I’m writing today as your constituent to urge you to become an Original Co-sponsor for reintroduction of the bipartisan, bicameral Ensuring Lasting Smiles Act (ELSA), led by Senate sponsors Senator Tammy Baldwin (D-WI) and Senator Joni Ernst (R-IA) and House sponsors Congresswoman Anna Eshoo (D-CA-18) and Congressman Drew Ferguson (R-GA-3).
About 4% of children in the US are born with congenital anomalies that affect the way they look, develop, or function. Many born with congenital anomalies suffer from severe oral defects (such as cleft lip or palate), skeletal defects (such as craniosynostosis), vision defects (such as congenital cataracts), hearing defects (such as microtia), or other loss of bodily functions. Individuals who do not receive timely, continuous care for their congenital anomalies face long-term physical and psychological injuries.
Most group and individual health plans state that they include coverages for congenital anomalies, and all 50 states require health insurers to provide coverage for the treatment of congenital anomalies. Despite this, health plans systematically and routinely deny or delay claims and appeals for treatment of many congenital anomalies by wrongfully categorizing certain treatments or body parts as cosmetic or not medically necessary. This common practice leaves families with the burden of paying 100% of the cost for their child's medically necessary treatments, despite maintaining private health plans.
The Ensuring Lasting Smiles Act will close loopholes and ensure that group and individual health plans do not deny or delay medically necessary treatments of congenital anomalies, therefore improving the health of countless Americans. ELSA would require a group health plan, and a health insurance issuer offering group or individual health insurance coverage, to provide coverage for outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect, including any medically necessary item or service to achieve normal body functioning, and it clarifies that coverage includes adjunctive dental, orthodontic, and prosthodontic support. ELSA explicitly excludes coverage of cosmetic surgeries.
In the 117th Congress, ELSA gained strong bipartisan support, and it passed in the House of Representatives with a 310-110 vote. In preparation for ELSA’s reintroduction in the 118th Congress, the bill sponsors and a broad coalition of patient-focused and professional medical organizations have worked together to strengthen ELSA’s language by addressing feedback and incorporating recommendations from federal agencies. ELSA is endorsed by over 70 national health care professional and patient advocacy organizations.
Please co-sponsor the bill to help ensure this important legislation gets passed! To learn more and cosponsor, contact Sen. Baldwin’s or Sen. Ernst’s office, or Rep. Eshoo’s or Rep. Ferguson’s office.
Thank you in advance for supporting ELSA and for being an advocate for people born with congenital anomalies! We appreciate your help.
