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A major contributor to this rise in spending is likely due to the effects of a higher prevalence of cigarette smoking among people who were newly insured under the Patient Protection and Affordable Care Act from 2010-2014 and their subsequent increased use of medical services

"We'd take like a 25 percent hit just from cigarettes --and then on top of that, whatever else that goes with it." But, others believe the health benefits outweigh the business costs

To Foulds, its not clear whether behavioral differences are a cause or an effect of nicotine use

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