The Importance of the Ensuring Lasting Smiles Act

Health insurance in the United States often denies surgeries crucial for children and adults with congenital facial conditions. For years, surgeries necessary for eating, breathing, or speaking have been wrongly labeled as “cosmetic” by insurers. The Ensuring Lasting Smiles Act (ELSA) promises a change by ensuring these individuals receive the needed medical care without unjust financial burdens on families.

Despite state laws like ‘Wendolyn’s Law’ in Arkansas, insurance loopholes continue to delay and deny vital treatments. This forces families to pay tens of thousands out of pocket, threatening their financial stability. Congenital anomalies affect approximately 4% of U.S. children. These can impair swallowing, chewing, breathing, and hearing. Yet, insurance denials persist, often contrary to state mandates. About 1 in every 1,000 U.S. births results in a cleft lip and/or cleft palate. While congenital heart defects occur more frequently, denials for craniofacial condition coverage are still common. Sometimes, these occur retroactively after procedures are completed.

ELSA addresses coverage for medically necessary surgeries, not cosmetic ones. For example, surgery for a child with a cleft palate is necessary for normal jaw function. Currently, insurers may argue that such procedures fall under dental coverage, leading to denial. Even letters from global experts on craniofacial issues declaring a procedure’s necessity may be ignored. Often, family physicians, rather than specialized experts, review these claims.

The issue is significant. Nonprofits regularly receive pleas from families denied coverage for critical surgeries, like secondary bone grafts. These are not isolated cases. Stories of children mocked or bullied due to untreated conditions are widespread, resulting in lifelong emotional trauma. The remedy exists, but without coverage, these families struggle with exorbitant costs.

Wide bipartisan support backs ELSA, including endorsements from over 70 professional societies. Influential politicians like Senators Tammy Baldwin (D-Wis.) and Joni Ernst (R-Iowa), along with Representatives Neal Dunn and Kim Schrier, support it. This legislation is vital, not controversial. Most families face multiple procedures, possibly up to 16 by age 16, which are medically essential. Without timely care, permanent physical and psychological damage may result.

There’s an urgent need for Congress to pass the Ensuring Lasting Smiles Act. This will prevent financial devastation and ensure that children live healthy, fulfilling lives. Adam Levy, executive director of the American Cleft Palate Craniofacial Association, emphasizes the importance of this act. It’s a crucial step towards supporting patients with craniofacial differences by providing them necessary, timely care.