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The Human Costs of Tobacco Use New England Journal of Medicine Health Insurance Costs by U.S. State in 2026. Premiums are often highest in smaller, rural or northeastern states with older populations and fewer insurers and lower in some competitive markets or higherincome Can You Add a Tobacco Surcharge? SBAM Small Business Association of Michigan Hidden Costs: The Economic Burden of Cigarette Smoking on U.S. Healthcare Spending ASH > Action on Smoking & Health State policies limiting premium surcharges for tobacco and their impact on health insurance enrollment PMC

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