Twenty-nine states and the District of Columbia have laws that protect smokers' rights (in blue).

More job-seekers are facing an added requirement: no smoking — at work or anytime.

As bans on smoking sweep the USA, an increasing number of employers — primarily hospitals — are also imposing bans on smokers. They won't hire applicants whose urine tests positive for nicotine use, whether cigarettes, smokeless tobacco or even patches.

Such tobacco-free hiring policies, designed to promote health and reduce insurance premiums, took effect this month at the Baylor Health Care System in Texas and will apply at the Hollywood Casino in Toledo, Ohio, when it opens this year.

"We have to walk the walk if we talk the talk," says Dave Fotsch of Idaho's Central District Health Department, which voted last month to stop hiring smokers.

Each year, smoking or exposure to secondhand smoke causes 443,000 premature deaths and costs the nation $193 billion in health bills and lost productivity, according to the Centers for Disease Control and Prevention. The CDC says 19.3% of U.S. adults smoked last year, down from 42.4% in 1965.

"We're trying to promote a complete culture of wellness," says Marcy Marshall of the Geisinger Health System in Danville, Pa., which begins its nicotine-free hiring next month. "We're not denying smokers their right to tobacco products. We're just choosing not to hire them."

The policies stir outrage, even in the public health community.

"These policies represent employment discrimination. It's a very dangerous precedent," says Michael Siegel, a professor at Boston University's School of Public Health. He says the restrictions punish smokers rather than helping them quit.

"What's next? Are you not going to hire overly-caffeinated people?" asks Nate Shelman, a smoker and Boise's KBOI radio talk show host whose listeners debated the topic last month. "I'm tired of people seeing smokers as an easy piñata."

After several companies, including Alaska Airlines, adopted smoker-hiring bans a couple of decades ago, the tobacco industry and the American Civil Liberties Union lobbied for smoker rights. As a result, 29 states and the District of Columbia passed smoker-protection laws.

Some laws exempt non-profit groups and the health care industry, and 21 states have no rules against nicotine-free hiring.

Federal laws allow nicotine-free hiring because they don't recognize smokers as a protected class, says Chris Kuzynski with the U.S. Equal Employment Opportunity Commission.

There's no data on how many U.S. businesses won't hire smokers, but the trend appears strongest with hospitals, says Lewis Maltby, president of the National Workrights Institute, a non-profit offshoot of the ACLU that opposes the hiring bans.

Many of the new policies expand on smoke-free workplace rules. At Bon Secours Virginia Health System, more than 300 employees have kicked the habit since its campuses went smoke-free in 2009, and one applicant did so since it began nicotine-free hiring Nov. 30, says administrative director Kim Coleman.

The bottom line will benefit because health care costs for tobacco users are $3,000 to $4,000 more each year than for non-smokers, says Bon Secours' Cindy Stutts. "There's also an impact on productivity," she says, because smokers take more breaks.

Paul Billings of the American Lung Association says he's seen no data that prove nicotine-free hiring gets people to quit. He says cessation programs are a better bet. Still, his group won't hire smokers: "We're non-smoking exemplars."