The medical device excise tax continues to rile industry stakeholders and politicians on both sides of the aisle, and a new survey from the industry trade group AdvaMed is intended to aid in the ongoing fight to repeal the controversial 2.3 percent excise tax, which was included in President Obama's health care reform law.

Survey results examined the first-year impact of the tax on AdvaMed member companies and found some common trends: mainly reductions in jobs but also in R&D and U.S. investment.

"We said this was going to be bad for the device industry and ultimately patients and this survey shows we were right — this proves it's time to change course," David Nexon, AdvaMed's senior executive vice president for policy, told DOTmed News.

According to the report, the impact the tax has had on industry employment adds up to about 33,000 jobs. Specifically, it has led to employment reductions of approximately 14,000 industry workers and the foregone hiring of 19,000 workers.

"Figures were in line with projections from studies prior to implementation of the device tax. Some people challenged those studies and said job loss wouldn't be significant, but our survey results are pretty close to the original pessimistic projections," said Nexon.

According to material from AdvaMed, independent estimates of the relationship between direct employment in the industry and indirect employment among suppliers and in the general economy found a ratio of four indirect jobs for each direct job. Applying this ratio to jobs lost or foregone suggests that the impact of the tax on indirect employment would be approximately 132,000 jobs for a total job loss due to the tax of as many as 165,000 jobs, said AdvaMed.

As far as R&D loss, the survey found that roughly 30 percent of respondents have reduced R&D because of the tax, and almost 10 percent have relocated their manufacturing outside of the U.S. or taken measures to expand manufacturing at facilities abroad.

Investments have also been stifled by the tax. According to the survey, three-quarters of respondents said they have either deferred or cancelled capital investments as well as plans to open new facilities, reduced investment in start-up companies, found it more difficult to raise capital (among start-up companies), or reduced or deferred increases in employee compensation.

AdvaMed sent the survey out to its entire membership base — roughly 330 companies — at the end of 2013. The results were based on the 38 companies who responded, or 15 percent of AdvaMed members.

"That was also 40 percent of the total revenues so it was actually a pretty good response rate," said Nexon.

He said the respondents were split almost in half between large and small companies.

The medical device excise tax was included in the Affordable Care Act as a way to raise roughly $30 billion over 10 years to offset the cost of reform. One of the reasons medical device companies were singled out to be hit with the tax was because they would likely benefit through higher revenues as more Americans gain health coverage under the law.

Despite aggressive lobbying by medical device makers, industry partners and even some politicians, the 2.3 percent excise tax went into effect on Jan. 1, 2013. It applies to the sale of medical devices by manufacturers and importers. From the get-go, the medical device industry said it will force companies to lay off workers and dry up important R&D funding.

But critics say the case for repealing the tax is not strong enough. The Center on Budget and Policy Priorities, a non-profit think tank, published a piece that said arguments against the excise tax don't withstand scrutiny. It cited Martin Rothenberg, head of a device firm in New York, who said the tax will add little to the price of a new device that his firm is developing: "If our new device proves effective and we market it effectively, this small increase in cost will have zero effect on sales. It would surely not lead us to lay off employees or shift to overseas production."

Critics also suggest that politicians in Congress — particularly Democrats — who have supported repeal efforts, have only done so to appeal to their constituents. Democratic Senator Al Franken of Minnesota — a state that is home to more than 40 device makers — is one example.

Rep. Charlie Dent, a Pennsylvania Republican, is the latest member of Congress to take measures aimed at the tax. He is introducing legislation to repeal it as part of a larger deal aimed at unemployment benefits. Dent has offered to extend unemployment benefits in exchange for a repeal, among other things.

However, one of the main issues with repealing the tax would lie in trying to find replacement funding for the $30 billion taken out.

Despite the obstacles, supporters are forging ahead.

"We are cautiously optimistic," said Nexon.