Either way, most people who don't have insurance can afford it, they choose not to have it for some reason. And most of them go to the ER at some point. And at that point, is that $8-$20 annually? No, that's potentially $8,000 for one visit, which is half of some people's annual income. A periodic checkup can't prevent a broken bone or some horrible infection. I think you're the one who has a lot of questions you're leaving unanswered. Why are you so concerned with just the people who absolutely can't afford any health insurance and will be hit with the fine?