Remember this post about taxing plastic surgery? Well, it appears that the Senate, in its effort to tax everything possible to pay for health care reform (you’re right, I’m exaggerating, not everything… health insurance companies will make out okay) is forging ahead with its plan to tax cosmetic surgery.

Sen. Harry Reid (D-NV) has introduced a 5% excise tax on cosmetic surgeries that are “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 a disfiguring disease.” In case you’re keeping score, that’s just half of the original tax.

I highly encourage you to read the various proposals involving health care reform floating around in the House and Senate. Only, it’s just slightly impossible since it’s a moving target.

This latest one? It’s actually a Senate Amendment to a House Bill. Follow me for a moment.

The bill number is HR 3590 – but there are four versions (!) of this bill.

According to THOMAS (Library of Congress), the bill was introduced as the Service Members Home Ownership Tax Act of 2009 on September 17, 2009. It passed the House in October 2009 and was moved to the Senate. On November 21, 2009, a motion to proceed to consider the bill was passed, 60-39 (you can view the roll call here). That same day, Senator Reid proposed Amendment S.AMDT.2786 to the bill – a 247 page amendment. That amendment “in the nature of a substitute” is the Patient Protection and Affordable Care Act, introduced in the bill as follows:

SA 2786. Mr. REID (for himself, Mr. Baucus, Mr. Dodd, and Mr. Harkin) submitted an amendment intended to be proposed by him to the bill H.R. 3590, to amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes; which was ordered to lie on the table; as follows:

An amendment “in the nature of a substitute” is a substitution of the body of a piece of legislation. The Senate describes it as “an amendment that would strike out the entire text of a bill or other measure and insert a different full text.” And yet, keep the name.

So, um, wow. Now the bill is even longer. And better yet, it’s attached to popular items like modifying the first-time homebuyers credit for members of the Armed Forces. Who’d vote no to that?

Which brings me to my cynical question du jour: was the health care reform bill amended to another bill for purposes of consolidation and simplification? Or something else?

Me? I don’t know.

As to the cosmetic surgery excise tax is specifically included in the Act at Section 9017 which adds, you guessed it, another amendment. It says, “Subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new chapter: CHAPTER 49–ELECTIVE COSMETIC MEDICAL PROCEDURES.” The specific language regarding the tax can be found at Section 5000B(a).

So I’ve beat up on this this sequence of events a little bit. But let me give you some context… Do I think the Tax Code is complicated? Sure I do. Do I think that simplifying it is an easy task? Of course not – or we would have done it already (yes, I believe that). But I have serious concerns about substituting and amending parallel bills with a number of versions especially when the title you retain is not related to the most meaty part of the bill. Why? Because it renders it virtually impossible for the average taxpayer to follow along.

Do I think that’s purposeful? I’m not saying that it is. But is it transparent? Absolutely not.

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