Smoking And Health Care Reform Research Paper

Team Research Paper: Smoking and Healthcare Reform

Introduction

In recent years, following the Affordable Care Act becoming law, business has taken a blow at the hands of the government. As the Act continues to be slowly implemented, many companies have adopted new practices in an attempt to cut the costs of healthcare, while still maintaining the benefits already set in place for employees. Among these practices is refusing employment to smokers. Although this practice is not entirely new to companies, it is becoming a more popular option for those looking to save on premiums wherever possible. So this begs the question, is it socially responsible to discriminate against potential employees based on their use of cigarettes? This is a question

that remains to be answered. Like many ethical issues, the situation is not clear cut and there is legitimate justification for both sides. Upon reading this essay, the reader should be well informed of the implications and consequences of refusing to hire smokers within a corporation, and be able to form an educated opinion of the ethical question this practice raises.
This essay will map out an in depth analysis and evaluation, beginning with defining the facts and assumptions of the issue at hand. From there, the major issues, sub-issues, and related issues of the topic will be outlined, leading to the identification of all stakeholders. An analysis of the issue will be done, with respect to the corporate social responsibility perspective of the economic, legal, ethical, and philanthropic implications of the practice. An evaluation of the subject will then be conducted, followed by a recommendation to the corporate world for improved social responsibility. This should serve as an outline of the essay, as well as a guide to analyze and conduct an educated opinion of the issue.

Facts and Assumptions
What started as a move towards smoke-free work environments is evolving into a refusal to hire smokers all together by businesses, and requiring applicants to take a nicotine test as a screening tool. Although there are some companies who have had policies barring employment of smokers for up to 20 years, such as Alaska Airlines, Union Pacific, and Turner Broadcasting, only recently has this become a trend. Hospitals in several states have implemented such practices in the last few years, such as Baylor Health Care System and Methodist Hospital System, and many companies have followed suit (Deschenaux, 2011) (Roberts, 2014). According to those who have delved deeper into the issue, “the increasing cost of health insurance (as well as anxieties regarding the unknown long-term effect of health-care reform) may have motivated recent hiring bans” (Roberts, 2014, p. 581). There are a number of reasons why an employer would choose not to hire people who smoke, one being the higher insurance costs that come with covering a smoker (Irvine & Nguyen, 2014). The Employer Shared Responsibility Mandate under the Affordable Care Act requires that all companies with 50 or more full-time employees, or a mixture of full-time and part-time employees whose weekly hours equate to 50 full-time employers, provide a shared, affordable healthcare plan for all employees working 30 or more hours a week, or else be subjected to a monthly penalty fee (Weder, 2014). In 2011, it was estimated that the cost of healthcare and lost productivity of a smoker in the workplace averages to be about $3,391 more per year (Lessack, 2011). Pair these two facts with the rising cost of private healthcare, due to the law now prohibiting insurance companies from discriminating against pre-existing conditions and altering full-time employment from 40 hours per week to 30 hours per week, and it comes as no surprise that employers are seeking to cut corners wherever they can.
For many, it may come as a shock that this type of prejudice is legal.

Currently, there is no federal law forbidding this type of discrimination against applicants that is clear-cut enough to give smokers any advantage in this issue. Many claim that banning the hiring of smokers is disability discrimination, as nicotine is an addictive drug, and that smokers are protected under the Americans with Disabilities Act. Others argue that a nicotine addiction does not qualify as a disability because it does not impair to a far enough extent. Whatever the argument, it has yet to be decided if someone can use the ADA to successfully overcome smoker discrimination (Lessack, 2011). However, all is not lost for those in need of a nicotine fix. As it stands, 29 states, and the District of Columbia, have outlawed smoker-free policies (Deschenaux, 2011). Of those 29 states and the District of Columbia, “18 jurisdictions have enacted statutes prohibiting discrimination against smokers", “eight states protect the use of lawful products”, and “four states offer statutory protection for employees who engage in lawful activities” (Deschenaux, 2011, p. 44). Texas is not one of these states, and still allows for companies to ban smokers from employment in the

workplace.
Some other reasons employers give as justification for deeming smokers as unqualified are that smokers miss work more often due to sickness, smokers are less productive, and the employer is filling a moral obligation to encourage smokers to quit, as “smoking is bad for health and smokers do not behave in their own best interests” (Irvine & Nguyen, 2014, p. 753). Although it is true that the effects of smoking are detrimental to health, it is an assumption that the increase in banning employment for smokers is just a loophole for employers to dodge some of the effects of the Affordable Care Act.

Major Issues
There are many good arguments to be had in the opposition of this new trend.

Those who are against smoker discrimination contend that placing employment restrictions on smokers, while may be meant for the good of society, will have an adverse effect on smokers, perpetuating health disparities, by taking away needed income which makes it harder to obtain health coverage. Therefore, the policy, intended for the greater good, could result in negative consequences that outweigh the benefits, implying that there is a double effect to the situation (Roberts, 2014). Another argument is the very obvious issue of personal liberty. No company should be able to dictate what an employee does while off the clock. A company that sets a smoker-free policy is unfairly using their power to control parts of workers’ lives that should be left to the discretion of the worker alone. Smoker discrimination is an indirect way of forcing a worker to live a life parallel to what the employer considers acceptable by withholding the right to make a living. This creates a “might equals right” justice system, where the companies who hold all of the money hold the power to dominate workers, who will be obliged to adhere to such standards in order to feed their families. Although the amount of companies employing this strategy is limited for now, if the numbers continue to grow, there are forty-seven million Americans who will end up out of work or be forced to quit participating in a completely lawful

activity, essentially against their will (Deschenaux, 2011). Finally, by refusing to hire smokers, some of a position’s best and most qualified candidates may be overlooked. Although statistics may not be in favor of smokers and their ability to deliver, a statistic is never sufficient enough to define a single person from a group of people, and it is unfair to ban a group of people from working somewhere based on statistics.
There are compelling arguments for those in favor of such smoking prohibitions as well. Although, in your typical workplace, employee healthcare does not come directly out of the company’s pocket, the group premiums they are able to offer accounts for a part of an employee’s compensation in the form of benefits. The lower premiums a company can offer, the better the benefits they can offer, which in turn, will allow them to employ more valuable employees. Since the premium rates a company offers are based off of the overall health of the company, the company will have the ability to offer lower rates if they do not have employees with higher risk of health issues serving as outliers. Smokers cause higher premiums, which ultimately costs employers more money, as they will have to make up for the higher premiums in some way (Lecker, 2009). Hiring only non-smokers saves the company money, in a sense, because if they can offer superior benefits, they do not have to compensate for higher costs with higher wages. There are also companies whose insurance benefits for employees do come directly from the employer’s account. Some employers will pay the premiums for their workers, and there are also those who use self-service insurance by way of an administrative service only contract (Herman, 2015). In cases of ASO contracts, employers cover the medical claims expenses for their employees and “take on the financial risk of employees’ health” (Herman, 2015, pp. 7). Companies who insure their employees in this way want the healthiest people they can get. Aside from healthcare, there are other cost related reasons for a company to refrain from employing smokers. A 1998 study showed that smokers have a 50% higher rate of absenteeism than their counterparts (Lecker, 2009). A study also showed that smokers spend 39 less minutes per day working as opposed to non-smokers, due to smoke breaks (Lecker, 2009). Other conclusions made from studies are that smokers are more likely to be injured on the job due to accidents, and that hiring smokers can also result in significant property damage from the odor and cigarette burns (Lecker, 2009).