Get healthy or get fired

The Baltimore Sun

LANSING, Mich. -- Get ready to say goodbye to the days of high-fat meals, junk-food snacks and that after-work cigarette you always enjoy smoking - at least if you intend to have a job and health insurance.

The rules of the workplace are changing, and personal behavior and lifestyle habits - those unrelated to what you do at work - are now fair game for employers determined to cut health-care costs.

If you smoke, you might not get hired or you could get fired. If your cholesterol is too high, you can pay higher premiums for your insurance. The same goes for blood pressure, body mass and blood glucose levels. The requirements embraced by a growing number of companies are encroaching on privacy and raising questions about who will qualify for health insurance, as well as employment.

"Employers are trying to thin out their health-care costs, by any means necessary," said Jeremy Gruber, legal director for the National Workrights Institute of Princeton, N.J. "We're only seeing the beginning of this. Employers started with smokers. Now they're moving on to the general population."

Indianapolis-based Clarian Health has told its 13,000 employees that, starting in 2009, it will charge them $5 per pay period if they use tobacco or exceed specified levels of cholesterol, blood pressure and other measurements. Penalties could reach $30 per paycheck.

The Cleveland Clinic, on Sept. 1, started nicotine testing in pre-employment physicals. If nicotine is found, applicants will not be hired.

And Weyco Inc., a Michigan firm that drew national attention in 2005 when it fired four employees who used tobacco, has expanded the health insurance requirement, penalizing employees whose spouses smoke or chew tobacco. Penalties are $50 per employee paycheck.

Although thousands of employers have put in place incentives for their workers to live healthier lifestyles, the vast majority of employers have not embraced the approach of penalizing employees who don't satisfy medical or behavioral dictates.

But punitive measures are gaining a foothold in the workplace, according to lawyers and groups that follow insurance and employment trends, because health-care costs are growing at high single-digit to double-digit rates annually.

The question for employees is: How far will these requirements on personal habits and penalties go, and what sort of criteria will employers use to define good health?

"Your privacy is being whittled away, piece by piece," said Anita Epolito, who was fired by Weyco, a health benefits administrator, in 2005 after refusing to stop smoking.

"They're trying to change behavior after 5 o'clock," Epolito said. "What's next? No McDonald's? No caffeine? No Krispy Kreme?"

Gary Climes, vice president and general manager of Meritain Health Michigan, which now owns Weyco, noted that the firings did not violate Michigan law and that Weyco's 150 employees have, over time, accepted the new rules.

"It really comes down to a personal choice as far as do you want to be employed here," Climes said. "We're putting that on the employee to make a choice."

Weyco performs random testing every three months, usually covering about 30 employees, Climes said. They'll get a call at their desks asking that they come to a room and blow into a Breathalyzer-like device that measures carbon monoxide levels. If the reading is higher than a certain level, employees will be directed to submit to a urine test. If they fail the urinalysis twice, they will be dismissed. One person was fired in 2006, Climes said, and none this year.

Obesity and galloping health-care cost increases for many employers have fueled the movement to reduce employer costs.

"Costs are spinning out of control, and companies don't want to be left holding the bag," said Chicago lawyer H. Candace Gorman, who specializes in labor and employment law.

"They will cut as many people for whatever reasons they can get away with. Until Congress steps to the plate and joins the rest of the Western world in mandating universal coverage, the employers and insurance companies will whittle away the coverage, hoping that only the healthy will be covered."

Political critics of the Weyco firings have launched an effort in the Michigan Legislature to outlaw the practice, but it faces stiff resistance from the state's business community, led by the Michigan Chamber of Commerce.

Wendy Block, the chamber's director of health policy and human resources, said the Weyco firings have created "negative PR" for the company but added that her organization opposes any effort to restrict the freedom of employers to control costs. Most employers, Block said, do not penalize employees.

Toni Talbot, a human resources consultant, said firing employees for tobacco use is "bad policy" and "intrusive."

"Do I want people to live healthy lives? Yes," Talbot said. "Do I want to get into their daily lives? No."

That line is blurring. In 2006, Scotts Miracle-Gro Co. fired one of its employees in Massachusetts after discovering that he smoked. The employee has sued the company, alleging that the dismissal violated his civil rights.

Although anti-discrimination laws in 30 states and the District of Columbia outlaw what happened in Michigan, there are few clear limits on how far employers can go when it comes to hiring and insuring people who are not disabled.

That void has created the current changing climate and all the questions about what might come next.

Tim Jones writes for the Chicago Tribune.

Tightening up

If you smoke, you might not get hired or you could get fired. If your cholesterol is too high, you could pay higher premiums for health insurance. The requirements embraced by a growing number of companies are raising questions about who will qualify for health insurance, as well as employment.

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