skip to main content

S. 560 (116th): Ensuring Lasting Smiles Act

Should children with facial anomalies such as cleft palate benefit from mandatory coverage requirements by health insurers?

Context and what the legislation does

Congenital facial anomalies such as cleft palate or hypodontia can emotionally scar their victims for life, as well as cause physical problems if left untreated. But many health insurance plans deny coverage for reconstructive surgeries or other procedures that could ameliorate or solve such problems by claiming that the procedures are purely cosmetic or qualify under separate dental insurance plans.

The Ensuring Lasting Smiles Act would mandate that all health insurance plans cover any medically necessary surgery or procedure to correct any birth defects. Purely cosmetic surgery or procedures would be exempted from the legislation’s requirement.

The House version was introduced on February 26 as bill number H.R. 1379, by Rep. Collin Peterson (D-MN7). The Senate version was introduced the same day as bill number S. 560, by Sen. Tammy Baldwin (D-WI).

What supporters say

Supporters argue the legislation helps those in need, who through no fault of their own often rack up exorbitant health care costs.

“There is nothing cosmetic about treatments which are necessary to perform normal bodily functions,” Rep. Peterson said in a press release. “Insurers should do what they can to help beneficiaries, particularly in cases where the healthy development of a child is at stake.”

“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,” Sen. Baldwin said in a separate press release, referring to the story of a Wisconsin teenager with ectodermal dysplasia whose facial reconstructive surgeries weren’t covered by his family’s health insurance plan.

“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,” Sen. Baldwin continued. “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.”

What opponents say

GovTrack Insider was unable to locate any explicit statements of opposition, likely due to the poor optics of appearing to advocate against a bill that would help children with congenital anomalies. But many oppose federal legislation imposing more regulations on the already heavily-regulated health insurance industry, arguing such regulations raise prices and impede the free market of business.

Odds of passage

With large bipartisan support, the legislation’s odds of passage are seemingly high — despite failing to pass after its introduction last year.

The House version has attracted 200 bipartisan cosponsors: 148 Democrats and 52 Republicans, among the most cosponsors of any legislation introduced this Congress. It’s also far more than the August 2018 version, which attracted 16 House cosponsors: nine Democrats and seven Republicans. It now awaits a potential vote in either the House Energy and Commerce or Ways and Means Committee.

The Senate version has attracted 25 bipartisan cosponsors: 13 Republicans and 12 Democrats. That’s also notably more than the August 2018 version, which attracted seven cosponsors: five Democrats and two Republicans. It now awaits a potential vote in the Senate Health, Education, Labor, and Pensions (HELP) Committee.

Last updated Sep 20, 2019. View all GovTrack summaries.

The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Feb 26, 2019.

Ensuring Lasting Smiles Act

This bill requires private health insurance plans to cover diagnosis and treatment services for congenital anomalies and birth defects, such as reconstructive services and prosthetics. Coverage must include services that functionally improve, repair, or restore any body part that is medically necessary for normal bodily functions or appearance, as determined by the treating physician.