Most adult smokers view electronic cigarettes -- the increasingly popular devices that deliver jolts of nicotine, without the tobacco, via water-based or aromatic vapors -- as a halfway house between smoking and quitting.
But employers, health insurers and -- most importantly -- policymakers haven't fully made up their minds yet.
Big businesses like Wal-Mart and UPS charge employees higher insurance premiums if they smoke, and both companies consider smoking e-cigarettes -- or "vaping" -- the same as traditional smoking, at least for premium accounting purposes. Cleveland Clinic, which refuses to hire smokers, similarly won't hire e-smokers.
UPMC, which announced last year that it would outlaw all work-shift smoking -- even on unpaid breaks -- will begin enforcing the ban July 1.
It, too, considers electronic cigarettes to be a form of smoking and included them in the ban.
"As a health care organization, giving the appearance of smoking is counter to our mission," spokeswoman Gloria Kreps said. "Additionally, the U.S. Food and Drug Administration has not tested the safety or effectiveness of e-cigarettes as an aid to quit smoking."
CVS Caremark doesn't allow employees to use e-cigarettes at its corporate campuses; Starbucks bans e-cigarettes for employees and customers; and three states (New Jersey, Utah and North Dakota) specifically ban e-cigarettes in the workplace, in addition to other kinds of smoking, according to The Wall Street Journal.
But insurers, for now, are leaning in the opposite direction.
"For our commercial business and the ACA products, we follow the governmental defined smoking policy that smoking is the use of cigarettes, cigars and chewing tobacco," said Highmark spokesman Aaron Billger.
UPMC Health Plan is taking the same approach -- tobacco usage is different from "vaping" -- but could adjust its policy as evidence dictates. "We are currently evaluating how e-cigarettes should be treated going forward, both for surcharge and cessation purposes, as well as from a clinical perspective generally," said Gina Pferdehirt, spokeswoman for UPMC Health Plan.
The view of health carriers -- not to mention the U.S. Department of Health and Human Services -- matters, because insurers that choose to sell individual policies by way of the Affordable Care Act are, in most states, allowed to charge substantially higher premiums to those who smoke or use tobacco products, up to 50 percent higher.
But those who applied for individual ACA-related plans between October and April merely were asked if they used tobacco products, and if they had used them regularly (more than four times a week) in the last six months.
"A consumer is not asked about e-cigarettes or the type of tobacco product used. It is possible that a consumer could interpret the question about tobacco to refer to e-cigarettes, but health plans do not ask about e-cigarettes," said Clare Krusing of America's Health Insurance Plans, a national lobbying group for health carriers. "The law and regulations refer to 'tobacco use' and 'tobacco products.' ... There is no guidance [or] specification on e-cigarettes."
The issue goes beyond the individual policy market, though -- the health care law also requires health plans, in most cases, to cover the cost of smoking-cessation counseling and products without any out-of-pocket cost to the patient. But because the FDA has not approved the e-cigarettes as a smoking-cessation device, they cannot be prescribed by doctors or covered by insurance as a form of "preventive care."
Guidance of what has become a $2 billion industry is slowly being developed by the FDA and Congress. Last month, the FDA proposed new rules that would ban the sale of e-cigarettes to minors, and would require warning labels and federal approval for related products.
And last week, the U.S. Senate Health, Education, Labor, and Pensions Committee held a hearing on e-cigarettes.
Sen. Tom Harkin, D-Iowa, told those convened that the products, as now sold, constituted a "regulatory black hole. ... Anyone who claims that these products aren't targeting kids is clearly blowing smoke."
But at the same hearing, the FDA's leading tobacco authority said that e-cigarettes have the "potential to do good."
"If we could get all of those people to switch all of their cigarettes to these products, that would be good for public health," Mitch Zeller, director of the FDA's Center for Tobacco Products, said at the Thursday hearing.
If that's the case, should employees be allowed to smoke them in the workplace?
Cheryl Dooley, CEO of EBSCO Spring Co. of Tulsa, Oklahoma, arrived at the same conclusion after e-cigarettes helped her quit smoking for good three years ago. That's why, she said, she bought an e-cigarette device for each of her employees who is a smoker -- 28 in all.
"If I can quit -- and I was one of those hard cases -- then anybody can," she said. Several of her employees have successfully quit smoking cigarettes since adopting electronic cigarettes, and she's had no complaints from the nonsmokers in the office, she said.
"It may not be completely healthy," Ms. Dooley said, "but compared with cigarettes, [it's] 1,000 percent better."
Employees, on the other hand, aren't sold on workplace vaping -- 65 percent of respondents in a 2014 Harris Interactive survey, commissioned by an electronic cigarette manufacturer, said the e-cigarettes shouldn't be allowed at the office.
Even so, 63 percent of those who answered the phone survey said "they would not be bothered by someone using an electronic cigarette in close proximity."
Bill Toland: firstname.lastname@example.org or 412-263-2625.