H.R.3277 - Ensuring Lasting Smiles Act (119th Congress)
Summary
H.R.3277, the Ensuring Lasting Smiles Act, aims to mandate health insurance coverage for outpatient and inpatient items and services related to the diagnosis and treatment of congenital anomalies or birth defects. This coverage specifically targets anomalies affecting the eyes, ears, teeth, mouth, or jaw. The bill amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 (ERISA), and the Internal Revenue Code of 1986 to enforce these coverage requirements.
Expected Effects
The bill would require group health plans and health insurance issuers to provide coverage for reconstructive and adjunctive treatments related to congenital anomalies or birth defects. It also mandates that these plans provide notice to participants and beneficiaries regarding the new coverage. A study and report on network adequacy will be conducted by the Secretary of Health and Human Services to assess access to services and changes in out-of-pocket costs.
Potential Benefits
- Ensures comprehensive health insurance coverage for individuals with congenital anomalies or birth defects, specifically those affecting the appearance or function of the eyes, ears, teeth, mouth, or jaw.
- Mandates coverage for reconstructive services, procedures, and related complications, as well as adjunctive dental, orthodontic, or prosthodontic support.
- Requires health plans to provide notice to participants and beneficiaries about the coverage.
- Promotes early intervention and treatment, potentially improving long-term health outcomes and quality of life.
- Addresses potential disparities in access to care for individuals with congenital anomalies or birth defects.
Potential Disadvantages
- May increase health insurance premiums for all covered individuals due to the expanded coverage requirements.
- Could lead to increased administrative costs for health plans and insurers to implement and manage the new coverage requirements.
- Potential for disputes over what constitutes a medically necessary treatment versus cosmetic surgery, despite the bill's exception for cosmetic surgery performed to reshape normal structures.
- The study and report on network adequacy may reveal gaps in access to specialized care, requiring further policy interventions.
- The financial burden on employers offering group health plans, especially small businesses, could be significant.
Most Disadvantaged Areas:
Constitutional Alignment
The bill appears to align with the general welfare clause of the Constitution (Preamble), as it seeks to promote the health and well-being of individuals with congenital anomalies or birth defects. Congress has the power to regulate interstate commerce (Article I, Section 8), which includes regulating health insurance companies that operate across state lines. The amendments to ERISA and the Internal Revenue Code fall under Congress's power to tax and regulate employee benefits.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).