If you're not poor, then you're not a Medicaid recipient, so there's not even a nominal tax.

If they were serious about this, they could assess this penalty as a payroll tax increase on everyone who pays into Medicaid who can't quit smoking or control their weight. This isn't a state bill to punish people who've sinned by being obese or smoking, it's a state bill to punish people who've sinned by being obese or smoking while also being poor