Support for Ensuring Lasting Smiles Act

ADA and coalition led by AAOMS show their support for Ensuring Lasting Smiles Act

The American Dental Association (ADA) including 34 other organizations presented a letter on February 28, 2019, to Senators Tammy Baldwin from Wisconsin and Joni Ernst from Iowa, as well as House Representatives Collin Peterson and Denver Riggleman to show their support for the Ensuring Lasting Smiles Act (ELSA).

Under ELSA, medically necessary services for correction and restoration of congenital abnormalities will be eligible for coverage—for both private insurance group and individual healthcare plans.

The support coalition, led by the American Association of Oral and Maxillofacial Surgeons, stated that the bill would benefit patients with congenital anomalies and remove the current hurdles to access medically necessary diagnosis, medication, and treatment. The National Foundation for Ectodermal Dysplasias, the American Society of Plastic Surgeons, and the American Association of Orthodontists were lead partners in supporting the ELSA.

The Ensuring Lasting Smiles Act was reintroduced to the 116th Congress as well as the House on the same date, February 26, 2019.

The coalition stated, “We appreciate your leadership in recognizing the importance of ensuring access to the care and services necessary to improve or restore body function or approximate a normal appearance due to a congenital anomaly, such as cleft lip and palate, skeletal and maxillofacial abnormalities, facial paralysis, microtia, hypodontia, and craniosynostosis.”

The Centers for Disease Control and Prevention defines congenital defects as “common, costly and critical.” According to statistics, more than 3% of newborns in the United States suffer from congenital abnormalities. Craniofacial defects can prevent children from breathing, eating, and speaking normally. To help the patient develop and function properly, it requires extremely personalized surgery, and early intervention is the key. Such patients have to be handled by a specialist team of pediatric dentists, orthodontists, dermatologists, speech therapists, and plastic, oral and maxillofacial surgeons. Treatment can last over several years.

The coalition also claimed that private health insurance companies often refuse or delay procedures that are corrective by wrongly claiming them as cosmetic procedures. “They fail to recognize the medical conditions of these patients,” they added.

If children receive delayed care that’s medically necessary, it can adversely affect their development and lead to coverage denials for reconstructive surgery. Eventually, they have to turn to other programs for coverage including Medicaid and the State Children’s Health Insurance Program.