On May 8, 2025, Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA), alongside Representatives Kim Schrier (D-WA-08) and Neal Dunn (R-FL-02), reintroduced the Ensuring Lasting Smiles Act (ELSA), which would require all private health insurance plans to cover medically necessary treatments for congenital anomalies or birth defects. This bipartisan legislation aims to close a longstanding gap in coverage, ensuring individuals have access to vital care, including essential dental and oral procedures.

Despite existing laws mandating coverage for congenital anomalies, many families continue to face denied or delayed claims for oral reconstructive treatments. Health insurance companies often classify these procedures as cosmetic, leaving families with overwhelming financial burdens. ELSA directly addresses this issue by ensuring coverage for outpatient and inpatient services related to congenital anomalies affecting the eyes, ears, teeth, mouth, or jaw. The bill clarifies that treatments necessary to restore or improve function, such as dental, orthodontic, and prosthodontic care, must be covered when deemed medically necessary by a treating physician.

Impact on General Dentistry: The AGD strongly supports ELSA, recognizing the critical role general dentists play in treating patients with congenital anomalies. Many affected individuals require extensive dental care throughout their lives, often facing barriers to treatment due to insurance coverage limitations. By advocating for the passage of this bill, AGD aims to ensure that dental professionals can provide essential care without financial obstacles preventing patients from accessing necessary treatment. The full bill text can be found here.