A lawmaker argued on Wednesday that a 10% tax on indoor tanning, which would be repealed under the new Republican health plan, discriminates against women. Here's what dermatologists have to say
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One of many pieces of the Affordable Care Act (also known as Obamacare) that Republicans plan to do away with is a tax on indoor tanning bed services that was implemented in 2010.

Why? According to Congressman Jason Smith, R-MO, one of the reasons is that the tax discriminates against women.

“What I found on Google is roughly 80% of who’s taxed are women,” he said at a meeting of the House Ways and Means Committee this week. “So out of the $600 million that has been created by this tax … $480 million has come from the backs and the pockets of women.”

“Today’s International Women Day,” Smith continued. “It’s interesting that no one is bringing that up.” He then proposed that if the government was going to tax tanning beds, it might as well tax the sun—which, he said, according to his internet research, actually causes more skin cancer.

But dermatologists say there’s good reason for the tax—and that by acting as a deterrent against tanning, it has the potential to protect more women, and men, than it hurts.

The 10% tax affects most facilities that offer tanning booths or beds, which are required to collect this tax from customers. (It does not apply to spray-on tanning services, topical creams and lotions, physical fitness facilities that meet specific criteria, or to phototherapy services performed at licensed medical practices.)

Critics argue that the tax has forced tanning salons to close and resulted in lost jobs, and some have claimed that it’s racist against people with light skin; now, Smith says it disproportionately hurts women. In the same meeting, Congressman Jim Renacci, R-OH, argued that tanning “actually could be healthy,” according to some studies. (He did not specify which studies.)

But dermatologists beg to differ.

"Tanning is unhealthy and it absolutely should be taxed," says Suzanne Olbricht, MD, chief of dermatology at Beth Israel Deaconess Medical Center and president-elect of the American Academy of Dermatology. "Tanning creates health problems that somebody's got to pay for—and when we're in this big insurance pool together, it costs the rest of us money." (A study published last month in the Journal of Cancer Policy found that healthcare costs associated with skin cancers from UV light devices totaled $343 million in 2015 alone.)

Dr. Olbricht also says there's no question that tanning is harmful. Ultraviolet light is used by doctors to treat some conditions, such as depression and psoriasis, but the spectrum of light is narrower and more controlled than what's used for commercial tanning, she says—and even then, some patients develop skin cancer as a result. "Saying it might be healthy is like saying that climate change might not be real," she says.

As for Smith’s claim that the sun causes more skin cancer than tanning beds? That may be technically true: About 90% of nonmelanoma skin cancers are associated with exposure to ultraviolet radiation, according to the nonprofit Skin Cancer Foundation—and it’s clear that most people spend more time outdoors than they do in tanning beds. About 86% of cases of melanoma, the deadliest form of skin cancer, are also linked to UV exposure.

But proportionately, people who visit tanning facilities regularly face a much higher skin-cancer risk than the general public. "They get a lot more ultraviolet light radiation in total than people who don't [go tanning], even more than people who spend a lot of time out in the sun," says Dr. Olbricht. (Plus, sunscreen use is encouraged when spending time outdoors—advice that most tanners probably aren't following.)

More than 419,000 cases of skin cancer in the U.S. each year are linked to indoor tanning, according to the Skin Cancer Foundation. People who have tanned indoors, even once, have a 67% increased risk of developing squamous cell carcinoma and a 29% increased risk of developing basal cell carcinoma, compared to those who haven’t. What’s more, those who’ve used tanning beds 10 or more times have a 34% increased risk of developing melanoma, while those who started tanning before age 35 have a 75% increased risk.

In fact, more people develop skin cancer because of tanning than develop lung cancer because of smoking. And, by the way, the federal government also taxes tobacco. (Similar taxes have been proposed, and some implemented, at the state and local levels for soda and junk food, as well.)

In 2010, the Skin Cancer Foundation called the tanning tax “an important step forward in the fight against skin cancer.” In a press release, educational spokesperson Bruce E. Katz, MD, said the legislation would hopefully serve a double purpose, “not only raising billions for health care, but giving people one more reason to protect their health by staying away from tanning salons."

This week, the Foundation announced that it was disappointed to learn of the proposed elimination. “Repealing this tax will make indoor tanning easier, thereby putting lives at risk,” reads an official position statement. The American Academy of Dermatology also opposes the tax repeal.

And yes, the majority of tanning salon patrons are women and teen girls—despite age restrictions in many states—but men can also benefit from staying away. Between the ages of 15 and 39, men are 55% more likely to die of melanoma than women. This year alone, the disease will kill an estimated 6,380 men and 3,350 women in the United States.

The tax is one of many pieces of the Affordable Care Act that Republicans plan to do away with as part of their repeal-and-replace bill. It’s worth noting that Smith has voted to de-fund women’s health clinics, and that the Republicans' proposed health care plan freezes funding for Planned Parenthood—an organization that provides low- or no-cost preventive care to millions of women a year.

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The Associated Press reported today that the bill would limit access to or raise costs of basic health services like prenatal care, contraception, and cancer screenings. (Of course, at least one lawmaker thinks women should have to pay more for these things.) If Smith really wants to discuss policies that hurt women—on International Women’s Day or any day, for that matter—these might be a few good places to start.