[Congressional Record Volume 168, Number 59 (Monday, April 4, 2022)]
[House]
[Pages H4140-H4144]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ENSURING LASTING SMILES ACT
Ms. ESHOO. Madam Speaker, I move to suspend the rules and pass the
bill (H.R. 1916) to provide health insurance benefits for outpatient
and inpatient items and services related to the diagnosis and treatment
of a congenital anomaly or birth defect, as amended.
The Clerk read the title of the bill.
The text of the bill is as follows:
H.R. 1916
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Ensuring Lasting Smiles
Act''.
SEC. 2. COVERAGE OF CONGENITAL ANOMALY OR BIRTH DEFECT.
(a) Public Health Service Act Amendments.--Part D of title
XXVII of the Public Health Service Act (42 U.S.C. 300gg-111
et seq.) is amended by adding at the end the following new
section:
``SEC. 2799A-11. STANDARDS RELATING TO BENEFITS FOR
CONGENITAL ANOMALY OR BIRTH DEFECT.
``(a) Requirements for Care and Reconstructive Treatment.--
``(1) In general.--A group health plan, and a health
insurance issuer offering group or individual health
insurance coverage, shall provide coverage for outpatient and
inpatient items and services related to the diagnosis and
treatment of a congenital anomaly or birth defect.
``(2) Requirements.--
``(A) In general.--Coverage provided under paragraph (1)
shall include any medically necessary item or service to
functionally improve, repair, or restore any body part to
achieve normal body functioning or appearance, as determined
by the treating physician (as defined in section 1861(r) of
the Social Security Act), due to congenital anomaly or birth
defect.
``(B) Financial requirements and treatment requirements.--
Any coverage provided under paragraph (1) under a group
health plan or individual or group health insurance coverage
offered by a health insurance issuer may be subject to
coverage limits (such as medical necessity, pre-
authorization, or pre-certification) and cost-sharing
requirements (such as coinsurance, copayments, and
deductibles), as required by the plan or issuer, that are no
more restrictive than the predominant coverage limits and
cost-sharing requirements, respectively, applied to
substantially all medical and surgical benefits covered by
the plan (or coverage).
``(3) Treatment defined.--In this section:
``(A) In general.--Except as provided in subparagraph (B),
the term `treatment' includes, with respect to a group health
plan or group or individual health insurance coverage offered
by a health insurance issuer, inpatient and outpatient items
and services performed to improve, repair, or restore bodily
function (or performed to approximate a normal appearance),
due to a congenital anomaly or birth defect, and includes
treatment to any and all missing or abnormal body parts
(including teeth, the oral cavity, and their associated
structures) that would otherwise be provided under the plan
or coverage for any other injury or sickness, including--
``(i) any items or services, including inpatient and
outpatient care, reconstructive services and procedures, and
complications thereof;
``(ii) adjunctive dental, orthodontic, or prosthodontic
support from birth until the medical or surgical treatment of
the defect or anomaly has been completed, including ongoing
or subsequent treatment required to maintain function or
approximate a normal appearance;
``(iii) procedures that materially improve, repair, or
restore bodily function; and
``(iv) procedures for secondary conditions and follow-up
treatment associated with the underlying congenital anomaly
or birth defect.
``(B) Exception.--The term `treatment' shall not include
cosmetic surgery performed to reshape normal structures of
the body to improve appearance or self-esteem.
``(b) Notice.--Not later than one year after the date of
the enactment of this section and annually thereafter, a
group health plan, and a health insurance issuer offering
group or individual health insurance coverage, shall, in
accordance with regulations or guidance issued by the
Secretary, provide to each enrollee under such plan or
coverage a written description of the terms of this section.
Such description shall be in language which is understandable
to the typical enrollee.''.
(b) ERISA Amendments.--
(1) In general.--Subpart B of part 7 of subtitle B of title
I of the Employee Retirement Income Security Act of 1974 is
amended by adding at the end the following:
``SEC. 726. STANDARDS RELATING TO BENEFITS FOR CONGENITAL
ANOMALY OR BIRTH DEFECT.
``(a) Requirements for Care and Reconstructive Treatment.--
``(1) In general.--A group health plan, and a health
insurance issuer offering group health insurance coverage,
shall provide coverage for outpatient and inpatient items and
services related to the diagnosis and treatment of a
congenital anomaly or birth defect.
``(2) Requirements.--
``(A) In general.--Coverage provided under paragraph (1)
shall include any medically necessary item or service to
functionally improve, repair, or restore any body part to
achieve normal body functioning or appearance, as determined
by the treating physician (as defined in section 1861(r) of
the Social Security Act), due to congenital anomaly or birth
defect.
``(B) Financial requirements and treatment requirements.--
Any coverage provided under paragraph (1) under a group
health plan or group health insurance coverage offered by a
health insurance issuer may be subject to coverage limits
(such as medical necessity, pre-authorization, or pre-
certification) and cost-sharing requirements (such as
coinsurance, copayments, and deductibles), as required by the
plan or issuer, that are no more restrictive than the
predominant coverage limits and cost-sharing requirements,
respectively, applied to substantially all medical and
surgical benefits covered by the plan (or coverage).
[[Page H4141]]
``(3) Treatment defined.--In this section:
``(A) In general.--Except as provided in subparagraph (B),
the term `treatment' includes, with respect to a group health
plan or group health insurance coverage offered by a health
insurance issuer, inpatient and outpatient items and services
performed to improve, repair, or restore bodily function (or
performed to approximate a normal appearance), due to a
congenital anomaly or birth defect, and includes treatment to
any and all missing or abnormal body parts (including teeth,
the oral cavity, and their associated structures) that would
otherwise be provided under the plan or coverage for any
other injury or sickness, including--
``(i) any items or services, including inpatient and
outpatient care, reconstructive services and procedures, and
complications thereof;
``(ii) adjunctive dental, orthodontic, or prosthodontic
support from birth until the medical or surgical treatment of
the defect or anomaly has been completed, including ongoing
or subsequent treatment required to maintain function or
approximate a normal appearance;
``(iii) procedures that materially improve, repair, or
restore bodily function; and
``(iv) procedures for secondary conditions and follow-up
treatment associated with the underlying congenital anomaly
or birth defect.
``(B) Exception.--The term `treatment' shall not include
cosmetic surgery performed to reshape normal structures of
the body to improve appearance or self-esteem.
``(b) Notice.--Not later than one year after the date of
the enactment of this section and annually thereafter, a
group health plan, and a health insurance issuer offering
group health insurance coverage, shall, in accordance with
regulations or guidance issued by the Secretary, provide to
each participant or beneficiary under such plan or coverage a
written description of the terms of this section. Such
description shall be in language which is understandable to
the typical participant or beneficiary.''.
(2) Technical amendment.--The table of contents in section
1 of such Act is amended by inserting after the item relating
to section 725 the following new item:
``Sec. 726. Standards relating to benefits for congential anomaly or
birth defect.''.
(c) Internal Revenue Code Amendments.--
(1) In general.--Subchapter B of chapter 100 of the
Internal Revenue Code of 1986 is amended by adding at the end
the following:
``SEC. 9826. STANDARDS RELATING TO BENEFITS FOR CONGENITAL
ANOMALY OR BIRTH DEFECT.
``(a) Requirements for Care and Reconstructive Treatment.--
``(1) In general.--A group health plan shall provide
coverage for outpatient and inpatient items and services
related to the diagnosis and treatment of a congenital
anomaly or birth defect.
``(2) Requirements.--
``(A) In general.--Coverage provided under paragraph (1)
shall include any medically necessary item or service to
functionally improve, repair, or restore any body part to
achieve normal body functioning or appearance, as determined
by the treating physician (as defined in section 1861(r) of
the Social Security Act), due to congenital anomaly or birth
defect.
``(B) Financial requirements and treatment requirements.--
Any coverage provided under paragraph (1) under a group
health plan may be subject to coverage limits (such as
medical necessity, pre-authorization, or pre-certification)
and cost-sharing requirements (such as coinsurance,
copayments, and deductibles), as required by the plan, that
are no more restrictive than the predominant coverage limits
and cost-sharing requirements, respectively, applied to
substantially all medical and surgical benefits covered by
the plan.
``(3) Treatment defined.--In this section:
``(A) In general.--Except as provided in subparagraph (B),
the term `treatment' includes, with respect to a group health
plan, inpatient and outpatient items and services performed
to improve, repair, or restore bodily function (or performed
to approximate a normal appearance), due to a congenital
anomaly or birth defect, and includes treatment to any and
all missing or abnormal body parts (including teeth, the oral
cavity, and their associated structures) that would otherwise
be provided under the plan for any other injury or sickness,
including--
``(i) any items or services, including inpatient and
outpatient care, reconstructive services and procedures, and
complications thereof;
``(ii) adjunctive dental, orthodontic, or prosthodontic
support from birth until the medical or surgical treatment of
the defect or anomaly has been completed, including ongoing
or subsequent treatment required to maintain function or
approximate a normal appearance;
``(iii) procedures that materially improve, repair, or
restore bodily function; and
``(iv) procedures for secondary conditions and follow-up
treatment associated with the underlying congenital anomaly
or birth defect.
``(B) Exception.--The term `treatment' shall not include
cosmetic surgery performed to reshape normal structures of
the body to improve appearance or self-esteem.
``(b) Notice.--Not later than one year after the date of
the enactment of this section and annually thereafter, a
group health plan shall, in accordance with regulations or
guidance issued by the Secretary, provide to each enrollee
under such plan a written description of the terms of this
section. Such description shall be in language which is
understandable to the typical enrollee.''.
(2) Clerical amendment.--The table of sections for such
subchapter is amended by adding at the end the following new
item:
``Sec. 9826. Standards relating to benefits for congenital anomaly or
birth defect.''.
(d) Rule of Construction.--A group health plan or health
insurance issuer shall provide the benefits described in
section 2799A-11 of the Public Health Service Act (as added
by subsection (a)), section 726 of the Employee Retirement
Income Security Act of 1974 (as added by subsection (b)), and
section 9826 of the Internal Revenue Code of 1986 (as added
by subsection (c)) under the terms of such plan or health
insurance coverage offered by such issuer.
(e) Effective Date.--The amendments made by this section
shall apply with respect to plan years beginning on or after
January 1, 2024.
SEC. 3. DETERMINATION OF BUDGETARY EFFECTS.
The budgetary effects of this Act, for the purpose of
complying with the Statutory Pay-As-You-Go Act of 2010, shall
be determined by reference to the latest statement titled
``Budgetary Effects of PAYGO Legislation'' for this Act,
submitted for printing in the Congressional Record by the
Chairman of the House Budget Committee, provided that such
statement has been submitted prior to the vote on passage.
The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from
California (Ms. Eshoo) and the gentleman from Virginia (Mr. Griffith)
each will control 20 minutes.
The Chair recognizes the gentlewoman from California.
General Leave
Ms. ESHOO. Madam Speaker, I ask unanimous consent that all Members
may have 5 legislative days in which to revise and extend their remarks
and include extraneous material on H.R. 1916.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from California?
There was no objection.
Ms. ESHOO. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I rise in full support of H.R. 1916, the Ensuring
Lasting Smiles Act. On behalf of the 4 percent of American children
born annually with congenital anomalies or birth defects, I am very
proud to sponsor this much-needed legislation.
This bill will ensure that health plans do not deny or delay
medically necessary treatment of congenital anomalies. In many cases,
coverage for well-known anomalies, like heart defects or spina bifida,
is already the standard. But for babies who have oral defects such as
cleft palates, skeletal defects, congenital cataracts, or hearing
defects, insurance companies have systematically denied or delayed
medically necessary treatments.
I became a sponsor of this legislation after Kevin Koser testified at
our Health Subcommittee, which you are a member of, Madam Speaker,
about his beautiful son, Kannon. He shared with the subcommittee how
Kannon asked Santa Claus for teeth so he could ``chomp big bites'' of
food.
I was really shaken by that and by the fact that in our country, such
a rich and great country as America, we would put treatment that allows
a child to eat out of reach because of insurance red tape.
A baby named Rosie in my congressional district is one of the 1,300
babies born in the United States each year with congenital cataracts.
In just a few months, her family spent over $4,000 out of pocket on
contact lenses for her. Without these lenses, babies like Rosie are
blind, and they have no chance of ever developing normal vision.
These stories are repeated across our country every single day, but
today is the day that we can begin to change that. This legislation is
one of the most popular bills in the House, with 316 bipartisan
cosponsors, including more than half of the Republican Conference.
The time has come for this important, popular, and much-needed bill
to finally pass the House of Representatives.
Madam Speaker, I reserve the balance of my time.
Mr. GRIFFITH. Madam Speaker, I yield myself such time as I may
consume.
Madam Speaker, I am disappointed that all Members could not reach an
agreement on this bill. I have an
[[Page H4142]]
amendment that would specify the types of conditions required to be
addressed by this bill, which would help clarify its intent for the
implementing agencies.
Madam Speaker, I include in the Record the text of my proposed
amendment.
In the heading of section 2, strike ``congenital anomaly or
birth defect'' and insert ``craniofacial, oral, or
maxillofacial congenital anomaly or birth defect''.
In section 2799A-11 of the Public Health Service Act,
section 726 of the Employee Retirement Income Security Act of
1974, and section 9826 of the Internal Revenue Code of 1986,
as proposed to be added by section 2--
(1) in the heading, strike ``congenital anomaly or birth
defect'' and insert ``craniofacial, oral, or maxillofacial
congenital anomaly or birth defect''; and
(2) in subsection (a), strike the term ``congenital anomaly
or birth defect'' and insert ``craniofacial, oral, or
maxillofacial congenital anomaly or birth defect'' each place
such term appears.
Mr. GRIFFITH. Madam Speaker, the stated goal of the bill is a good
one, making sure those who, through no fault of their own, are born
with a condition requiring extensive medical care can eat, drink, and
thrive.
I would love to be able to tell families like the one in my district
with two children experiencing ectodermal dysplasia that insurance
would pay for the hundreds of thousands of dollars of surgery necessary
to allow their teeth and mouths to function properly. But this bill
needs more work, and my amendment could have addressed its most
significant flaw.
Had the bill gone through regular order, I would have offered this
corrective amendment.
The biggest problem here is that not one person can articulate which
medical procedures or treatments would be required to be covered by
insurance.
The bill is titled healthy smiles, referencing cleft palate,
ectodermal dysplasia, et cetera, but not one person can articulate
which medical procedures or treatments would be required to be covered
by insurance. This is, in part, because the FDA has no statutory or
regulatory definition of what a congenital anomaly or birth defect is.
Further, one part of the bill requires insurers to ``include any
medically necessary item or service to . . . restore any body part to
achieve normal body functioning or appearance,'' while another part
provides that ``'treatment' shall not include cosmetic surgery.''
Technical comments from the Department of Labor support my belief
that these two provisions ``seem to be in tension.'' There is a tension
between the two sections.
Because the language is so vague, CBO found it difficult to estimate
the cost. They expressed uncertainty around identifying the procedures
and services that would be considered medically necessary. Nonetheless,
they took a stab at it and guessed it would cost around $1.8 billion.
My amendment would resolve these concerns by replacing the phrase
``congenital anomaly or birth defect'' with ``craniofacial, oral, or
maxillofacial congenital anomaly or birth defect'' to specify the types
of conditions advocates of this bill have been discussing for months.
Most of the people who signed on as cosponsors thought that was just
what they were doing. They didn't know they were going to cover, as the
gentlewoman has said, the 4 percent of children born with any kind of a
birth defect.
Given that my amendment cannot be considered today, I will be voting
``no.''
Now, you may wonder, how did I come to this conclusion? When my
oldest son was born 16 years ago, when I called my wife's father, his
first question was, ``Does he have all his fingernails?'' because my
wife was born with a congenital birth defect. She doesn't have
fingernails on her index fingers. This has caused them to be injured
numerous times over the years.
There is no question it qualifies under this bill for some kind of
treatment, whether it be an implant to replace those nails--if this
bill passes, we will be doing everything from the healthy smiles that
the bill purports to do all the way down to fingernails.
Now, she is fine. She has grown up. She has adjusted. Everything is
good. But the first question my father-in-law asked was, ``Does he have
all his fingernails?'' because, for years, it was a concern to him as a
father, as a parent.
This bill would deal with that, and that is why it is hard to say
what it is going to cost because a lot of smaller defects like my
wife's fingernails would be covered under this.
{time} 1745
And if it is covered, by golly, you know they are going to fix it.
The worst thing she has to do now is wear gloves when we take out the
Christmas tree and try to be careful. But as a child, it was a bigger
issue, and like I said, the tips of her index fingers are a little
bulbous. She might be offended by this, but if you look closely, it
looks a little bit like E.T.'s finger, though it is not quite as long
and it doesn't light up. But it is a birth defect that this bill would
cover at huge cost to the American public and to the American
taxpayers.
This bill goes too far. I wish we had the opportunity to accept my
amendment, which we can't do on a bill that is on suspension, because
then we could make sure it dealt with the big items that only affect a
much smaller part of the population and that truly do need to be dealt
with.
Madam Speaker, I reserve the balance of my time.
Ms. ESHOO. Madam Speaker, the bill that we are taking up today was
passed by the Energy and Commerce Committee. It hasn't changed. The
gentleman, Mr. Griffith, had an amendment. He withdrew it. He had the
opportunity, but he withdrew it.
Madam Speaker, I yield such time as he may consume to the gentleman
from New Jersey (Mr. Pallone), the chairman of the Energy and Commerce
Committee.
Mr. PALLONE. Madam Speaker, I thank Chairwoman Eshoo for yielding.
Madam Speaker, I rise in strong support of H.R. 1916, the Ensuring
Lasting Smiles Act, a bipartisan bill that will help patients with
congenital anomalies and birth defects get the necessary treatment that
they deserve.
Three percent of American children are born with congenital anomalies
or birth defects that affect the way they look, develop, or function,
often for the rest of their lives. These children require serious
medical treatment. But for far too long, insurance companies have been
unfairly denying treatment, despite an official medical diagnosis, by
deeming it cosmetic or because the treatment involves dental services.
This is unacceptable. This treatment is critically important and
medically necessary, particularly for children with serious dental
anomalies.
During our legislative hearing on this bill in committee, we heard
from Kevin Koser about his family's longstanding struggles to get his
son Kannon's medical treatment covered. Kannon was diagnosed with
ectodermal dysplasia when he was 1 year old, and this had a drastic
impact on his health and quality of life. Ectodermal dysplasia is a
congenital anomaly that affects the development of the hair, skin,
teeth, and other body parts. Kannon sprouted his first tooth at the age
of 4, and this has severely restricted his diet and impacted his
ability to speak.
In accordance with the treatment plan established by his doctor, his
family began pursuing dentures for Kannon; however, their family health
plan denied the medically necessary treatment for Kannon and deemed it
as not a covered benefit. The Koser family is not alone.
Madam Speaker, there are countless children across the country whose
medically necessary treatments are unfairly denied by insurance
companies. These children may have to forego the care they need to live
healthy and fulfilling lives because their families simply cannot
afford the treatment. Too often, their families are stuck with the
financial burden of paying out of pocket for medically necessary
treatment despite having health insurance, and children like Kannon are
forced to delay necessary care that is meant to restore bodily
function.
The National Foundation for Ectodermal Dysplasias estimates that some
families will pay upwards of $150,000 out of pocket in their lifetime
for medically necessary treatments. This is for medical care that
should be rightfully covered by insurance.
The Ensuring Lasting Smiles Act will require all individual and group
market health plans to cover medically necessary treatment resulting
from congenital anomalies and ensure that children like Kannon get the
treatment they need. This is important, commonsense legislation that
has--as Ms.
[[Page H4143]]
Eshoo said--310 bipartisan cosponsors. I commend Ms. Eshoo for her
leadership on this legislation as the prime sponsor of the bill.
This important bill will improve the health and well-being of
countless Americans and ensure that individuals born with congenital
anomalies have the opportunity to live a healthy life. Children like
Kannon and his family should have the peace of mind to know that
medically necessary treatment will be covered.
Madam Speaker, I urge all of my colleagues to support this bill.
Mr. GRIFFITH. Madam Speaker, I yield myself the balance of my time.
Madam Speaker, I will submit that my amendment was not offered at the
full committee. Two years ago, when we were taking this bill through
regular order, at that time it was discussed that we would try to work
on language that would narrow the scope before it came to the floor. I
assumed that that would be done before this bill was brought up on a
suspension; that has not happened. I would be more than happy, if we
have to come to loggerheads over it, that we have that discussion where
we can discuss all the potential costs, all the potential birth defects
that might be covered, including the minor ones, the ones that don't
have an effect on lasting smiles, which is also included in this.
Now, the gentlewoman's heart is in the right place, and I have great
respect for her, and understand what she is trying to do. I just think
that there is so much unknown cost for so many minor birth defects and
small inconveniences that might be cosmetic or might not be, depending
on which doctor makes that decision, because we don't have a good
definition either in the bill or in the standard lingo of the FDA, et
cetera.
I think we are buying a whole lot more expense, both to the American
taxpayer, and, I believe, this is going to push up the cost of health
insurance on families that are already having difficulties making those
health insurance payments. All of that is correct.
And the chairman of the committee--also his heart is in the right
place--mentioned ectodermal dysplasia. I have no problem with us
treating that. It affects a small number of people. It is a huge cost
on a handful of families out there--maybe a few more than a handful--
but it does affect people disproportionately who cannot afford to have
that fixed, and it does create huge problems on eating, on talking, et
cetera. Those are the things we want to go after.
What I want to make sure we are not doing is spending billions of
dollars of American taxpayer dollars or raising the cost of health
insurance because we are going to take care of everything down to two
index finger fingernails missing, et cetera. That is my concern.
Madam Speaker, as you can tell, I feel passionately about this, and I
yield back the balance of my time.
Ms. ESHOO. Madam Speaker, I yield myself the balance of my time.
I thank the gentleman for his kind comments about me. I think that
there are a couple of important points to be made. And that is that CBO
estimates that insurers will respond to this bill by raising premiums
by less than 0.1 percent. What CBO does not score are the savings from
providing this needed medical care because that medical care goes on
and on and on. And the costs to families are exorbitant.
As I said earlier today, I think this is a very good bill. I
acknowledge all the advocates from all over the country that worked so
hard to bring us to this moment.
Madam Speaker, I look forward to the vote today on this bill that has
been with us since 2020, and I yield back the balance of my time.
Ms. JACKSON LEE. Madam Speaker, I rise in strong support of H.R.
1916, the Ensuring Lasting Smiles Act.
The purpose of this bill is to provide health insurance benefits for
outpatient and inpatient items and services related to the diagnosis
and treatment of congenital anomalies and birth defects.
This bill requires private health insurance plans to cover the
diagnosis and treatment of birth defects, congenital disorders, or
congenital malformations, conditions developed prenatally and may be
identified before or at birth, or later in life.
The coverage must include services and items 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.
This bill protects patients against increased insurance premiums by
clearly specifying that coverage for these treatments may be subjected
only to the same limits that apply to other injuries or sicknesses
without imposing any greater financial responsibilities on the patient
or family.
This legislation would also close an insurance coverage loophole for
people born with congenital anomalies who need complex oral restorative
care.
It would ensure that health plans cover medically necessary services
related to a patient's anomaly or birth defect, including any serious
dental and oral-related procedures that are necessary to maintaining
health and overall function.
Insurance companies usually cover the preliminary procedures to treat
congenital anomalies, but often deny and delay follow-up reconstructive
procedures.
Denial or delay of these reconstructive procedures could lead to
long-term physical and psychological injuries.
Insurance companies claim these follow up procedures are only
cosmetic in nature, which then places a significant burden on patients
and their families.
It is relatively rare for a child with a congenital deformity or
developmental anomaly to undergo just one procedure that corrects all
the associated health implications the first time.
On average, these children can expect anywhere from three to five
surgical procedures and many more treatments before achieving
structural normalcy and function in the affected body parts.
These families are then forced to pay huge out-of-pocket costs for
treatment coverage or, in worst case scenarios, terminate treatment.
For example, people born with ectodermal dysplasia's are often unable
to properly develop teeth.
Their teeth may be missing, completely absent, have defective enamel
or be shaped differently.
If the teeth are not repaired or replaced, these individuals could
have chewing, swallowing, digestive, speech and self-esteem issues.
Someone born with ectodermal dysplasia spends a significant amount of
money on necessary medical and dental care throughout their lifetime.
This amount of money can become so excessive that families may have
no option other than selling their cars, remortgaging their homes, and
foregoing a college education to afford medically necessary dental
care.
Far more families simply go without care because they can't afford
it.
Dental care is also subject to a double-standard, while some
individuals who lose their teeth due to an accident receive dental
benefits under the existing statutes, those who are missing teeth due
to ectodermal dysplasias, a medical condition they were born with, do
not receive these same dental benefits.
The Ensuring Lasting Smiles Act would fix this.
This bill would help more families than those affected by the
ectodermal dysplasias. It would cover a broad range of congenital
anomalies.
Many people born with congenital anomalies suffer from severe oral
defects such as:
Cleft lip or palate
Hypodontia
Enamel hypoplasia
Skeletal defects like craniosynostosis
Vision defects like congenital cataracts or aphakia
Hearing defects like microtia
Other loss of bodily functions
According to the Center for Disease Control and Prevention (CDC), one
in 33 babies in the United States is born with a congenital anomaly.
Of those 120,000 children born annually with birth defects,
approximately 40,000 require reconstructive surgery.
Medical professionals and surgeons are fortunately able to correct
many of these problems, however some insurance companies deny access to
care by labeling the procedures as ``cosmetic'' or ``non-functional''
in nature.
Too many children born with congenital anomalies are denied coverage
despite the long-term harm of such conditions.
The Ensuring Lasting Smiles Act would address delays and denials in
coverage and guarantee that children suffering from birth defects and
anomalies get the treatment they need.
I ask my colleagues to join me in voting for H.R. 1916 because this
law guarantees the payment of health insurance benefits for necessary
medical care and treatment due to any congenital anomaly.
These families deserve to see the day when they no longer have to
fight for coverage of medically necessary treatments and their children
and loved ones receive the treatments they desperately need and
deserve.
[[Page H4144]]
The SPEAKER pro tempore. The question is on the motion offered by the
gentlewoman from California (Ms. Eshoo) that the House suspend the
rules and pass the bill, H.R. 1916, as amended.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds
being in the affirmative, the ayes have it.
Mr. GRIFFITH. Madam Speaker, on that I demand the yeas and nays.
The SPEAKER pro tempore. Pursuant to section 3(s) of House Resolution
8, the yeas and nays are ordered.
Pursuant to clause 8 of rule XX, further proceedings on this motion
are postponed.
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