Smoking Cessation, Surcharges, Bans and Health Care Costs

Friday, December 03, 2010

The evidence of the harm caused by smoking and tobacco use has been well known and documented for several decades. Smoking, according to the U.S. Surgeon General, accounts for 443,000 deaths and cost $198 billion dollars in health care costs annually.  Yet millions of Americans continue to smoke, the CDC estimates that 43 million Americans are active smokers.  Furthermore, the U.S. Surgeon General reports that each day 1,000 teenagers start smoking.  While tobacco use is known for its relationship to cancer, it is just as correlated to co-morbidities such as:
                              

    • Heart disease

    • Cerebrovascular disease

    • Chronic bronchitis

    • Emphysema

    • Stomach ulcers
                                   

To address health care issues associated with smoking and tobacco use, many employers have taken steps to support cessation and employers are beginning to implement smoker surcharges and bans. Smoker cessation programs are designed to assist smokers in quitting. Surcharges are additional charges paid by smokers to obtain medical, Rx, dental, and/or life insurance coverage. Smoker bans are outright bans against smoking even during the employee’s non-working time. The logic is simple, if you smoke and/or use tobacco products; your likelihood is significant that you will require more health care than a non-smoker will, thus you should contribute more towards the cost of that health care.

Oddly, employees and even the American Civil Liberties Union object to smokers being charged more than non-smokers based on “lifestyle discrimination”. The concept of Lifestyle Discrimination is associated with numerous private, off-duty time activities engaged in by employees and includes tobacco usage.  While this author will not attempt to address the legal issues surrounding employment rights and Lifestyle Discrimination, he will attempt to highlight issues behind an employer’s basis for smoker surcharges and bans.

Smoking and tobacco use is widely accepted to be the precipitator of several health care issues. Employers who provide employee health care absorb some portion of the costs associated with those health care expenses. Aside from the direct health care monetary cost, tobacco users, in general, have higher rates of absenteeism. As such, organizations with high rates of smoking and tobacco use are at a competitive disadvantage compared to organizations with lower rates of smoking and tobacco use due to higher health care costs and relative increases in rates of absenteeism.

Smoker cessation programs, smoker surcharges, and smoker bans are attempts by employers to control the cost of production in the same manner that employers attempt to control the cost of any products or services, which lead to production. Employers have a genuine desire to promote and maintain the health and well-being of its workforce and family as a means of being a corporate citizen in the same manner that organizations support cancer research and prevention of birth defects.