The more painful you make it, the more incentive they have to simply not pay it. What's government gonna do if they don't? What do hospitals do if they dont pay currently?At least under Obamacare they're paying the fine/tax/whatever. Now they're paying nothing. But as I noted, the penalty must be made more painful -- somehow, some way.
Ultimately? Nothing. One way or another a bunch of poor people can rack up infinite amounts of health care and spread the cost elsewhere. There is no cost containment incentive, hence costs go crazy.
We're letting health care bankrupt us die to our refusal to restrict it from non-payers.