Who's responsible? An observation about health care insurance

The issue of health care was the topic of a recent newspaper article. 

As the article reported the Affordable Health Care Act (Obamacare) is supposed to give everyone an opportunity to have health care insurance at an affordable price depending on their circumstances.  If everyone took advantage of it, it would mean everyone could get the care they need without the need for public assistance.

The article went on to note that a slight twist to this is that the insured must give up their $9 per day cigarette habit if they have one.  Someone can't willingly contribute to their poor health while receiving public assistance.

Well, it seems that rather than give up that disgusting habit (oh, and save $63 a week), people are opting out of the program thereby leaving the tax payer to pick up their health care tab.  As it now stands, no public hospital can turn away a patient for any reason. If they can't pay, then you and I pay.

Something's wrong here.  Why should we pay for a smoker's very poor and very unhealthy choices?

I generally understand why hospitals will not turn people away but then why isn't the patient the one who should pay and if they can't pay, the cost should be deducted from their earnings and if they don't earn anything, they should work it off somehow.

The whole system is a mess but we don't hear anything about it from politicians.  But, hey, don't worry.  Trump will fix it!