A new report suggests that cars in California and states signed onto its emissions rules are responsible for $37 billion in health-and climate-related costs each year.

The projection comes from the American Lung Association of California, and implicitly means broader financial implications for the nation as a whole, as it only encompasses the 10 states that have zero-emissions-vehicle sales programs.

Those 10 states are California, Connecticut, Maine, Maryland, Massachusetts, New Jersey, New York, Oregon, Rhode Island and Vermont.

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According to the report, costs includes those from 220,000 missed days of work, 109,000 asthma attacks and 2,580 premature deaths per annum.

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The report further states that every gallon of gas burned adds $18.42 to public bills that we pay with our taxes.

One way to reduce costs, according to the report, is to increase EV sales. The report states that if new-car sales are 100 percent EV by the year 2050, and 65 percent of the cars on the road overall are EVs, the costs will drop by $21 billion to $15.7 billion.

If the grid shifts to 100 percent renewable energy, the beneficial result will be 40 percent.

“I think people haven’t been used to factoring health and climate into the daily choices they’re making,” Bonnie Holmes-Gen, the American Lung Association of California’s senior director of air quality and climate change, said. “We’ve quantified the hidden costs.”

The report comes just as the EPA, National Highway Traffic Safety Administration and California Air Resources Board are performing a mid-term review of the Corporate Average Fuel Economy standards. The agencies need to decide whether to tighten or loosen restrictions by April of 2018, and many observers think the standards will be tightened, which would give a boost to the EV space, since EV production will help automakers meet stricter standards.

The American Lung Association of California recommends the continued use of EV-only HOV lanes and EV tax credits, as well as increasing infrastructure to support EVs, as other ways to help spur stalled EV sales.