During the last legislative session State Health Plan officials proposed subjecting state employees to random tests to check for nicotine. The device they proposed to use for conducting these tests is the “smokerlyzer”. The smokerlyzer was mocked to death and the proposal was dropped. But now the testing has reappeared in Winston-Salem.
The city is testing employees to find out who is smoking. The smokers pay a surcharge and are stuck in higher cost health plans. This story  about the program doesn’t mention if the smokerlyzer is used specifically, but other testing methods, which include cheek swabs and drawing blood, are even more draconian.
Punishing people for an addiction is a terrible way to design a health plan. You should never impose financial penalties on people who fail to kick an addiction. If you want to impose some cost sharing then the city could impose a surcharge on those who refuse to enter a treatment program.
But the most effective way Winston-Salem could reduce smoking rates is by convincing their state senator  to stop opposing increases in the cigarette tax.