Fort Worth no-smoking proposal pits employers' healthcare costs vs. personal freedoms

The Fort Worth City Council's consideration of a policy against hiring smokers has stirred strong opinions.

Some see a slippery slope toward employment discrimination while others consider it responsible promotion of workplace wellness.

While such a move would be rare for a city, employers everywhere are getting more involved in their employees' lifestyle decisions that affect health, experts say. Companies and some government agencies have crafted policies that range from banning smoking to charging penalties on the healthcare benefits of overweight workers.

"Their ultimate goal is to make their employees healthier, and there is a direct correlation between that and reducing healthcare costs," said Danny Cooner, president of Safety First, a division of Behavioral Health Systems, a company that helps employers enact wellness and smoke-free campaigns.

A surge in bans on the hiring of smokers has led 29 states to enact laws protecting smokers, but Texas is not among them.

Several large companies with such bans say they have worked well.

The 19,000-employee Baylor Health Care System's hiring policy took effect Jan. 1, and it has seen no decline in job applications, said Becky Hall, vice president of health and wellness. Less than 3 percent of job offers have been rescinded because urine tests suggested that the candidates used nicotine.

Fort Worth and numerous private companies have inquired about the policy, she said.

"We have been pleasantly surprised by the amount of outreach we've been getting from other businesses asking how we implemented this," Hall said.

Union Pacific Railroad, which has 45,000 employees nationally and 8,000 in Texas, instituted a similar policy in 2005.

But such policies invite questions about whether they infringe on personal freedoms.

"I think it's opening up a can of worms," said Vince Chasteen, president of the Fort Worth's employees association. "It's one of those things where you do not want to hire anybody for a variety of reasons, like a pre-existing health condition, like heart disease or cancer. Next thing you know they're going to say you can't eat at a fast-food restaurant."

Concerns about proposal

The City Council will hear a presentation on the no-smoking hiring proposal May 8 but will not vote on it. Mayor Betsy Price has stressed that the concept originated as a city employee's idea to reduce costs as part of the Mayor's Big Idea campaign.

A 2009 study by the Journal of Tobacco Policy and Research found that smokers take more sick days than nonsmokers.

The U.S. Centers for Disease Control and Prevention puts a $3,391 price tag on each employee who smokes: $1,760 in lost productivity and $1,623 in extra medical expenditures.

Other government entities have instituted hiring bans on smokers, including Sarasota County, Fla., according to news reports.

Several Fort Worth council members, however, have indicated that they are uncomfortable with the idea because the city could miss out on qualified candidates.

Councilman Jungus Jordan, an ex-smoker, said that he supports offering employees incentives to quit smoking but that he can't support practices that deny employment because of bad habits.

A larger trend than hiring bans is the expansion of penalties or rewards to encourage participation in smoking cessation courses, said Steve Wojcik, vice president of public policy for the National Business Group on Health.

More than three-quarters of large employers offer such programs, according to a National Business Group on Health/Towers Watson survey. About 45 percent of those companies use incentives, such as imposing surcharges on employees who do not take part, he said.

Laws allow employers to impose an incentive on an employee who fails to participate in reasonable programs, he said. The incentive can be up to 20 percent of the cost of insuring that person. The average incentives in 2011 were about $300 per individual employee and $600 per family.

The 2010 healthcare overhaul, if it stands, would increase that incentive cap to 30 percent by 2014, he said.

That impending change has some organizations worried that companies will punish people for health conditions that they can't control. The American Cancer Society was among several organizations that expressed concern in a letter to federal officials last year.

"We are deeply concerned that without the inclusion of effective and enforceable consumer protections, the current regulations could be used as a back door to medical underwriting for individuals with pre-existing health conditions or disabilities based on their health," the organizations wrote.

Promoting wellness

Smokers are not the only ones feeling heat from employers. Also on the rise are wellness campaigns, including some that use incentives to encourage employees to participate in weight loss programs.

Some companies measure employees' height, weight, blood pressure and cholesterol and then craft a wellness campaign to target whatever prevalent health issues are discovered, Cooner said.

"If 10 percent of your workforce has high blood pressure, 10 percent is diabetic and 10 percent has high cardiac risk factors, then you've got a formula for very high costs," he said. "You've also got to think about productivity."

A hospital in Victoria has made headlines for a hiring policy in which it reportedly does not hire people who are too overweight. Applicants with a body mass index over a certain level are not considered.

Alabama also imposes a $25 monthly health insurance surcharge on state employees with certain body mass indexes, Cooner said.

Employees may be able to avoid extra charges if they can show a medical reason why they cannot achieve a health outcome, such as a thyroid condition contributing to obesity, Wojcik said.