AGD has signed on as a supporting organization of
H.R. 3277 /
S. 1677, the
Ensuring Lasting Smiles Act (ELSA Act). This bill was introduced by Representatives Neal Dunn (R-FL-02) and Kim Schrier (D-WA-08) in the House of Representatives and Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA) in the Senate. The legislation would expand health insurance coverage to include inpatient and outpatient services for diagnosing and treating congenital anomalies or birth defects that primarily affect the eyes, ears, teeth, mouth, or jaw. Coverage includes reconstructive treatments, dental and orthodontic support from birth through treatment completion, and follow-up care, with no cost-sharing more restrictive than other medical benefits. Cosmetic surgery not resulting from a medical diagnosis of a congenital anomaly is excluded. The law requires group health plans and insurers to provide notice to participants by January 1, 2026, and mandates a study by the Secretary of Health and Human Services by December 31, 2027, evaluating provider network adequacy and changes in patient out-of-pocket costs and procedure expenses.
Impact on General Dentistry: By requiring coverage for diagnosis, treatment, reconstructive procedures, orthodontic care, and related follow-up services from birth through completion of treatment, the Elsa Act could reduce financial barriers that often prevent patients from receiving comprehensive dental care for conditions such as cleft lip and palate, ectodermal dysplasia, and other craniofacial abnormalities. The legislation may increase patient access to general dentists who participate in multidisciplinary treatment teams, improve continuity of care, and reduce uncompensated or delayed treatment resulting from insurance coverage limitations. In addition, limits on cost-sharing and the requirement that plans provide these benefits in a manner comparable to other medical services could improve treatment adherence and long-term oral health outcomes for affected patients.
