You may be aware of the following Excise Tax on elective cosmetic medical procedures. Please review the following information and consider sending this to your senator. We strongly encourage your support! Thank you, The Caniglia Center Senators of the 111th Congress:  http://www.senate.gov/general/contact_information/senators_cfm.cfm Dear Senator______________: As a constituent of yours from [City/town, State] and a facial plastic and reconstructive surgeon, I write in strong opposition to Sec. 9017, Excise Tax on Elective Cosmetic Medical Procedures included in the "Patient Protection and Affordable Care Act." The imposition of this tax discriminates against women and state experience has demonstrated that it fails to achieve projected savings. Discriminates Against Women Contrary to popular belief, cosmetic surgery is no longer an exclusive luxury afforded by the very wealthy. Eighty six percent (86%) of cosmetic surgery patients are working women and this five percent tax discriminates against these 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. These data clearly refute the suggestion that elective surgery taxes are "luxury" or "sin" taxes affecting a privileged few. State Experience Failure Since New Jersey - the only state to adopt a tax on elective medical procedures - passed a 6% tax on elective medical procedures in 2004, the NJ Department of Taxation has experienced a 59% shortfall based on projected revenue estimates. In fact, New Jersey Assemblyman Joseph Cryan, the sponsor of the 2004 bill, is leading efforts to repeal the tax. Arbitrary and Difficult to Administer As evidenced with the recent experience in New Jersey, 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. Physicians as Tax Collectors This provision places physicians in the role of tax collector and holds physicians liable should an individual fail or refuse to pay the tax. The provision mandates implementation in only six weeks (1/1/2010), placing an incredible burden on physician offices. I oppose all taxes on physicians, in any and all forms, due to their deleterious effects on health care costs and access to patient care. Medical care should not be used as a tool to fix broken finances. Thank you for your serious consideration of the issues I have raised in this letter. Sincerely,