Bill would ensure health insurance covers needed treatment

Ensuring Lasting Smiles Act would protect individuals with congenital anomalies, birth defects

A bill was reintroduced in Congress May 8 that would require all private group and individual health plans to cover needed services for individuals born with congenital anomalies or birth defects. 

Spearheaded by Sens. Tammy Baldwin, D-Wis., and Joni Ernst, R-Iowa, and Reps. Kim Schrier, M.D., D-Wash., and Neal P. Dunn, M.D., R-Fla., the Ensuring Lasting Smiles Act, known as ELSA, would ensure coverage for inpatient and outpatient care and reconstructive services and procedures, as well as adjunctive dental, orthodontic or prosthodontic support.  

The ADA joins numerous oral health groups and patient advocates who have expressed support for the legislation. The groups have stated it would eliminate burdens that prevent access to necessary diagnosis and treatment for those with anomalies and birth defects. 

The bipartisan bill previously passed the U.S. House of Representatives in 2022 following advocacy from ADA members and after it was a featured issue at the ADA Dentist and Student Lobby Day. It failed to advance in the Senate before the end of the session. 

Specifically, the legislation would: 
•    Ensure that all group and individual health plans cover outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect that primarily impacts the appearance or function of the eyes, ears, teeth, mouth or jaw. 
•    Stipulate that such coverage include services and procedures that improve, repair or restore function due to a congenital anomaly or birth defect, including treatment to any missing or abnormal body part that the treating physician determines is medically necessary. 
•    Exclude cosmetic procedures or surgery. 
 
“For millions of Americans, medically necessary care for birth defects can cost thousands of dollars out of pocket, or for others, it is entirely out of reach because of the cost – despite having health insurance,” Sen. Baldwin said. “I’m proud to work with Democrats and Republicans to put this care in reach so more Americans can lead healthy lives, and more families can focus on caring for their loved ones, not figuring out how they will afford medically necessary care.” 
  
The Ensuring Lasting Smiles Act is supported by a broad coalition of national health care professional and patient advocacy organizations, including the ADA. Other organizations include the National Foundation for Ectodermal Dysplasias, American Academy of Pediatric Dentistry, American Association of Oral and Maxillofacial Surgeons, Pathways for Rare and Orphan Solutions, Rare and Undiagnosed Network, American Institute of Dental Public Health, FACES: The National Craniofacial Association, Children’s Wisconsin, Crane Dental Laboratory, Inc., American Cleft Palate Craniofacial Association, M-CM Network, American Academy of Ophthalmology, Ear Community, American College of Surgeons, Academy of General Dentistry, TMJ Association, American Association of Orthodontists, American Society of Plastic Surgeons, American Academy of Pediatrics, American Association for Pediatric Ophthalmology & Strabismus, and American Association for Dental, Oral and Craniofacial Research.