It is basically a hole in a bucket. As long as money is going in faster than it is leaking out it will work. The overall medical cost of people who could afford insurance but are not getting it then get something like cancer is a pretty small percentage of the over all medical cost in this country and it won't crash the system. The mandate was at bone they threw to the insurance companies to get them to sign on and was more about forcing young healthy people to subsidize older less healthy people than it was about pre-existing conditions.