Tobacco Facts.

Winston-Salem workers who use tobacco will be eligible only for the city’s basic health-coverage plan.

A new city policy will try to save money by raising health-insurance premiums for municipal employees who use tobacco products, a change that has some workers upset.

Starting in January, health-insurance premiums will go up by an undetermined amount for city employees unless they take a test to prove they are tobacco-free, defined as having no nicotine in their body.

In addition, for the first time, people who smoke or use other tobacco products will be eligible only for the city’s basic health-coverage plan. They will not qualify for the city’s Basic Plus health plan, in which the city covers more costs.

Martha Wheelock, an assistant city manager, said that health-care costs are still being analyzed and the exact amount of the premium increase is not yet clear, although a preliminary figure of $20 per month was given in the city’s proposed 2010-11 budget.

Wheelock said that having tobacco users pay more for health insurance continues a trend of trying to keep down costs overall.

“We as a city have talked about smoking in particular for a number of years, at least internally, and I think we’re ultra-sensitive to the topic given where we live and the roots of our city,” she said.

The city’s projected health-care costs for 2010 are $20.9 million — up 10 percent. Winston-Salem is self-insured; BlueCross BlueShield of North Carolina administers the city’s plan.

Last year, all premiums went up 25 percent, but those who joined an expanded wellness program and took biometric tests were eligible to pay the old amount. About 80 percent to 90 percent of employees took the screening.

Wheelock said it is too early to know how much the changes planned for January will save the city. She said the city doesn’t break down its health-care costs by source, so there are no exact figures for how much smoking costs the city. But she said studies suggest that curbing smoking would be fruitful.

“The trend data shows that over time, this will save us and the employees themselves money,” she said.

Testing has found that 500, or 14 percent, of the 3,600 covered city employees and retirees use tobacco products. But because not everyone took the tests, the percentage likely is higher, Wheelock said.

With the program, Winston-Salem joins a growing number of government employers, including the state of North Carolina, in attempting to cut costs by improving employees’ health.

Under the state health plan, which also covers teachers, smokers are limited to a plan in which they pay 30 percent of medical costs, while nonsmokers or those in programs to quit pay only 20 percent of medical c osts. The plan’s smoking component is projected to save the state $13 million for the 2010-11 fiscal year.

Of North Carolina’s major cities, Winston-Salem is the only one adopting such a change, although Charlotte is considering restricting smokers to a higher-deductible plan next year.

The nicotine tests will likely be given yearly, Wheelock said, but other than that, the city hasn’t yet decided how to enforce the new policy. There are no plans for random testing for compliance, an idea considered for the state plan but discarded last month.

The city’s plan was announced in May, although rumors had gone around for months. Normally, the city makes health-coverage announcements in the fall, but Wheelock said the statement was moved up because it was likely to affect employees more than usual.

“I think we’re going to work extra hard to explain it to our employees,” Wheelock said.

The plan already has some smokers concerned. The city banned employees from smoking in city buildings two years ago, and some people said they thought the continued restrictions were unfair to smokers.

“It’s a little harder to quit than they think,” said Mickey Ferguson, a heavy-equipment operator for the streets department. Ferguson, a smoker, was among several employees who expressed reservations with the plan.

The city will again offer smoking-cessation classes to employees, and it started paying for anti-smoking aids last year.

About 50 employees took the smoking-cessation classes last year. City officials expect as many as 175 to take the classes during the 2010-11 fiscal year. Workers said that the classes have helped some people quit — but some stopped attending or saw few results.

Jeff Goins, a technician in the city’s parts department, has smoked for years, although he’s tried to quit several times. He was in the first round of classes, and they helped him kick the habit — but only for 4½ months. He said he didn’t plan on taking the classes again.

“It’s a waste of time. I know I have a problem,” he said. “I have to go with their policy, but I don’t think it’s a fair decision.”

By Sarah Morayati
Journalnow: June 15, 2010

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