Say hello to the nose job tax. To raise money for the health overhaul, Democrats are proposing a new 5% tax on elective cosmetic procedures. The tax was a surprise addition to the sweeping 2,074-page bill that Senate Majority Leader Harry Reid unveiled late Wednesday. It generates $5 billion over a decade for the plan, which is expected to cost $849 billion over a decade.

The tax would fall on the individuals who undergo the procedures. If they don’t pay it when they’re billed for their surgery, then it falls to the provider who performed the procedure. Not all cosmetic surgeries would get taxed. According to the bill, the tax would only apply if the surgery “is 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 disfiguring disease.” It would take effect Jan. 1.