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Due to the increase in smuggling, expected tax revenues would only increase by 2%, or $6.7 million.[55] The top five states for casual importers individuals bringing in untaxed cigarettes purchased elsewhere for personal consumption are New York (24%), California (20%), Massachusetts (19%), Washington (17%) and Minnesota (17%)

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INDIAN HEALTH SERVICE HOSPITALS: LONGSTANDING CHALLENGES WARRANT FOCUSED ATTENTION TO SUPPORT QUALITY CARE