a cap of 1 million won out-of-pocket maximum for policy clarity, while the two governments subdivided the income ranges into three and seven. The conservative governments and the civil society did not properly have communication networks, which led to not policy cooperation but political conflicts.