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Practically speaking, "substantial element of their daily operations" means "over 25 percent of their retail floor area" would need to be given over to "essential" goods, Smith said

This group has lower healthcare costs than older individuals, so their exclusion may reduce the marketplaces long-run stability by limiting risk-pooling. Smokers enrollment is critical to achieving universal coverage, as their rates of insurance coverage are markedly lower than those of non-smokers

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[83] Animal research suggests that monoamine oxidase inhibitors, acetaldehyde [82] [84] and other constituents in tobacco smoke may enhance its addictiveness