Are women the target of a hidden tax in the Health Care Bill? Photo: Getty Images

After we reported last week that the 5% cosmetic tax provision in the current health care reform bill would tax everything from botox to boob jobs, we decided to investigate further.

Check out this statistic: 86% of all cosmetic surgery patients are women, of which 60% earn a household income between $30,000-$90,000, according to the The American Society of Plastic Surgeons (ASPS).

"Women are under extreme pressure to maintain a youthful and conventionally attractive appearance, in the workplace and elsewhere – we can even be fired for not wearing makeup-up," says Jill Filipovic of the Feministe blog.

"But when women respond to the pressure by getting cosmetic surgery, we're labeled shallow, and now, potentially taxed. It's a damned-if-you-do, damned-if-you-don't position."

Democratic Senate Majority Leader Harry Reid – who authored the provision – has a simple reason for adding the tax to the healthcare reform bill. "We needed money to make the bill work, and this is an idea that had been raised before in the finance committee," Reid tells StyleList.

The bill is expected to raise $5.8 billion over 10 years to help pay for the $849 billion plan, the Agence France-Presse reports.

But some cosmetic surgeons argue that the tax unfairly targets the wrong group.

"Generally, I find that cosmetic surgery patients want to look their best, so they eat healthy and stay in shape. These kinds of people don't cost the health-care industry a lot. If you want to go after someone to pay for the cost of this bill, why not target industries that are contributing to the problem – like the fast food, smoking and alcohol industries?" says Miami Plastic Surgeon Dr. Carlos Wolf

"It's completely sexist," adds New Jersey dermatologist Dr. Jeffrey A. Rapaport.

"I'm shocked there hasn't been more of a backlash from women's groups and female representatives in Congress – they're basically asking women to pick up the extra costs of healthcare," says Rapaport.

If the 5% cosmetic tax passes, many doctors are concerned the extra cost will cause patients to seek lower-priced and less regulated alternatives elsewhere. In southern California – the cosmetic surgery hotbed of the country – it's not uncommon for female patients to travel south of the border in search of a cheaper solution. And as we saw recently with the recent Miss Argentina gluteoplasty tragedy, falling into the wrong hands can equate to bad results -- or even worse.

In fact, dermatologists and surgeons in the area often reconstruct botched jobs.

"I've seen and fixed women burned by bad laser treatments – especially women with ethnic skin tones, since they're more prone to scarring," says Los Angeles dermatologist Dr. John Shieh. "People can rent laser machines for the weekend down there and just take one or two classes before they operate on patients. There's also a big market to buy old technology – while a new laser machine could cost $150K, an old used one might just be $15K. Putting yourself in the situation of having an unskilled person use outdated technology on you can be very dangerous," says Shieh.

If lawmakers think cosmetic surgery a luxury of the privileged, they're wrong: 86% of patients are women, of which 60% earn between $30,000-$90,000. Photo: Getty Images



While the percentage of male patients are still small, the numbers have still doubled within the past few years as cosmetic surgery has gained popularity, become more affordable, and downtimes have diminished with new technology. And the most popular request by male patients? Senator John Kerry isn't the only fan; cosmetic doctors list Botox as the landslide number one requested service by men.

The 5% cosmetic tax is not the first of its kind. In 2004, the state of New Jersey passed a 6% cosmetic tax to help pay for uninsured hospital patients. Almost immediately after the tax was passed, the author of the bill - New Jersey Assemblyman Joseph Cryan – has unsuccessfully tried to repeal it. And recently, Cryan wrote Senate Majority Leader Reid a letter calling for a stop to the national 5% cosmetic tax proposal.

In the letter, Cryan cites concerns that the New Jersey tax disproportionately affects middle class working women, blurs the line between what is considered reconstructive or cosmetic surgery, and only earned $7 million in revenue instead of the projected $26 million in the first year – which ended up putting the state in an even more financially perilous situation. Cryan adds that 10 other states have considered the tax but have subsequently voted it down, and that he advises the 5% cosmetic tax be voted down as well.

"I've lost patients to other states, and people get very upset with us when we collect the tax from them," says Dr. Rapaport of his Englewood Cliffs, New Jersey-based practice.

But what bothers Dr. Rapaport the most is the connotation the tax creates about his patients.

"I think there's an unspoken statement being made here about women who elect to have cosmetic surgery," says Rapaport.