S.1677 - Ensuring Lasting Smiles Act (119th Congress)
Summary
S.1677, the Ensuring Lasting Smiles Act, mandates that group and individual health insurance plans provide coverage for outpatient and inpatient services related to the diagnosis and treatment of congenital anomalies or birth defects affecting the eyes, ears, teeth, mouth, or jaw. This bill amends the Public Health Service Act, ERISA, and the Internal Revenue Code to ensure this coverage. A study and report on network adequacy are also required to assess access to these services and changes in out-of-pocket costs.
Expected Effects
The bill will expand health insurance coverage for individuals with congenital anomalies or birth defects, ensuring access to necessary medical and dental treatments. It requires health plans to provide notice of this coverage to beneficiaries starting January 1, 2026. The Secretary of Health and Human Services will conduct a study on network adequacy and out-of-pocket costs, reporting findings to Congress by December 31, 2027.
Potential Benefits
- Improved Access to Care: Ensures individuals with congenital anomalies have access to necessary medical and dental treatments.
- Reduced Financial Burden: Lowers out-of-pocket costs for families needing specialized care for birth defects.
- Comprehensive Coverage: Mandates coverage for a wide range of services, including reconstructive procedures and adjunctive dental support.
- Early Intervention: Supports treatment from birth, addressing both functional and appearance-related issues.
- Increased Awareness: Requires health plans to notify beneficiaries of available coverage.
Potential Disadvantages
- Potential Premium Increases: Health insurance premiums could rise due to expanded coverage requirements.
- Administrative Burden: Insurance companies may face increased administrative costs to implement and manage the new coverage mandates.
- Limited Scope: The bill focuses on specific congenital anomalies, potentially excluding other medical conditions from similar coverage.
- Cost-Sharing Requirements: Cost-sharing requirements (deductibles, co-pays) are still permitted, potentially limiting access for some.
- Study Delay: The study on network adequacy and out-of-pocket costs is not due until December 31, 2027, delaying potential corrective actions.
Constitutional Alignment
The bill aligns with the general welfare clause of the Constitution (Preamble), as it aims to promote the health and well-being of individuals with congenital anomalies. It does not appear to infringe upon any specific individual liberties or rights outlined in the Bill of Rights. The regulation of health insurance falls under the commerce clause (Article I, Section 8), granting Congress the power to regulate interstate commerce, which includes health insurance markets.
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).