U.S. Representatives Drew Ferguson (R-GA) and Anna Eshoo (D-CA) and U.S. Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA) reintroduced bipartisan, bicameral legislation to ensure health insurance coverage for needed treatment and procedures for individuals born with congenital anomalies or birth defects. The Ensuring Lasting Smiles Act would close a coverage gap to ensure that health plans cover medically necessary services related to a patient’s anomaly or birth defect, including any serious dental and oral-related procedures that are necessary to maintaining health and overall function.
“As a practicing dentist for nearly 25 years, building better smiles was my career, and it continues to be a top priority of mine in Congress,” Rep. Ferguson said. “The Ensuring Lasting Smiles Act would require all private, individual health care plans to cover medically necessary dental services, including reconstructive surgeries that are a result of congenital anomalies or birth defects. This life-changing bill will give families the opportunity to save for their children’s futures by addressing a loophole that has long allowed insurance companies to routinely deny oral or dental claims for medically necessary treatments.”
“Too many children born with congenital anomalies are denied coverage despite the long-term harm of such conditions. These are children like Rosie, the daughter of a family in my district who has congenital cataracts. She requires contact lenses because glasses aren’t powerful enough, and without these lenses she is blind and will have no chance of ever developing normal vision,” said Rep. Eshoo. “The bipartisan Ensuring Lasting Smiles Act would cover these medically necessary treatment options and close the loopholes insurance companies use to avoid paying for these treatments and services. I’m proud to reintroduce this bill to help keep America’s children healthy and smiling.”
“Aidan’s story continues to inspire my work on this issue to guarantee that individuals born with congenital anomalies have access to the comprehensive health treatments and coverage they need,” said Senator Baldwin. “Despite covering all of his other medical care, his family’s insurance continues to refuse to cover his dental care needs, forcing them to spend thousands of dollars out of their own pockets. That’s why I’m introducing bipartisan legislation to close this loophole and make sure families like Aidan’s can get the health care they need at a price they can afford.”
“Young Iowans, like Alli Steele and many others, have been diagnosed with Ectodermal Dysplasia. When their families realized the procedures would cost thousands of dollars out of pocket because they weren’t covered by their health plans, they turned to elected officials for help. Their stories and struggles are the reason I’ve teamed up with Democrats and Republicans on this effort to ensure that all health plans cover medically-necessary services related to a patient’s congenital abnormality, including reconstructive surgeries and oral-related procedures,” said Senator Ernst.
Background:
Specifically, the Ensuring Lasting Smiles Act 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;
- 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 would otherwise be covered for any other injury or sickness. The bill makes clear that this includes adjunctive dental, orthodontic or prosthodontic support; and
- Exclude cosmetic procedures or surgery.
There are 132 cosponsors in the U.S. House of Representatives and 34 cosponsors in the U.S. Senate. The Ensuring Lasting Smiles Act is also supported by a broad coalition of national health care professional and patient advocacy organizations.
About four percent of children in the U.S. are born with congenital anomalies or birth defects that affect the way they look, develop, or function, often for the rest of their lives. Many born with congenital anomalies suffer from severe oral defects (such as cleft lip or palate, hypodontia, enamel hypoplasia), skeletal defects (such as craniosynostosis), vision defects (such as congenital cataracts or aphakia), hearing defects (such as microtia), or other loss of bodily functions. Patients who do not receive timely, continuous care for their congenital anomalies face long-term physical and psychological injuries. Individuals who suffer from ectodermal dysplasia and other craniofacial anomalies can expect to incur significant out of pocket costs on reconstructive oral and dental procedures related to their disorder during their lifetime. The Ensuring Lasting Smiles Act would address this and ensure that children suffering from congenital anomalies or birth defects get the treatment they need and deserve.
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