Penn Medicine decision not to hire smokers part of a controversial trend

Penn Medicine's decision to hire only nonsmokers starting July 1 is part of a slow-moving trend that goes back decades and that is still controversial even among public health workers, who often see tobacco as enemy No. 1.

"I'd be much more enthusiastic about them providing programs" - which Penn also does - "to help employees stop smoking," said Kathleen Sebelius, U.S. Health and Human Services secretary, who was asked about the decision Wednesday during a visit to The Inquirer.

Some large national companies, such as Turner Broadcasting, stopped hiring smokers in the 1980s. Twenty-nine states, including New Jersey, outlawed the practice as discriminatory. As a result, the University of Pennsylvania Health System's new policy will apply only in Pennsylvania.

Hospital systems, citing their mission of caring for patients and serving as community leaders as well as a need to save money on employee health insurance, have taken the lead with various tobacco policies in recent years. Smoking is now prohibited on all hospital campuses in South Jersey and on most in Southeastern Pennsylvania.

The Cleveland Clinic was among the first to stop hiring smokers. Among the large systems that followed were Baylor and the Geisinger Health System in central Pennsylvania.

Locally, St. Luke's Hospital & Health Network in the Lehigh Valley was an early adopter, in 2010. Abington Memorial Hospital joined a year later. Roxborough Memorial Hospital stopped hiring smokers on Sept. 1.

"It's been a non-event," said Roxborough administrator Michael Henrici, adding that one potential employee had been turned away.

When the decision was announced to the medical staff, "they actually broke out in applause," he said. "The goal is to be a leader in the community here in Roxborough in establishing a healthy workplace."

Henrici said the hospital got more complaints two years ago when it implemented a health insurance surcharge, now $25 every two weeks, for employees who smoke. Like other hospitals, Roxborough offers free smoking-cessation programs to workers and has grandfathered in smokers already on staff.

Penn added a $15 biweekly surcharge in 2012 to the 11 percent of its 17,500 employees who declared they used tobacco.

In a description of the policy, Penn notes that the Centers for Disease Control and Prevention estimate that smoking and exposure to second-hand smoke contribute to 443,000 premature deaths a year and $193 billion in annual health-care costs and lost productivity.

Employers, who have long been prohibited from charging workers more for group health insurance due to preexisting medical conditions, have nevertheless been able to require workers to pay more based on smoking and other behaviors if the companies have wellness policies.

The federal health-care overhaul expands that policy. And though the new law outlaws discrimination due to medical conditions for the first time in individual policies, it makes an exception for tobacco use, allowing a surcharge of up to 50 percent, said Karen Pollitz, a health insurance analyst at the Kaiser Family Foundation in Washington.

Some see hiring as a different issue.

"The tobacco companies made a highly addictive product, and it is difficult to quit," said Cynthia Hallett, executive director of Americans for Nonsmokers' Rights, a Berkeley, Calif., group that fights for smoke-free workplaces nationwide but that has not taken a position on hiring. "I don't know that we can penalize people who are addicted to cigarettes because that is exactly what the tobacco companies wanted to do."