When Having Insurance Still Leaves You Dangerously Uncovered

That's a lot of money. This is true even in the employer-based insurance market. In 2016, almost 30 percent of workers were enrolled in a high-deductible health care plan. More than half of employees with individual plans had deductibles of at least $1,000. Two-thirds of covered workers had co-pays, and 25 percent had co-insurance for primary care. Almost 20 percent of workers were in plans with an out-of-pocket maximum of $6,000 or more.

Mrs. Clinton proposed a tax credit for those with high out-of-pocket spending, up to $5,000 per family, or $2,500 for individuals. This tax credit would be applied to insured Americans whose out-of-pocket health care spending rises above 5 percent of their income.

... this would cost the government money -- quite a bit of it, in fact. It's estimated that the tax credits alone would cost more than $110 billion in 2018. Some of this government spending would be offset by people choosing to take private insurance (with the credits) over Medicaid, which could reduce Medicaid spending by $25 billion. Over all, it's estimated that this policy would increase the federal deficit in 2018 by just over $90 billion. Of course, this could be offset by new taxes or fees, but those would surely be unpopular.

... Mr. Trump offered no specific plans for reducing out-of-pocket spending. But that's not surprising. It wasn't that long ago that one of the most favored means by which conservatives proposed to bring down health care spending was to have consumers put more "skin in the game." Many of them believed that if consumers were more exposed to health care spending, if they had to pay more out of pocket for care, then they would be more responsible consumers because of it.

In fact, calls have already begun for Mr. Trump to expose people to even more out-of-pocket spending. Right now, the Affordable Care Act has provisions that help reduce cost-sharing below the out-of-pocket maximum for those making less than 250 percent of the poverty line who purchase a silver-level plan. Those payments are made directly to health plans that cover those people.

It may be possible for the president to cut off those payments immediately, without any congressional involvement. If he were to do that, and it's unlikely, it would either cripple those insurance companies, or they'd withdraw immediately from the exchanges, terminating coverage and leaving millions without health insurance overnight.