"There are precedents for employers to reach beyond the doors of the workplace, but my hope would be to go the other way; to educate and show how smoking affects productivity and long-term health and your family," he says. "My direction would be to expand the incentives for people not to smoke, to be clear in the hiring that there is an expectation down the road that no quarter is given for people who smoke."
Smokers at Gundersen are encouraged to join support groups, and they can get cash incentives for passing risk assessment tests that measure smoking.
"There are no penalties, but we have made it pretty clear that the organization is not responsible to support your habit by giving you any special breaks or times compared with coworkers," he says. "You have to carry your own load."
About 21% of Wisconsin adults smoke. At Gundersen, 12% of employees smoke. The health system boasts that it has seen a 40% decrease in the number of employees who continue to smoke once they've been in the organization at least five years.
As healthcare costs continue to soar well above the Consumer Price Index, Thompson—like Nicholas—believes more employers may take the hard-line stance against hiring smokers.
"Employers are going to get more and more anxious about how expensive the delivery of healthcare is and they will do things that they can control that they believe can help reduce costs," he says.
Perhaps even hard-pressed employees may soon call for a ban on hiring new coworkers who smoke, if it's determined that the policy provides some relief from crippling annual healthcare premium hikes. After all, 80% of Americans don't smoke, and that number is growing every day.