This liberal agrees, adverse selection is a failure

WA Post editorial:

Talk to literally any economist, including conservative ones, and you’ll learn that this idea would lead to adverse selection, a huge spike in premiums for sick people..., a proliferation of mini-med junk plans that cover virtually nothing..., and a possible death spiral. A more detailed explanation of this phenomenon is here. ...Contrary to the predictions of economists everywhere, the HHS propaganda document claims that the Cruz amendment would cause insurance coverage to go up and premiums to fall. Astoundingly, even premiums for people in the Obamacare-compliant plans — which, again, economic theory suggests would get stuck with only the very sickest, most expensive Americans — would allegedly decline relative to current law. ...

Yes, any honest economist will tell you that buying medical services for all adverse medical conditions is bankruptcy.  Hence the downward spiral for Obamacare.  None of the Republicans want anything to do with the program, Trumpster is going to pay an increasingly high subsidy to the insurance companies as the nurses union discovers an infinite demand for adverse medical conditions.

So, who is going to raise the penalty? The Dems lost four elections as they raised Obamacare taxes, but the taxes will be shooting straight up as folks find alternative money and insurance. For example, what happens when folks begin buying insurance from the Virgin Islands, unregulated. Government could never track the payment streams.

A quick search reverals the legality of off shore insurance:

To ensure that you only pay for the cover you really need, you can choose whether or not you want to include the USA in your Lifeline insurance cover.
Please Note: Due to the extremely high cost of healthcare treatments in North America, coverage which includes the USA is generally an average of three times the cost of cover for other parts of the world. Therefore, unless you will be spending significant amounts of time in the United States, we recommend that you DO NOT select this option.
Some Americans want to self-insure their health risk up to a point. But under current law, Americans can’t purchase a plan with deductibles higher than $6,600. Gone are the days with Americans could purchase $10,000 deductible plans from carriers like Blue Cross. It is now illegal for an American health insurance company to sell you a deductible of $10,0000, $25,000 or more.
Buying health insurance offshore allows a full array of choices in plan design, at costs significantly lower than one would expect.
A LLoyds syndicate, for example, could underwrite a health policy to be sold to Americans with coverage extended to the USA . However the purchase would necessarily have to be made offshore. To our knowledge no one has come up with such a product yet. The first one that does will do well.

So, even with three times the coverage cost it is cheap by US standards. How easy for  American to buy complete or supplemental insurance plans from  off shore.