As Congress struggles to produce a health care reform bill that can be sold to voters during and after the August recess, one idea that’s emerging is a tax on plastic surgery.

Peter Cohn (no relation) of National Journal’s CongressDaily reported that the Senate Finance Committee has been considering a 10 percent excise tax on cosmetic surgery that is not deemed medically necessary. The idea came up when the committee met with Peter Orszag, director of the White House Office of Management and Budget. The tax would be aimed at cosmetic surgery procedures prohibited under Section 213 of the Tax Code, which covers eligible and non-eligible itemized deductions for medical expenses.

According to IRS Publication 502, that includes “any procedure that is directed at improving the patient's appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease. You generally cannot include in medical expenses the amount you pay for procedures such as facelifts, hair transplants, hair removal (electrolysis), and liposuction.” Nose jobs, tummy tucks, teeth whitening and Botox injections would supposedly also fall into this category. NBC is already calling the proposed tax the Bo-tax.

However, the IRS does allow taxpayers to deduct the amount paid for cosmetic surgery “if it is necessary to improve a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or a disfiguring disease.”

Some states already impose taxes on cosmetic surgery. New Jersey, for example, has been imposing an excise tax on plastic surgery since 2004, but it has only contributed about 25 percent of the revenue that was originally anticipated, according to the American Society of Plastic Surgeons.

The Senate Finance Committee is desperate to come up with ways to pay for health care reform. The committee seems to be about the only place in Congress where there is some bipartisan negotiating going on, mainly between chairman Max Baucus, D-Mont., ranking member Charles Grassley, R-Iowa, and four other members. However, there were reports emerging that the agreement taking shape leaves out a public option for health insurance, which President Obama has all but demanded as a requirement, and an employer mandate requiring large businesses to provide health insurance for employees.

Without those provisions, the health care reform effort could well fall apart when Congress returns from recess unless the negotiations stay on track. Some members of Congress could well need some Botox injections at that point to fill in the crows’ feet and frown lines they’ll get from worrying over all the votes and campaign contributions they’ll lose.

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