All I know is that I am a senior citizen that refuses health insurance, and can attribute my lack of need for medical care primarily to God, but also to positive dietary and lifestyle changes over the year. When the ACA was enacted, and I saw the one year premium for me, it was more that what I spend out of pocket for medical care in 20 years. So I agree with Karl that subsidized insurance should not pay the bills of diabetics that continue to drink sodapop, lung cancer bills of smokers, and liver transplant bills of alcoholics.