One of the measures of the Affordable Care Act (ACA) that the new Republican plan would repeal is the 10 percent excise tax on indoor-tanning services.
From both a health and an economic perspective, the repeal of that tax — which had been estimated to generate $2.7 billion during the ACA’s first 10 years — is perplexing, to say the least. Indoor tanning is recognized as a significant contributor to the rising numbers of Americans who are developing and dying from skin cancer. The indoor tanning tax was designed to discourage people, particularly young people, from using the devices.
Furthermore, as a recent study reports, indoor-tanning-related skin cancers exact a heavy price on the U.S. economy: an estimated $343 million a year in direct medical costs and $127 billion in lost productivity and other indirect costs over the lifetime of the people affected.
If the authors of the ACA replacement legislation want to save lives and money, they should take a look at the research on the health and economic impact of indoor tanning.
The health risk
Yes, any kind of tanning increases the risk of developing skin cancer, but many studies have specifically linked indoor tanning to skin cancer, including a 2010 University of Minnesota study, which found that frequent users of indoor tanning devices were up to three times more likely to develop melanoma than those who had never used the devices.
That research helped lead Minnesota legislators in 2014 to join what is now about a dozen other states in banning minors from using indoor tanning devices.
Indoor tanners of any age put themselves at risk of developing skin cancer, but most of the estimated 30 million people in the U.S. who use indoor tanning devices at least once a year are female and young. As Mayo Clinic researchers noted in 2012, that fact may explain why the incidence of melanoma increased eightfold among young women (aged 18 to 39) between 1970 and 2009 — twice as much as among young men.
Indeed, melanoma is now the most common form of cancer in the U.S. for young adults aged 25 to 29 and the second most common form of cancer for young adults aged 15 to 29, according to the Melanoma Research Foundation.
Melanoma is also the leading cause of cancer death in women aged 25 to 30 and the second leading cause of cancer death in women aged 30 to 35.
In the new study in the Journal of Cancer Policy, researchers from the University of North Carolina estimated that 263,000 cases of skin cancer among Americans in 2015 could be attributed to indoor tanning: 9,000 cases of melanoma, 86,600 cases of squamous cell carcinoma and 168,000 cases of basal cell carcinoma.
Based on the average annual cost of treating patients with each form of the disease, the researchers then estimated that indoor-tanning-related skin cancers cost $343.1 million in direct medical expenses each year.
Next, the researchers determined the years of potential life lost by the 263,000 Americans with indoor-tanning-related cancers, as well as the average lost earnings per person. That led them to estimate that the U.S. economy will lose about $127 billion in lost productivity costs over the lifetime of those people.
“Our calculations are all conservative, so this is the lower end of the estimate — the impact could be even higher than this,” said Hugh Waters, a health economist at the University of North Carolina and the study’s lead author, in a released statement.
Also, as Waters and his co-author, Dr. Adewole Adamson, a dermatologist affiliated with the University of North Carolina, point out in their paper, several other medical conditions — keratitis, photodermatoses, dermatitis and porokeratosis — are also associated with indoor tanning. But a scarcity of specific data on those associations caused the researchers to not include those conditions in their analyses.
More needs to be done
It’s not clear how much the ACA’s excise tax on indoor tanning has discouraged people from using such services, although the tanning salons themselves have suggested that usage fell 20 to 25 percent after it went into effect.
In 2015, the Internal Revenue Service said it had collected $78 million from the excise tax, far below the $300 million that had been projected.
However, as Waters and Adamson suggest, that lower revenue from the tax may be due to the “increasing public recognition of the dangers of tanning devices.”
“The Centers for Disease Control and Prevention (CDC) have prepared a comprehensive set of strategies designed to reduce the prevalence of indoor tanning in the U.S.,” they add. “These strategies are needed to address the serious public health and economic consequences of the use of tanning beds.”
Whether the Trump administration and Congress have the desire to implement those strategies remains to be seen. The proposed health plan will also slash the CDC’s budget.
FMI: You’ll find the study on the Journal of Cancer Policy’s website.