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On November 21, at the 11th hour, a cosmetic surgery tax provision was slipped in the Senate Health Reform bill and at 8:00 p.m. by a vote of 60-39, the Senate approved a motion to proceed to consideration of the Patient Protection and Affordable Care Act. It is expected that the debate on the Senate floor will last a minimum of two weeks and potentially up to Christmas and beyond. Should the Senate pass this bill, they will then have to reconcile their version of health reform with the bill passed by the House of Representatives earlier in the month. The American Society of Plastic Surgeons OPPOSES the Senate bill and will be working with colleagues in the surgical coalition to fight this legislation.

To raise money for the health overhaul, Senate Democrats are proposing a new 5% tax on elective cosmetic procedures. The tax was a last minute addition to the sweeping 2,074-page bill that Senate Majority Leader Harry Reid unveiled late Wednesday, November 18th. The Joint Committee on Taxation estimates this tax generates $5.8 billion over a decade. The tax would fall on patients, and physicians are required to collect the tax at the point of service. If the tax is not collected by the patient, it then falls to the provider who performed the procedure. According to the bill, the tax would only apply if the surgery “is not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.”

We strongly urge you to take action NOW by calling your senators and Congress to protest this tax. The U.S. Capitol switchboard is 202-225-3121 where you can be connected to your Senators and Representatives in Congress.

Here is the letter that I sent to our two California senators explaining why I believe this tax is unfair.

Senator Dianne Feinstein                         Senator Barbara Boxer

United States Senate                                     Washington, D.C.
331 Hart Senate Office Building                    112 Hart Senate Office Building
Washington, D.C. 20510                                Washington, D.C. 20510
Phone: (202) 224-3841                                  Phone: (202) 224-3553
Fax: (202) 228-3954                                       Fax: (202) 224-0454


As a practicing plastic surgeon in California, I strongly urge you to oppose taxing elective medical procedures.  Elective surgery taxes discriminate against women given that 86 percent of cosmetic surgery patients are female.

 Moreover, contrary to popular belief, cosmetic surgery is no longer an exclusive luxury afforded by the very wealthy.  In fact, 86% of cosmetic surgery patients are working women.  In the first research of its kind, conducted with people planning to have cosmetic surgery within the next two years, 60% of respondents reported a household income of $30,000-$90,000 a year. Most importantly, 40% of the 60% reported income of $30,000-$60,000.  Only 10% of respondents reported household income over $90,000.  This data clearly refutes the suggestion that elective surgery taxes are “luxury” or “sin” taxes affecting a privileged few.

These taxes are arbitrary and difficult to administer.  As evidenced with the recent experience in New Jersey, the only state to impose a cosmetic tax,  the line between “cosmetic” and “reconstructive” surgery is not always clear and leaves the determination of medical necessity up to state tax auditors—a completely inappropriate proposition.  This can be a potential auditing nightmare; implementation of this subjectively imposed tax will require an inordinate amount of time to interpret and administer with questionable return.

As your constituent, I urge you to oppose a cosmetic surgery tax.


Martin A. O’Toole, MD

Pasadena Cosmetic Surgery