Yes, it would cost him more *if* he needed surgery. I think the argument that violating ones civil rights because it "might" be in his best interest is a weak one. From my perspective, it's his choice to make good or bad.
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Don't get me wrong, I'm not completely against all of ACA. I'm certainly not against its goals. I am fundamentally opposed to mandated purchases into unregulated for profit industries. I am more against this type of mandate than I am for ACA. This would still be my opinion if I needed some of the benefits of ACA.