E-Cigarettes Pose Interesting Wellness Dilemma

one electronic cigarette with a tobacco cigarette (3d render)Should e-cigarettes be part of an employer-sponsored wellness program?

  • One study suggests electronic cigarettes help people stop smoking
  • Health reform’s Affordable Care Act (ACA) requires coverage of tobacco cessation programs under preventive care

That last point, as discussed in a recent article, is open to interpretation.

E-Cigarettes and Wellness

Companies that make e-cigarettes say the liquid, flavored vapors are safer than cigarettes. For e-cigarette opponents, that theory holds as much validity as safety proclamations from tobacco companies.

A National Review article labels public health agencies’ opposition an anti e-cigarette conspiracy.

The article suggests agencies like the Federal Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), the American Cancer Society and American Lung Association use the same deceptive practices of tobacco advertising of the past.

Is this a case of smoke and mirrors?

Proponents of e-cigarettes believe the focus belongs on helping smokers quit.


The ACA allows for a tobacco premium surcharge for tobacco use. However, there are also provisions for cessation interventions.

Preventive Care

Health reform’s ACA requires no copayment, coinsurance or deductible for certain preventive care by a network provider.

Included in the list of preventive care is Tobacco Use screening and cessation interventions for tobacco users.


The ACA also refers to tobacco and smoking as it relates to health-contingent wellness plans.

Health-contingent wellness programs require an individual to meet certain health-related measurements to qualify for a reward.

For example, employees who complete a smoking cessation program may receive a credit toward their medical plan deductible.

Butt What About…

Enter e-cigarettes.

Employer sponsors of wellness programs have plenty of questions.

  • Smoker Status − Would the use of e-cigarettes (instead of tobacco cigarettes) qualify an individual as a non-smoker? Qualify them for a wellness reward?
  • Nicotine replacement − Should e-cigarettes be viewed in the same light as nicotine patches/gum/inhalers?
  • Chemical component − Does it make a difference if e-cigarettes are nicotine-based versus some other chemical?

Health reform’s ACA lacks a definitive answer from a compliance standpoint. The legislation is silent on the use of e-cigarettes.

As expected, employers can find plenty of opinions.

  • E-cigarette proponents use word games, citing specific ACA language that focuses on smoking and not tobacco
  • Opponents believe references to tobacco in other ACA sections imply nicotine and smoking
  • Some health professionals believe there is insufficient clinical evidence to support a wellness value

The questions join an employer’s long list of unanswered questions on health reform compliance.

Questionable health value adds to the ever-changing health care recommendations.


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Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.

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