Will being fat outweigh job skills?
It’s a relevant question after Geisinger Health System announced last week it will no longer hire people who test positive for nicotine. Starting Feb. 1, those who smoke cigarettes and cigars or use any form of smokeless tobacco need not apply.
The move narrows the job prospects of many in northcentral Pennsylvania, where Geisinger employs 15,000 and hired nearly 3,000 last year.
Geisinger cited assorted motives, including setting a strong anti-tobacco example and creating a healthier environment for patients and employees.
But it acknowledged that reducing employee health care costs — tobacco is a huge contributor to illness — is another goal.
Virtually all employers who provide health benefits share that goal, so others might well follow Geisinger’s lead.
Health care organizations would seem likely to move first, since they’ve led the way on policies such as stamping out tobacco use on their premises.
About five years ago, most Harrisburg-area hospitals and several other health care organizations simultaneously announced tobacco bans on their premises.
Holy Spirit Health System took it even further, making it a work policy violation to use tobacco during work hours — even if they left hospital property.
Following Geisinger’s announcement, several Harrisburg-area hospitals said they too have considered drawing the line at hiring tobacco users, but opted against it.
At least for now.
“We’ve had discussions but there’s no active plan to take that step right now,” said Jean Waverka, a Holy Spirit spokeswoman.
Megan Manlove, a Penn State Milton S. Hershey Medical Center spokeswoman said: “We haven’t made any decision yet, but we have been looking at and following the issue.”
PinnacleHealth System likewise said it held such discussions, said spokeswoman Christina Persson.
Several other large local employers were unwilling to discuss the subject. Rather, they pointed to wellness programs they use to help employees change unhealthy behaviors including smoking.
Still, employers believe it’s within their rights to impose such policies — and a right ever-rising health care costs might force them to exercise.
In announcing its intent to screen out tobacco users, Geisinger noted Pennsylvania is one of 20 states that allow such a policy.
“If this was a government mandate, that’s when we would be opposed to it,” said Lesley Smith, a spokeswoman for the Pennsylvania Chamber of Business and Industry. “If it’s legal, which it is in Pennsylvania as I understand it, then the employer should have the ability to make those decisions that are best for their operation.”
Smith said the policy might become widespread given the burden of employee health care costs.
“Obviously for small businesses, health care costs are a great concern and many are looking for whatever they can do to control costs,” she said.
HOW FAR CAN THE BUSINESSES GO?
If employers were to begin shunning additional applicants with potentially expensive health risks, next in line would likely be people who are obese, and those with adult-onset diabetes.
Both are often related to lifestyle choices, and both are major contributors to medical costs.
Still, it’s unclear how far businesses can go.
On one level, it seems legal for Pennsylvania employers to screen out applicants who have high body mass index — BMI — and maybe those with diabetes.
But the employer would surely be flirting with legal challenges, said Solomon Krevsky, a Harrisburg-based lawyer and expert on employment law.
Krevsky noted that people with medical conditions that amount to a disability are protected by the Americans With Disabilities Act.
Court rulings have been mixed on whether obesity is a protected disability, he said. But an employer who excluded job seekers who are obese also would invite a legal challenge.
“I think an employer would be on a tightrope,” he said.
And an employer who sought to exclude diabetics would be on even shakier ground, since the diabetes could stem from medical factors beyond the applicant’s control, Krevsky said.
“I believe an employer would steer clear … it would almost certainly come under attack,” he said.
Dennis Scanlon, a Penn State professor of health policy and administration, views the Geisinger policy as a further swing of the pendulum toward penalizing people with behavior-related health risks.
He believes it’s logical for employers to at least consider applying the approach to people who are overweight or have diabetes.
On the other hand, he notes that while health care costs connected to smoking, obesity and diabetes are significant, they account for only a portion of total health care costs, so many other tactics will be needed to solve the health care cost crisis.
Scanlon further views the Geisinger move as another step in the direction of penalizing people who engage in unhealthy behaviors.
For a long time, the approach was to share the costs of unhealthy behaviors, which were borne by health insurance plans and government programs such as Medicare.
But rather than screening out job applicants with unhealthy behaviors, Scanlon believes the more likely path might be toward requiring people with such behaviors to pay more toward health care, even with government programs such as Medicare.
“We’re entering a really interesting time when I wouldn’t be surprised to see more of this,” he said.
QUESTIONS OF PERSONAL RIGHTS
Capital Blue Cross, whose anti-tobacco stance includes a smoke-free campus, said it has no plans to draw the line at hiring nicotine users.
Capital, which collaborates with employers to reduce health care expenses, further said it senses no trend toward avoiding employees with obvious health risks.
According to Capital, businesses are mostly focused on using workplace wellness programs and related incentives to encourage people to change unhealthy behaviors such as smoking and being overweight.
“We encourage customers to create an environment that leads to healthy changes,” said Kelly Shreve, Capital’s manager of health education and wellness.
Interestingly, that approach remains central even at Geisinger.
For example, Geisinger said it won’t randomly test employees hired under the new tobacco policy to ensure they remain free of nicotine. (The policy applies only to people hired after Feb. 1; present employees aren’t affected.)
Rather, the new employees would be expected to admit their tobacco use when completing annual benefits-related paperwork. They would subsequently be encouraged to participate in a tobacco cessation program and, beginning in 2013, they would have to pay slightly more toward their health care.
A Geisinger executive said the approach is related to maintaining trust, and being consistent with other policies, such as Geisinger’s illegal drug policy, which requires pre-employment testing, but no random tests after the person is hired.
But what about individual rights?
Beyond that, companies that screen out people with unhealthy behaviors risk offending the public and customers.
They further risk screening out talented employees, although that concern might be at a low ebb given the high unemployment rate.
Lewisberry resident John Miller see the Geisinger policy as a possible threat to personal rights.
“I don’t think it’s right,” he said. “What you do at home is your business. It’s taking away people’s freedom. They are putting too many restrictions.”
A Harrisburg woman who didn’t want her name published said: “I would call that kind of like a discrimination. I respect the decision but I don’t think that’s going to be a good idea. It doesn’t seem fair. There’s a lot of smokers out there. At least they should give them their spot were they can relax. I know smoking is not good for your health but people choose to smoke. It’s a choice the person makes.”
Another smoker, who lives in Camp Hill, said: “It’s probably a good idea … It will give an extra boost to quit.”
She also said smoking can hurt production. “I’ve worked with people who are constantly sneaking out for cigarettes,” she said.
Yet the woman, who wants to quit, said she tries to keep her children away from public places where people smoke.
“I don’t want them inhaling it,” she said. “Just the smell of it. When you walk into a nice office and somebody is reeking of it, it’s kind of a turnoff.”
BY DAVID WENNER AND IVEY DeJESUS