Alabama representative Mo Brooks last March, calling for repeal of the ACA:
“My understanding is that (the new proposal) will allow insurance companies to require people who have higher health care costs to contribute more to the insurance pool,” Brooks said in comments that generated swift backlash. “That helps offset all these costs, thereby reducing the cost to those people who lead good lives, they’re healthy, they’ve done the things to keep their bodies healthy. And right now, those are the people — who’ve done things the right way — that are seeing their costs skyrocketing.”
Yesterday, Brooks announced that he has been diagnosed with an aggressive form of prostate cancer.
As libertarians have argued for years, government intervention to improve public health doesn't necessarily save money in the long run. By extending life, we even out the health care costs for healthy and unhealthy people. This report actually claims that the healthy may even have higher long-term health care costs than the unhealthy.
That means that, collectively, the unhealthy who die younger end up subsidizing Medicare coverage for those who have lived healthier lives. And that means that insurers are also subsidizing Medicare because they pay the upfront cost for early death. But it's not really insurers, it's those who pay the premiums.
Bottom line: the argument that premiums should be adjusted based on health status is complicated. It does not boil down to simple fairness, and taking good care of one's self, may, on average, cost more in the long run. What the healthy may lose by subsidizing the sick with overall higher insurance premiums during working years, they recoup on the back end through Medicare. And let's not forget years of social security retirement income that the dead won't receive, even though they may have paid in year after year while alive. But even that is complicated by surviving spouse benefits.