Another Bad Side Effect of Employer-Based Insurance

A.G. Sulzberger reports in the New York Times about a new practice by some employers: refusing to hire smokers:

More hospitals and medical businesses in many states are adopting strict policies that make smoking a reason to turn away job applicants, saying they want to increase worker productivity, reduce health care costs and encourage healthier living.

The policies reflect a frustration that softer efforts -- like banning smoking on company grounds, offering cessation programs and increasing health care premiums for smokers -- have not been powerful-enough incentives to quit.

The new rules essentially treat cigarettes like an illegal narcotic. Applications now explicitly warn of "tobacco-free hiring," job seekers must submit to urine tests for nicotine and new employees caught smoking face termination.

I have to side with Boston University School of Public Health's Dr. Michael Siegel, who points out, "Unemployment is also bad for health." Smokers denied jobs based on their tobacco use are likely to feel hopeless and unlikely to have the employer-sponsored health insurance that might provide them with quitting help - hardly a recipe for successful smoking cessation. Still, this is a rational response by employers who sponsor their workers' health insurance and see costs increase when their employees use lots of healthcare. It just doesn't sound like something that'll be good for the population's overall health.

If the Affordable Care Act's ultimate impact is that most under-65 people get their insurance through health insurance exchanges rather than employers, then employers can base their hiring decisions on candidates' abilities rather than their anticipated healthcare costs. And if insurers expect their plan members to keep the same insurance for longer than they keep their jobs, they might be more motivated to offer counseling, patches, and other assistance to help smokers quit.

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I don't know what percentage of plans don't cover smoking cessation, but I know that at least one large BC/BS doesn't.

And what's next - alcohol-free employees? BMI limits?

Smoking is bad for business.

Have you ever spent 4 hours inside a 10x10 conference room with 4 people who smoked? I had to tell my boss that I was going to call in to future meetings with that group.

If my insurance goes down, then who cares about the smokers? Smoking is dangerous and I have yet to see someone NOT throw a cigarette butt out their car window.

I can't believe how some people will blindly comply with anything govt. or big business pushes down their willing throats.

By Jarrod Starr (not verified) on 13 Feb 2011 #permalink

Liz, you need to work for more Fortune 100s.

Sure health insurance are removed from the company, but that's not going to stop companies from banning smoking to make the place better for customers, to increase productivity, to reduce cleaning costs, etc.

And if you compare it to the gun groups, I think Americans will come to have a legitimate fear of the US Fed banning smoking to reduce taxpayer health care costs.

In fact, I'm pretty sure taxpayers that don't smoke like me are going to want to ban smoking because why should I pay for your smoking, fucking, drinking, speeding, gambling sins and addictions.

What I don't understand Liz, is why we don't hear more arguments that to make American competitive, we have to allow US companies to compete on the same cost structure as the rest of the world.

That means universal taxpayer health care, not employer healthcare.

As a couple of people have pointed out, smokers can cause other problems that aren't related to healthcare, like bringing the smell of cigarettes indoors with them. I wouldn't assume that all smokers are so inconsiderate, though - I know some who make a point of spending a few extra minutes outside, stopping in the bathroom to use mouthwash, etc. after smoking a cigarette to get rid of the smell.

And as for competing with countries that offer universal healthcare, that's definitely an issue, and one I wish our lawmakers would pay attention to - but the only competition I hear politicians talking about these days is with China.

By Liz Borkowski (not verified) on 13 Feb 2011 #permalink

Bad said, Bad said, it always happen. Refusing to hire smokers? 8 out of 10 are smoker, ok, your company no more workers.

So when will they be hiring people based on weight? Being overweight is just as dangerous as smoking: do I not get the job because I'm carrying extra pounds and possibly subjecting my employer to medical bills related to diabetes, heart disease, etc?

I don't care for smokers but if that's going to be the reason not to hire someone, it needs to be fairly enforced.

"So when will they be hiring people based on weight? Being overweight is just as dangerous as smoking"

Unless I can catch fat off someone, no.

Unless I can become physically addicted to fat, no.

PS the other option would be to ban cigarettes completely.

"So when will they be hiring people based on weight? Being overweight is just as dangerous as smoking"

"Unless I can catch fat off someone, no. Unless I can become physically addicted to fat, no."

Hm. I think you're missing the point of my comment. I'm not talking about smoking's effect on others, I'm talking about hiring practices in light of insurance bills. If employers are looking at a person's health (smoker? gonna cost me $ in ins) they should also look at a person's weight. In fact, if they're not going to hire people because they smoke and they cite health reasons for that, what about people who like to ski? Or have kids on the cheer leading squad? These are dangerous activities that could cost employers and insurance companies plenty. Where do you draw the line?

"I'm not talking about smoking's effect on others, I'm talking about hiring practices in light of insurance bills."

That isn't really all that obvious from your statement.

Problem here is that you're fat whether you're eating at work or not. There are a lot of fat people. So when you haven't enough workers (because you discard the fat ones), the supply of workers is less than the demand. And therefore your payroll goes up even as your worker count goes down.

You can exist for years without management.

Try living as a company beyond the end of the current warehouse stock without workers.

So no. This isn't going to happen.

PS why must there always be a line drawn? There are two extremes that are obvious and a large area in the middle where you can go either way. No line.

I'm hoping there's a solution to all this mess. If people can just grab insurance from the new exchange pool I think that would be great.

I don't believe in smoking in the workplace. I live in Ohio and they passed a state law which prohibits smoking in any business now.

I also don't think it's fair to non smokers if the smokers are pushing premiums up in an organization. Say 50% of the workforce smokes and their claims spike through the year, the non smokers are also going to take a hit for their actions. All the premiums would rise leaving the employer to probably hand the cost down to the employees rising the employee contributions on the health plan.

I think the solution is universal healthcare, Joe.

A productive worker killed by cancer in their prime is a drain on the public.

a) they no longer produce anything
b) their family is now having to claim public charity
c) being that much poorer, the children are not going to succeed and become productive

so the "it will cost us" mantra is bollocks because it costs if you throw the ill to the wolves. And it's inhumane.

Why sell people's lives in the first place?

So pay for healthcare because it's the right thing to do (the christian thing, if you're wanting to persuade teaparty/republicans). That it will cost people innocent of wrongdoing is not a counter because if you're going that route of spending people's lives, it costs either way.

Then, if this drain on the public looking after smokers REALLY IS an economic problem: REMOVE THE TOBACCO. Make it illegal. Arrestable offence to smoke or possess tobacco products. And for those currently addicted, help them lose the addiction.

The problem is that the economic issue is a smokescreen (pardon the pun) because there's money to be made in the addiction, if only you can offload the consequences onto other people.

Whatever smoking make "cost the public" in terms of health care is compensated for by the increased amount of money gained by the taxation of cigarettes. One thing people don't realize is that if/when cigarettes go away or become illegal, the government (state and federal) will have to troll for it elsewhere. Whenever someone lights up, remember your tax burden is less because of it.

I appreciate smokers who try to be considerate: smoking outside, and far enough from doorways that people can enter and exit without passing through a cloud of fumes; disposing of their butts properly; using mouthwash.

But the fact is, I can smell smokers coming. I remember one memorable case where I was facing away from someone coming down a hallway. I was hit first by smell of stale cigarettes that had permeated their hair and clothing, and then by the overwhelming fragrance that the person doubtless thought was hiding it. And then a couple seconds later, I actually saw the person pass by me.

The hallway was outside a cardiac unit. I sure hope that person didn't live with whoever they were visiting.

That smell that clings to smoky clothes and furniture seems to be toxic itself.

That said, I don't think it actually helps anybody quit to not hire smokers. But I don't see any reason why smoking urine tests are any more invasive than the other drugs tests, particularly when you consider that those have high false positive rates, no real oversight, and can pick up on legally prescribed medications or poppy seed bagels.

I know of small companies that refuse to hire people who use fragrances because they have workers (or owners) who are sensitive to them. I think they should be able to use the same reasoning if they have employees who are sensitive to smoke.

"Whatever smoking make "cost the public" in terms of health care is compensated for by the increased amount of money gained by the taxation of cigarettes."

Really? Done the figures?

You need to include the loss of a trained adult who can no longer make a return on the time and money invested in training them.

Give me cigarettes or give me death!!

They'll have to pry my cigarettes from my cold, dead, umm ok then.

By Uncle Fester (not verified) on 18 Feb 2011 #permalink

Funnily enough, if I recall correctly (and my memory is really foggy on this point), smoking is already listed in Oregon's labor laws as an illegal cause for job discrimination... right up there with gender and race.