PROBLEM SOLVERS CAUCUS HELPS ADVANCE ENSURING LASTING SMILES ACT
WASHINGTON - Today, March 5, 2020, the Problem Solvers Caucus formally endorsed the bipartisan Ensuring Lasting Smiles Act, which will close an insurance loophole so that children born with congenital anomalies such as ectodermal dysplasias can get the medically-necessary treatments that they need.
H.R. 1379, the Ensuring Lasting Smiles Act (ELSA) was introduced in the House of Representatives by Reps. Collin Peterson (D-MN-07) and Denver Riggleman (R-VA-05). Problem Solvers Caucus Co-Chairs, Reps. Josh Gottheimer (D-NJ-05) and Tom Reed (R-NY-23) brought the bill to the Caucus for endorsement.
The legislation was recently placed on the consensus calendar and will receive priority access on the House floor by having more than 290 bipartisan cosponsors, thanks to a new House rule the Problem Solvers Caucus fought for early this Congress.
"Too many children born with congenital anomalies are denied coverage for the medically necessary treatment they need in order to avoid long-term physical and psychological injuries," said Problem Solvers Caucus Co-Chair, Rep. Josh Gottheimer. "With the Problem Solvers Caucus coming together to endorse the Ensuring Lasting Smiles Act, we are helping make sure children in need of reconstructive surgeries get the proper health care and treatment they deserve. This bipartisan legislation will help children in North Jersey and around our country grow up healthier and have a greater quality of life."
“Teeth are critical to general health, proper digestion and clear speech,” said Problem Solvers Caucus Co-Chair, Rep. Tom Reed. “The Ensuring Lasting Smiles Act (ELSA) will close a loophole that has allowed insurance companies to routinely deny oral or dental claims for medically necessary treatments to care for our children and families.”
“I am excited to see the Problem Solvers Caucus endorsement of the Ensuring Lasting Smiles Act (ELSA),” said Rep. Denver Riggleman. “ELSA would ensure all health plans cover medically necessary services, including reconstructive surgeries that are a result of congenital anomalies or birth defects. If enacted, this life-changing bill will allow the families the opportunity to save for their children's college tuition rather than spend money on reconstructive surgery. It will be a life-changer for families across the country. The Problem Solvers Caucus has prioritized common-sense legislation like ELSA and I am thankful for their endorsement.”
“There is nothing cosmetic about treatments which are necessary to perform normal bodily functions,” said Rep. Collin Peterson. “Insurers should do what they can to help beneficiaries, particularly in cases where the healthy development of a child is at stake.”
“Children born with congenital anomalies deserve to be covered by health insurance providers,” said Rep. Brian Fitzpatrick. “Rep. Peterson’s bill will make sure that health insurance coverage extends to help provide treatment for these children, and I am happy to see that the Problem Solvers are endorsing this commonsense legislation.”
“I am proud to endorse the Ensuring Lasting Smiles Act alongside my colleagues in the Problem Solvers Caucus,” said Rep. Salud Carbajal. “This bipartisan legislation would guarantee healthcare coverage for medical services that improve the lives of children born with congenital anomalies. No child should be denied access to necessary surgery simply because they cannot afford it—we're working to make certain that they're not.”
“This legislation will lessen the agony many parents suffer when they are trying to get their children’s congenital anomalies addressed through health services,” said Rep. Don Bacon. “I’m pleased the Problem Solvers caucus has decided to endorse this important piece of legislation.”
“Oral health is critical to overall health,” said Rep. Kendra Horn. “That’s why, last month, I was proud to host a round table of national oral health experts in the House of Representatives for a discussion on the importance of oral health care and the lack of parity in oral health care coverage. Far too many children in the United States suffer from oral or facial defects and cannot receive treatment because their insurance does not cover oral care. The bipartisan Ensuring Lasting Smiles Act addresses coverage denials to ensure that children with congenital anomalies and birth defects have access to the oral care they need. No child should be forced to hide their smile, and today’s bipartisan legislation takes a step forward to ensure that none feel like they have to.”
“I fully support the Problem Solvers Caucus endorsing this important bill,” said Rep. Bill Johnson. “Children with birth defects, such as a cleft lip or palate, should get the treatment they need, and health plans shouldn’t be able to deny it as merely a cosmetic problem – it’s a pre-existing condition.”
“The Ensuring Lasting Smiles Act is a bipartisan solution that will make real change in the lives of families across the country,” said Rep. Anthony Brindisi. “Holding these insurance companies accountable to living up to what they promise families is a common-sense solution that I am proud to support. With the Problem Solvers endorsement, we can get this done.”
“I am proud to support this bipartisan legislation that ensures all health plans cover the medical services necessary to treat children with congenital anomalies or birth defects,” said Rep. Steve Watkins. “No child should suffer due to their pre-existing condition because their health insurance does not cover the treatment they desperately need for healthy development.”
The Ensuring Lasting Smiles Act would address these coverage denials and ensure that children suffering from birth defects and anomalies get the reconstructive treatment they need.
The bipartisan legislation would:
- Ensure that all health plans cover medically necessary services, including reconstructive surgeries and oral-related procedures, as a result of congenital anomalies or birth defects;
- Stipulate that such coverage include services and procedures that functionally repair or restore any missing or abnormal body part that is medically necessary to achieve normal body functioning or appearance, and clarifies that this includes adjunctive dental, orthodontic or prosthodontic support; and
- Exclude cosmetic procedures or surgery.