ER is defacto coverage. As in they will treat you, and the generic cost of that treatment is overall covered by the tax penalty. But in the individual case, lacking insurance means you are on the hook for the full amount. And bankruptcy courts are likely to be far less lenient in discharging such debts precisely because you could have avoided them.
Well if risking your life's assets in return for only 85% of what the company refund is (I'm assuming you are in the 15% tax bracket).... yeah brilliant idea....
That's only true for the CURRENT tax year. In the end you still pay taxes on it. And if you end up with a serious but not catastrophic medical situation (which at 50+ is not unlikely) - they can and WILL attach your 401k...