Next year, states will begin implementing major provisions of the Affordable Care Act, the most controversial of these being the “individual mandate”—which requires all Americans to have health insurance, and the establishment of private exchanges where the uninsured can purchase coverage.
Buried within the minutiae of more than a thousand pages of new legal code are a number of so-called “wellness programs” designed to encourage Americans to take a more proactive stake in their own health and well-being. Among them is a contentious clause that permits insurers in state exchanges to levy a surcharge of up to 50 percent on beneficiaries who smoke, on the grounds that tobacco users’ high-risk behavior justifies singling them out.
By one estimate the policy would amount to $5,100 a year in extra premiums for a 60-year-old smoker.
Critics of the surcharge say that it wrongfully discriminates against one high-risk behavior while ignoring dozens of others. For instance, research shows that the 34 percent of Americans who are obese add an additional $190 billion to the U.S. medical bill each year, and obese workers are 42 percent more expensive to cover than employees who are “height-weight proportionate.”
To justify this clear double standard, architects of the smoker surcharge say that while obesity is a legitimate “heath status,” tobacco use is a choice. This opens up a dangerous can of worms.
Court rulings against the tobacco industry have repeatedly described nicotine as an addictive substance, and the medical community—and their counterparts in the recovery field—have gone to great lengths to impress upon officials and the public that drug and alcohol addiction is a disease. Addicts are eligible for all sorts of temporary government aid under this assumption, including access to medical services; to make nicotine addicts pay more for health care on the grounds that their addiction is a choice risks undermining years of addiction advocacy.
Nevertheless, many private insurers already assess a higher premium on tobacco users; employees who light up at major firms like Macy’s, PepsiCo and Gannett pay an average of $500 more a year for health insurance. Back in 2005, Montgomery County came close to becoming the first county in the nation to ban smokers from government jobs (officials backed off amid a public backlash); and effective July 1, 2013, the University of Pennsylvania Health System will cease hiring smokers and assess tobacco users who are already working for the organization a higher premium.
Twenty-nine states and the District of Columbia have laws on the books expressly prohibiting employers from disciplining their workers for legal activities engaged in during off-hours, but Pennsylvania isn’t one of them. And in states where they can get away with it, a number of companies have instituted autocratic policies designed to force smokers to quit the habit or quit their job. Here’s four of the most extreme:
1. Better Pass the Sniff Test
New Hampshire-based Kimball Physics has been enforcing an austere anti-smoking policy since the 1990s, when the state ruled that it was illegal for the company to hire only non-smokers. The rules are simple: If you smoke, you can still work at Kimball, but you’re not allowed on the premises if you smell like cigarettes. To enforce the rule, employees entering the facility must pass by a receptionist who administers a sniff test. According to company policy: “No tobacco-residuals emitting person, article of clothing, or other object is allowed inside any Kimball Physics building. This restriction also applies to anyone or anything emitting characteristic tobacco odors.”
2. Light Up and Lose Your Job (Your Spouse, Too!)
In 2005, Weyco Inc., a Michigan-based medical benefits administrator, began administering a breath test to its 200 employees to identify smokers. Those who refused to kick the habit were shown the door (four employees chose to quit in protest before even taking the test). In January 2006, the company took the policy a step further by extending the non-tobacco use guidelines to employee spouses. Employees whose husbands or wives refuse to take a test or came up positive wouldn’t be fired, but the workers would be fined $1,000 a year until their loved ones quit.
3. Please Spread the Message
According to the Seattle Times, since 2002 the Tacoma-Pierce County Health Department—which does not hire smokers—has made applicants sign an “affidavit of non-tobacco use” and pledge to “educate” citizens caught smoking within 50 feet its the building.
4. Prepare to Pee in a Cup
In 2005, the Massachusetts company that makes Scotts Miracle-Gro issued a ban on smoking on or off the job and began instituting random urine tests for nicotine. The next year, the company was sued by an employee who was fired on his birthday two weeks after starting his job as a lawn-care technician because his test showed he had smoked. A federal judge ruled that the company was within its rights to fire the man because he had been made aware of the policy before he was hired. In a court filing, the attorney for the plaintiff pointed out that Scotts has no policies compelling employees to abstain from other legal but unhealthy practices, such as consuming alcohol, eating processed sugars or spreading toxic chemicals on lawns.