If you do without, you do without. I would guess that most of them are technically below the poverty line, so it may not make any difference. Their needs are cheap, and their profit is probably equally cheap. They may not currently be subject to income tax. Why would it be any different?

On the other hand, everybody gets to pay for the support of lots of things that they don't use, such as the childless homeowners who get to pay the same property tax, which supports schools in most states.

Also, as I mentioned, there are those who are subject to laws that they choose not to obey, and on whom the laws are not enforced.

Frankly, I don't see this becoming an issue even if the health care legislation passes with the pieces you believe will be there.