On Tuesday, March 16th, Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA) and Representatives Anna Eshoo (D-CA) and Drew Ferguson (R-GA) 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 (ELSA) closes 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.
In the Senate, ELSA is also led by Senators Sherrod Brown (D-OH) and Lisa Murkowski (R-AK) along with 25 Original Co-sponsors in this Congress. In the House, there are 132 Original Co-sponsors.
Most group and individual health plans include coverage for congenital anomalies and many states require insurers to provide coverage of any health services related to congenital anomalies or birth defects. Despite this, health plans systematically and routinely deny or delay claims and appeals for treatment of congenital anomalies by wrongfully categorizing certain treatments or body parts as cosmetic or not medically necessary. This is a common practice across the country and leaves families with the burden of paying for their child’s treatment or procedures that are necessary, including medically necessary orthodontic treatment, to restore their ability to function. ELSA would address these coverage denials and delays and ensure that children suffering from congenital anomalies or birth defects get the treatment they need and deserve.
The AAO has joined a broad coalition of national health care professional and patient advocacy organizations to support this legislation. ELSA has been an AAO legislative priority for several years, and participants in the 2021 virtual Professional Advocacy Conference explained the importance of this legislation in meetings with bill leads Representatives Eshoo and Ferguson. You can read the full press release here.
To ask your legislators to sign on as a co-sponsor to ELSA, or to thank them for already co-sponsoring, you can easily do so via the AAO’s Voter Voice page.
