URBANA — When Carle Foundation Hospital and the former Carle Clinic outlawed smoking on their properties seven years ago, they made it a little more challenging for their employees to smoke at work.

Now, they're making it a little more expensive to be a smoker who works for Carle.

Starting Jan. 1, 2012, Carle hospital and physician group plan to start charging their smoking employees $30 more a month for health insurance than non-smoking employees pay.

That delayed starting date will give smokers six months to take advantage of a free smoking cessation program they're being offered, says Carle Senior Vice President of Human Resources Phil Kubow.

Carle is taking the step for the health of its employees — and to set a good example for patients, Kubow said.

It's also an issue of patient comfort: Smoking has been banned on the Carle campus since September 2004, but smoking employees still go off-campus to smoke at meal and break times and carry a smoke smell back with them, Kubow said.

"A strong smoke odor is not anything a patient wants to smell. It's just not conducive to their recovery," he said. "It's almost impossible to eliminate that odor."

There's also a financial issue at stake. Smokers are not only at risk for more diseases, those diseases add to health care costs. Carle's health plan is self-insured, and that's a $50 million annual expenditure, Kubow said.

Cigarette smoking remains the top cause of preventable disease and death worldwide, responsible for 393,000 annual deaths and over $193 billion in annual costs in the U.S., according to the American Lung Association.

According to the organization's 2004 data, those costs break down as $97 billion in lost productivity and $96 billion in direct health care expenditures, and average out to $4,260 per adult smoker.

How many of Carle's 6,000 employees are smokers, Kubow said, he doesn't know. But the average number of smokers for the local community is around 20 percent of the population.

Points for trying

Several other health care organizations in the area — among them Christie Clinic, Provena United Samaritans Medical Center and Provena Covenant Medical Center — don't plan to impose similar policies on their employees for now.

However, "I think everybody is kind of looking at it," said Christie's Human Resources Director Melodie McCammack.

Christie Clinic still has too many smokers on staff, she said, and "being a health care organization, it's very concerning."

The Provena hospitals in Champaign and Urbana don't charge employees more for health insurance if they smoke, but they do give smokers and others with unhealthy habits incentives in the way of insurance discounts if they make healthy changes.

Jason Whetsel, Provena's system manager of health and wellness, said employees can shave $240 a year off their health premiums if they meet their wellness goals from the previous year.

Smoking employees had a new goal added this year, he said. By Nov. 15, they either have to be tobacco-free or complete tobacco cessation counseling.

"You're either tobacco-free or you tried," Whetsel said.

He knows some employers are taking the more stringent step of charging smoking employees more for health insurance, he said, but there isn't a one-size-fits-all solution.

More than half of Americans approve of charging smokers more for health insurance, according to a Rasmussen Reports national telephone survey late last year.

The survey found 54 percent of adults think people who smoke should pay higher health insurance rates than non-smokers. Among non-smokers, 70 percent think smokers should pay more for their health insurance.

Help quitting

Kubow said Carle plans to ask its employees a simple question — do you smoke or don't you — and trust them on the answer.

Those who say yes and want help quitting will be offered six months worth of free help at Carle's expense through Health Alliance Medical Plan's "I Can Quit" tobacco cessation plan.

This program includes 90 days worth of medications and a year's worth of support and coaching by phone. The medications include antidepressants to block the nicotine high, nicotine replacement patches, gum and lozenges, and Chantix, a drug that blocks the pleasure receptors of the brain from nicotine, according to the company's Disease Management Coordinator Penny Shaw.

The program has a success rate of 28 percent at 12 months, considered to be highly successful, Shaw said. At 24 months, 85 percent of the quitters are still smoke-free, she said.

A health-conscious environment may also help. Champaign-Urbana Public Health District Administrator Julie Pryde said she knows charging higher premiums for smokers is a trend. But that's doesn't seem to be necessary at her workplace.

"We've had a lot of employees who started out here smoking and don't smoke any more," she said. "How many employees do we have here who smoke any more? I think we have two ... if that. But we used to have more and they all quit."

And nobody has an excuse not to exercise at public health headquarters if the weather outside is not so nice. There's a treadmill desk in every department so employees can work on a laptop and work those legs at the same time.

"We do lots of stuff to encourage healthy behaviors," Pryde said.

Carle also encourages healthy behaviors by shaving up to $260 a year off health premiums for employees who meet certain wellness goals, Kubow said. But there are still some employees who smoke.

Response to the higher insurance premiums for smokers has been positive overall, he said, but it's not making everybody happy.

"There are always a handful of employees that are frustrated. They feel that we are intruding into their personal lives," Kubow said.