To fight rising health care costs, companies across America are penalizing workers for a range of health conditions, including high blood pressure and obesity. Cigarette smokers and tobacco users have also been added to the list of targeted employees. In all, about 40% of American employers reward or penalize employees based on tobacco use (smoke and smokeless).

tobacco-nicotine-cigarettesIn addition, a growing number of companies are refusing to hire smokers. These employers argue that coaxing tobacco users to quit with free cessation programs or cash incentives hasn’t worked. Currently, these hiring bans against smokers are legal in 21 states. More states are considering enacting hiring bans against smokers – about 4% adopting the policy and an additional 2% planning to do so next year, according to a recent study by the National Business Group on Health and consulting firm Towers Watson.

Most firms simply ask job candidates if they smoke, but a few require candidates to take urine tests to be screened for nicotine. As part of the background check, some companies are now purchasing personal information from database marketing and broker companies. In addition, nationwide specialty consumer reporting agencies, including the Medical Information Bureau Inc., collect information on tobacco usage from its member insurance companies.

“It’s unethical,” says Ezekiel Emanuel, chair of medical ethics and health policy at UPenn’s Perelman School of Medicine. Employers’ main motivation isn’t employee health, he says, but “to get the smoker off their health bill and pass on the costs to someone else.” But proponents say employers have given other methods a fair shake and need a tougher approach. David Asch, who co-wrote the academic paper in support of the ban, says that with hiring bans, smokers face a social consequence that is potentially more painful than nicotine withdrawal.

To be sure, employers say they have tried gentler measures, only to have poor results. For example, The Cleveland Clinic, which imposed a hiring ban on smokers in 2007, has seen positive results. Cleveland Clinic CEO Delos “Toby” Cosgrove says, “I’ve gotten a lot of thanks for this smoking ban, actually.” Below, read more from the WSJ about how “Smoking is Hazardous to Your Employment.”

Warning: Smoking Is Hazardous to Your Employment

Companies aren’t just singling out overweight employees. Staffers who smoke are under fire too.

In small but growing numbers, employers in recent years have been refusing to hire smokers, arguing that coaxing tobacco users to quit with free cessation programs or cash incentives hasn’t worked. Some medical experts back the bans, saying the end result of reducing smoking is worth it. But other health-care experts say the policy crosses an ethical line by singling out poorer and less educated groups who, federal data shows, smoke more often.

In all, about four out of 10 employers reward or penalize employees based on tobacco use. But hiring bans, which are legal in 21 states, are gaining traction, with about 4% adopting the policy and an additional 2% planning to do so next year, according to a recent study by the National Business Group on Health and consulting firm Towers Watson. Most firms simply ask job candidates if they smoke, but a few require candidates to take urine tests to be screened for nicotine, as part of a broader drug test.

To date, along with some casinos, the bans have been most commonly followed by health-care employers, including Danville, Pa.-based Geisinger Health System and Baylor Health Care System, based in Dallas. Not surprisingly, that has prompted a debate within the medical community. Two groups of health researchers, for example, wrote dueling articles on the topic that were recently published in the New England Journal of Medicine after the University of Pennsylvania Health System recently said it would no longer hire smokers starting this July.

Ezekiel Emanuel, who co-wrote one of the papers, argues that the practice discriminates against poorer and less-educated populations, where smoking is more prevalent. Rates are also higher for those who live below the federal poverty line and who have received less than a high school education.

“It’s unethical,” says Mr. Emanuel, chair of medical ethics and health policy at UPenn’s Perelman School of Medicine. Employers’ main motivation isn’t employee health, he says, but “to get the smoker off their health bill and pass on the costs to someone else.” (A spokeswoman for the school says the new policy isn’t intended to be “discriminatory in any way” and is just aimed at reducing smoking.)

But proponents say employers have given other methods a fair shake and need a tougher approach. David Asch, who co-wrote the academic paper in support of the ban, says that with hiring bans, smokers face a social consequence that is potentially more painful than nicotine withdrawal. “We’ve tried a lot of things to quit smoking,” says Mr. Asch, a professor of health care management at UPenn’s Wharton business school.

To be sure, employers say they have tried gentler measures, only to have poor results. At Cleveland Clinic, which imposed a hiring ban on smokers in 2007, CEO Delos “Toby” Cosgrove says he first tried banning smoking on the property and offering free cessation treatment—but that as long as the company continued to hire smokers, it was like “a doctor smoking a cigarette and telling you to stop smoking,” he says. After the initial skepticism, he says, “I’ve gotten a lot of thanks for this, actually.”

With ever higher health care costs, private companies will continue to impose penalties and hiring bans against tobacco smokers, workers who use chewing tobacco (smokeless tobacco) and e-cigarette users (vapor cigarettes).

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