Health insurance increase for tobacco users/ecig users

[CANCHASER]

Ok, I am a government employee and was advised over the last year that our insurance rates would increase if we continued to use tobacco. They have given employees the oportunity to enroll and complete a smoking cessasion class in lou of paying additional rates for the year 2013. Many of my co-workers have taken it upon themselves over the last year to make the switch to ecigs and are doing wonderful. So far ok, I can live with the increase if I choose to continue to use tobacco BUT...... We received the information today they are including ecigs in the tobacco use. WTH. No where had they advised this prior to today, it said tobacco use, that's it, not ecig use.

I contacted our superiors today to argue the fact that they are supplying us with smoking cessasion and free nicotine patches/gum, how is an ecig any different than the patch. It is not tobacco but does contain nicotine. I was told they can permit the patches because they are FDA approved. They were unable to give an answer for those at work who use nicotine free juice but were very adamit that ecigs will not be allowed in any buildings. I can live with that, it's their building, I'll go outside to vape.

I believe I have gotten myself into a very large battle that I am unwilling to back down from. If anyone can give some advice on literature and other items I can research and print so that I can go into this battle well armed and fight for my constitutional right to vape and not be charged a crazy health insurance premium. Just a note, it is NOT the insurance company raising the rate but rather the government agency in which I work.


Thanks in advance for any help or advice you can give me.

 

[bryansthl]

Here print this out and show it to your superior ESC | About the ESC | ESC Press Office | ESC Press Releases | Electronic cigarettes do not damage the heart

 

[mwplefty]

Are you obligated to enroll in their insurance plan or can you choose your own? I seriously doubt that any non-governmental insurance have increased rates on e-cig users. When I go to the doctor, he asks if I smoke NOT if I vape.

 

[vsummer1]

If they are supplying nic replacement, just get some of that from them. And vape on your own time. If they test you for nicotine, you are covered. As for not allowing it in a government building, well, that is not unusual.

The government won't back down without the FDA.

But I agree with you, they are a bit misguided. Good luck!

 

[RoC1909]

I work for the State of California, and I vape at my desk and no one says a thing.

What bothers me is how about these fat .......uh, "larger" people who continue to eat and gain weight. Are they raising their insurance rates as well? Sorry to be so blunt, but that would really bother me if I switched from one habit that can kill me, and harm others around me, to another that has a extremely reduced chance of doing the same to my health, but does not harm others.

This sounds like the tobacco companies are pulling some strings in your situation and I would go tell them to go F themselves.

 

[rolygate]

The issue here is the insurance company that your employer uses. The company can set whatever terms it likes for its policies and if an employer wants to use that company and that particular policy it's up to them.

Insurance companies are not noted for being on the leading edge of anything. They make money by being well behind the times, their actuaries use data that is decades old as it is reliable. Don't expect mainstream companies to change any time in the next 30 years on the e-cigarette issue. Only a smaller company that needs the business and is prepared to take risks will do something like allowing a new alternative to smoking to be accepted as not smoking for insurance purposes.

Also note that most (but not all) insurance companies that differentiate between smokers and non-smokers require the employer to test employees once a year. The test is always a nicotine test (the urine cotinine analysis), for two reasons:

1. It's very cheap.
2. It also identifies people on NRT, classing them as smokers.

This is a necessary feature for the simple reason that about 98% of people on NRT will return to smoking. For all practical purposes, a person on NRT is a smoker. If an extremely small number of those on NRT succeed in quitting, that's good, but it hardly affects the fact that essentially NRT users are smokers. Anyone testing positive for nicotine is a smoker, in their eyes (with some justification).

Ecigs are something entirely new and won't affect major insurance companies for 30 years. They don't need to change so why should they.

 

[Vocalek]

I would have to disagree with this:

For all practical purposes, a person on NRT is a smoker.

It's only "practical" because those doing the testing opt for the cheaper test that fails to differentiate between having high carbon monoxide levels in the blood versus merely having nicotine in the blood.

Let's stay precise and insist that nobody can call us a smoker unless we inhale smoke -- and vapor is not smoke.

That would be like calling us an alcoholic for drinking root beer but (quite understanably) having a BAL of 0.0.

 

[dave8944]

I work for the State of California, and I vape at my desk and no one says a thing.

What bothers me is how about these fat .......uh, "larger" people who continue to eat and gain weight. Are they raising their insurance rates as well? Sorry to be so blunt, but that would really bother me if I switched from one habit that can kill me, and harm others around me, to another that has a extremely reduced chance of doing the same to my health, but does not harm others.

This sounds like the tobacco companies are pulling some strings in your situation and I would go tell them to go F themselves.

A few years ago all state employees in NC had to pay a higher rate if they were smokers OR if they were obese. The smoking part was enforced, but they never came to take everyone's BMI to enforce the obese part (as they said they would). It wasn't the insurance company that did it, but the state who employed the people. Luckily, it only lasted a couple of years and when the Republicans won back the legislator they repealed all those rules. E-cig.'s weren't on the radar back then, but I would have failed their test with it since they only tested if you had nicotine in your system. I'd say you ought to sign up for their smoking cessation class and just continue to vape privately. They won't know if the nicotine in your system comes from a patch or from vaping.

 

[rolygate]

I would have to disagree with this:

"For all practical purposes, a person on NRT is a smoker."

It's only "practical" because those doing the testing opt for the cheaper test that fails to differentiate between having high carbon monoxide levels in the blood versus merely having nicotine in the blood.

Let's stay precise and insist that nobody can call us a smoker unless we inhale smoke -- and vapor is not smoke.

That would be like calling us an alcoholic for drinking root beer but (quite understandably) having a BAL of 0.0.

Perhaps I can make my point clearer. I'd like especially to point out the issue of fairness for the majority, and particularly those who have a greater expectation of fairness since they have not injured anyone in any way.

Example 1
Let's forget about vapers for the first part of this argument, and imagine a situation where vapers (and Snusers) did not exist.

In this test we'll use a Carbon Monoxide test machine.

Now, if a carbon monoxide tester is used, it identifies current smokers, and might be seen as the ideal test. However, it does not identify those on NRT. We know that about 98% of those on NRT will return to smoking. Therefore the insurance company's test for smokers has missed several of them since, at the time of test, they were on NRT and not smoking. Next month, or in six months, they will return to smoking - since 98% of NRT users are smokers taking a short break. Assuming that there are higher costs for smokers, and there has been an attempt to identify them in order to defray costs and avoid placing smoker's costs on non-smoking employees, is this fair to the insurance company? Is this fair to the non-smoking employees? Is it fair to the employer? No, no, and no. Others are paying the costs of smokers who were not identified.

So, this test is fair to the successful 2% on NRT. It is unfair to everybody else as many smokers are not identified.

We omitted the fact there are Snusers and vapers, for the sake of clarity.

Example 2
OK, now let's include the Snusers and vapers. The carbon monoxide tester is used again, and it picks up all the current smokers - but misses those temporarily on NRT, plus the exclusive vapers and Snusers (i.e. not the dual-users).

A best case scenario is that many (but not all) the Snusers will stay off smoking; and many (but not all) the vapers will stay off smoking. No research tells us what proportion of vapers at at any given time will stay free of smoking - but it's not all of them. Those figures are probably available for Snus, perhaps by derivative calculation from existing data.

So it is reasonable to assume that some vapers and Snusers will return to smoking, in addition to the 98% on NRT who will fail. There is evidence that in a worst case scenario (which may be the norm), 31% of ecig users will remain smoke-free at one year; this means a failure rate of 69%. So 69% of vapers may return to smoking. As this is only the 12-month figure, it will be worse at 20 months, the final test date.

So now we have a situation where even more smokers are not identified. The carbon monoxide tester was used but many smokers slipped though the gap. Is this fair to everyone else? No.

Example 3
For this test, we'll use a nicotine test. Everyone is included and it's a real-world scenario.

The nicotine test picks them all up: the smokers, NRT users, vapers and Snusers.

The smokers have to pay the higher insurance premium (or don't get employed). So do all the other nic-positive subjects. We know that almost all the NRT users are smokers on vacation, so it's by and large a fair situation for them - unfair to a tiny minority who are almost invisible. As for vapers and Snusers, it may be the case that 50% of them (or more) will return to smoking. So I'd have to say that, overall, to maintain a balance of fairness for everybody else involved, it's fair to hit them all with an increased insurance cost. It's unfair for a percentage of the vapers and Snusers but overall they are a tiny minority when compared to everyone else involved in the cost equation.

Example 4
As above, but NRT users, vapers and Snusers picked up by the nic test can self-identify as non-smokers. They are immediately tested on the CO machine. Those who fail are placed in the smoker category, those who pass are placed in the non-smoker category but are monitored over a two-year period, by use of a carbon monoxide tester applied randomly and without warning. If they continue to pass they stay as non-smokers.

The cost of this exception process is equal to or greater than savings made by having higher premiums for smokers. In addition it can't be used for employment purposes as the majority of elective non-smokers will eventually fail.

This testing and exemption process is pointless and unfair to the majority of the other employees and to the insurance company, since everyone pays increased costs attributable to people who say they are not smokers, but who are at most say 3% of the group.


Conclusion
It's all very unfair to vapers, Snusers and the tiny, almost invisible number who succeed with NRTs. Unfortunately these are a minuscule number compared to other employees, who benefit from the reduction in costs caused by smokers. The employers and the insurance companies are also protected from unjustifiable costs. Only a tiny number of people are affected currently, and why should everyone else bear their costs?

The situation might be different in twenty years time when more than 50% of smokers will be vapers or Snusers. That means half of the smoking population, which is say 20% of the gen pop. So it will negatively impact 10% of people at that time. Perhaps when 10% are negatively affected it will be acceptable to raise costs for everyone else. It doesn't seem fair when we are talking about 3% or whatever.


Yes I'm a vaper, but I can see both sides of the argument

 

[Speedjester]

Most test check for cotinine.... Which is removed by the body quite quickly... Actually heavy smokers remove it in 24-48 hrs upon cessation and will test within normal limits...... Now for the 1 pack every 2-3 day smoker there body hold on to it and can store Cotinine in there system for a week maybe more upon cessation .

 

[Semiretired]

Is there a nic level with vaping that is low enough to avoid a positive test result or is the test that sensitive?

 

[Vocalek]

Perhaps I can make my point clearer. I'd like especially to point out the issue of fairness for the majority, and particularly those who have a greater expectation of fairness since they have not injured anyone in any way.

Example 1
Let's forget about vapers for the first part of this argument, and imagine a situation where vapers (and Snusers) did not exist.

In this test we'll use a Carbon Monoxide test machine.

Now, if a carbon monoxide tester is used, it identifies current smokers, and might be seen as the ideal test. However, it does not identify those on NRT. We know that about 98% of those on NRT will return to smoking. Therefore the insurance company's test for smokers has missed several of them since, at the time of test, they were on NRT and not smoking. Next month, or in six months, they will return to smoking - since 98% of NRT users are smokers taking a short break. Assuming that there are higher costs for smokers, and there has been an attempt to identify them in order to defray costs and avoid placing smoker's costs on non-smoking employees, is this fair to the insurance company? Is this fair to the non-smoking employees? Is it fair to the employer? No, no, and no. Others are paying the costs of smokers who were not identified.

So, this test is fair to the successful 2% on NRT. It is unfair to everybody else as many smokers are not identified.

We omitted the fact there are Snusers and vapers, for the sake of clarity.

Example 2
OK, now let's include the Snusers and vapers. The carbon monoxide tester is used again, and it picks up all the current smokers - but misses those temporarily on NRT, plus the exclusive vapers and Snusers (i.e. not the dual-users).

A best case scenario is that many (but not all) the Snusers will stay off smoking; and many (but not all) the vapers will stay off smoking. No research tells us what proportion of vapers at at any given time will stay free of smoking - but it's not all of them. Those figures are probably available for Snus, perhaps by derivative calculation from existing data.

So it is reasonable to assume that some vapers and Snusers will return to smoking, in addition to the 98% on NRT who will fail. There is evidence that in a worst case scenario (which may be the norm), 31% of ecig users will remain smoke-free at one year; this means a failure rate of 69%. So 69% of vapers may return to smoking. As this is only the 12-month figure, it will be worse at 20 months, the final test date.

So now we have a situation where even more smokers are not identified. The carbon monoxide tester was used but many smokers slipped though the gap. Is this fair to everyone else? No.

Example 3
For this test, we'll use a nicotine test. Everyone is included and it's a real-world scenario.

The nicotine test picks them all up: the smokers, NRT users, vapers and Snusers.

The smokers have to pay the higher insurance premium (or don't get employed). So do all the other nic-positive subjects. We know that almost all the NRT users are smokers on vacation, so it's by and large a fair situation for them - unfair to a tiny minority who are almost invisible. As for vapers and Snusers, it may be the case that 50% of them (or more) will return to smoking. So I'd have to say that, overall, to maintain a balance of fairness for everybody else involved, it's fair to hit them all with an increased insurance cost. It's unfair for a percentage of the vapers and Snusers but overall they are a tiny minority when compared to everyone else involved in the cost equation.

Example 4
As above, but NRT users, vapers and Snusers picked up by the nic test can self-identify as non-smokers. They are immediately tested on the CO machine. Those who fail are placed in the smoker category, those who pass are placed in the non-smoker category but are monitored over a two-year period, by use of a carbon monoxide tester applied randomly and without warning. If they continue to pass they stay as non-smokers.

The cost of this exception process is equal to or greater than savings made by having higher premiums for smokers. In addition it can't be used for employment purposes as the majority of elective non-smokers will eventually fail.

This testing and exemption process is pointless and unfair to the majority of the other employees and to the insurance company, since everyone pays increased costs attributable to people who say they are not smokers, but who are at most say 3% of the group.


Conclusion
It's all very unfair to vapers, Snusers and the tiny, almost invisible number who succeed with NRTs. Unfortunately these are a minuscule number compared to other employees, who benefit from the reduction in costs caused by smokers. The employers and the insurance companies are also protected from unjustifiable costs. Only a tiny number of people are affected currently, and why should everyone else bear their costs?

The situation might be different in twenty years time when more than 50% of smokers will be vapers or Snusers. That means half of the smoking population, which is say 20% of the gen pop. So it will negatively impact 10% of people at that time. Perhaps when 10% are negatively affected it will be acceptable to raise costs for everyone else. It doesn't seem fair when we are talking about 3% or whatever.


Yes I'm a vaper, but I can see both sides of the argument

I might agree with your argument if you can point me to the actuarial tables specifying exactly how many excess dollars the insurance companies pay out for treating X% of additional illnesses incurred by those who test positive for nicotine but not positive for exhaled CO.

In fact, I don't believe I've ever seen convincing evidence that any insurer outside of Medicare spends a lot of excess money on treating illnesses in smokers.

Mind you, I said actuarial tables. I don't trust government bean counter numbers and I certainly don't trust the numbers coming out of ALA, ACS, and AHA. I did once. Not since I joined ECF.

 

[dagnagan]

In fact, I don't believe I've ever seen convincing evidence that any insurer outside of Medicare spends a lot of excess money on treating illnesses in smokers.

Yes, if employers still provided health insurance to retirees, they would be able to justify higher premiums for smokers. But since nowadays almost no one except government employees have coverage after they retire, and almost all serious health effects of smoking show up after age 60, most of the costs of smoking are not going to fall on the employer or its insurance carrier.

I just don't think all the savings in health costs touted by the prohibitionists are going to materialize. As a smoker who never got out of the deductible in my thirty years at one company, I know that I subsidized a lot of babies (happy to do that) and in the last few years I worked, at least ten gastric bypass surgeries at ~$20k each.

 

[rolygate]

Is there a nic level with vaping that is low enough to avoid a positive test result or is the test that sensitive?

Blood plasma nicotine test and many urine cotinine tests are sensitive enough to show any nicotine or metabolytes (cotinine) present. There is a background level from the diet, which is normally considered to be a maximum of 3ng/ml nicotine in the blood, although there are numerous tales of vegetarians who are supposed to have measured higher than this. This is not so far-fetched if they eat eggplant (aubergine) on a regular basis as it has a surprisingly high nicotine content.

So, basically, if your blood nicotine level registered higher than 3ng you'd probably have some explaining to do. Some of the urine cotinine tests may be a bit flaky but it's hard to hide a positive result when some of these tests are quite accurate - the blood test reads nic from zero to 60ng, and cotinine from zero to 800ng. To beat a test you would need to abstain from nicotine totally for a week, and make sure to drink plenty of liquids. The residual cotinine level would fail any accurate test method for at least 4 days, and allowing for individual variations (always significant), several more days would need to be allowed.

Here are the blood test results for one vaper who was good enough to get a comprehensive test done and report the results in full. If you use the forum search at top right for 'blood test results' you can find lots of useful information. This is a custom Google search of ECF.


__________________________________________

Blood test results for an e-cigarette user who vaped 36mg liquid ad lib @ 3ml/day, every day prior to the test, and on the day of the test.


Nicotine and cotinine metabolite

Test information: Nicotine and metabolites, serum/plasma analysis performed by liquid chromatography-tandem mass spectrometry, all units are ng/ml.

nicotine...13
cotinine...247
3-oh-cotinine S/P....66

Nicotine unexposed user level would be less than 2, active tobacco user would be 30-50
Cotinine unexposed user would be less than 2, active tobacco user 200-800
3OHcot unexposed user would be less than 2, active tobacco user 100-500


___________________________________________

Interpretation
The nicotine level is the most interesting piece of information. The vaper concerned is an average user at 3ml a day although perhaps his nic level at 36mg is higher than most use. This usage level is about equivalent to 15 cigarettes a day or slightly more.

The nic level is comparatively low at 13ng, although contrary to the 'normal smoker' figure given for comparison here, which is probably a little high by today's slightly lower values, an 'average' smoker is usually reported at around 20ng. Smokers have been tested as high as 50ng, though, and there have apparently been tests at 60ng. A recent comparison of the nicotine delivered by Snus, cigarettes and e-cigarettes showed the smoker at 15ng, which is very close to the vaper's level shown here. A level of 13ng is basically normal to low for a smoker, there are many smokers who will test lower than this (e.g. those who smoke ultra-lights and don't smoke it down to the ....). A level of 30ng might be seen now for a heavy smoker of full-flavor cigs, right after consuming one.

The cotinine test again shows a smoker's level although at the low end. You can probably see that to get down to a non-smoker's value of about 3ng in order to pass a test is going to be difficult, especially as the half-life of cotinine is quite long and it takes many days to reduce to background level.

 

[Semiretired]

Thanks Roly. I have a friend that works in a lab and I am going to see if they can run the test on the side for me just to see what I would test at. First, I do not know if their lab does this type of test and I also do not know if they can run it for me on the side without getting into trouble, but if they do I will post. I vape 15 - 18mg now (reduced from 30mg initially) and have not touched a cig in almost a year now so I am interested in finding out... Wish me luck... Do you know if it is an inexpensive test?

 

[Bill Godshall]

CANCHASER wrote

Thanks in advance for any help or advice you can give me.

Please contact me at smokefree@compuserve.com or 412-351-5880 so I can try to help you with your situation.

Need to know some details that you may not want posted on ECF (e.g. What state do you live/work in? What government entity is your employer? Are you covered by a collective bargaining agreement?)

Bill Godshall

 

[cookiebun]

Is there a nic level with vaping that is low enough to avoid a positive test result or is the test that sensitive?

I was vaping less than half a mg of nic and still tested positive for continine on a urine test.

To the O.P.
I weaned myself off nicotine for exactly that reason. Your insurance company will test for nicotine, not carbon monoxide. It's an argument you'll never win.
Get off the nic. or pay the higher smokers rate. The insurance companies are not likely to change their policies regarding ecigs for decades.

 

[Vocalek]

I suspect that it isn't the insurance companies demanding no nicoitne. I think the employers are behind it.

 

[jamie]

Yes, if employers still provided health insurance to retirees, they would be able to justify higher premiums for smokers.

I believe that is backwards, it is in middle-age that higher premiums can be justified, and the opposite for retirees. Dying of lung cancer at 67 is NOT more costly to the health care system than having arthritis and a stroke and alzheimer's to age 95.

Actually, a long, healthy life costs more

 

[dagnagan]

I believe that is backwards, it is in middle-age that higher premiums can be justified, and the opposite for retirees. Dying of lung cancer at 67 is NOT more costly to the health care system than having arthritis and a stroke and alzheimer's to age 95.

Actually, a long, healthy life costs more

Well, you're right -- even if they did cover retirees, in the long run smokers would on average cost less because they on average die younger. Antis just won't listen to those facts, though; they want to talk in terms of money right up to the point where the numbers go against them, then they start squealing that it's immoral to talk in terms of money.