What the following says is simple. If only people needing health care enroll in a health insurance group, the premiums will skyrocket.
People needing care spend more on care than they pay in premiums while healthy people spend more in premiums than on health care.
When healthy people make the choice not to carry health insurance, it creates adverse selection and premiums that cannot be sustained causing more people to drop coverage and the situation continues to get worse. That is what might happen to Obamacare as premiums increase.
At the same time those who need care, but declined health insurance often shift the cost of care they can’t pay to others in the form of uncompensated care that is provided.
How insurance works
Health insurance markets only function when there are lots of people pooling their resources — young and old, relatively healthy and not.
“You need people to be paying into the insurance system when they’re healthy so that they can take out when they’re sick,” explains Cynthia Cox of KFF, a nonpartisan health research organization.
Younger, healthier people tend to pay more into the system than they consume in health care. Older, sicker people often consume an amount of health care that costs more than the amount they pay in. That dynamic creates a stable insurance system.
Right now, the Affordable Care Act markets seem to be pretty balanced. A record 24 million people are enrolled, and brokers report their clients are generally happy with their plan options and find the premiums affordable.
Source: NPR.org
QUINNSCOMMENTARY 
The expert you quote says: “You need people to be paying into the insurance system when they’re healthy so that they can take out when they’re sick,”
Of course, that is a lie. And, yes, I intentionally use the word lie.
When I pay my premium this month, it is insurance, providing me coverage this month. It does not provide coverage next month. So, if I paid my premium for October on the 31st, and didn’t pay anything in November, I had no coverage on November 1st, even though I just paid my premium the prior day.
There is no money to “take out”. KFF’s idea of health coverage is to have the healthy subsidize the sick, and by allowing the federal government control of the process, politicians get to take credit for taxing some (lately, just running deficits) while spending other people’s money to buy votes.
The money paid for health coverage today is spent today. There is no “take out” – this isn’t a drive thru a la McDonalds where you pay at the first window and later get the food at the second window.
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