Ensuring Lasting Smiles Act
Sponsored By: Senator Tammy Baldwin
Introduced
Summary
Requires health plans to cover diagnosis and treatment of congenital anomalies that mainly affect the appearance or function of the eyes, ears, teeth, mouth, or jaw. It mandates medically necessary reconstructive, diagnostic, and adjunctive dental, orthodontic, and prosthodontic services and excludes cosmetic surgery that reshapes normal structures.
Show full summary
- Families and children: Parents get guaranteed coverage for reconstructive and dental/orthodontic care from birth until treatment is complete, including follow-up care for related secondary conditions.
- Plans, employers, and tax rules: Group and individual insurers must cover these services and may not impose cost-sharing more restrictive than the plan's predominant medical and surgical benefits. Plans must notify enrollees in service descriptions for plan years beginning on or after January 1, 2026. The Employee Retirement Income Security Act and Internal Revenue Code are amended to mirror these coverage rules for employer and tax-qualified plans.
- Federal study and reporting: The Department of Health and Human Services must study provider network adequacy and changes in out-of-pocket and procedure costs, and report to Congress by December 31, 2027.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
1 provisions identified: 1 benefits, 0 costs, 0 mixed.
Coverage for facial and oral defects
This bill would require group and individual health plans to cover diagnosis and treatment for birth defects that mainly affect the eyes, ears, teeth, mouth, or jaw. Plans would have to pay for medically necessary reconstructive surgery and related care, plus dental, orthodontic, and prosthetic support from birth until treatment is finished. Plans could still charge copays, coinsurance, or deductibles, but not more strictly than the plan's usual medical cost-sharing. Elective cosmetic surgery for normal features would not be required unless a doctor says it is needed because of the birth defect. Plans must notify enrollees about this coverage by January 1, 2026, and the rule would apply to plan years starting on or after January 1, 2026.
Sponsors & CoSponsors
Sponsor
Tammy Baldwin
WI • D
Cosponsors
Joni Ernst
IA • R
Sponsored 5/8/2025
Amy Klobuchar
MN • D
Sponsored 5/8/2025
Lisa Murkowski
AK • R
Sponsored 5/8/2025
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 5/8/2025
Thomas Tillis
NC • R
Sponsored 5/8/2025
Angus King
ME • I
Sponsored 5/8/2025
Roger Marshall
KS • R
Sponsored 5/8/2025
John Reed
RI • D
Sponsored 5/8/2025
Chuck Grassley
IA • R
Sponsored 5/8/2025
Richard Blumenthal
CT • D
Sponsored 5/8/2025
Cory Booker
NJ • D
Sponsored 5/8/2025
Jeff Merkley
OR • D
Sponsored 5/8/2025
Mark Kelly
AZ • D
Sponsored 5/19/2025
John Boozman
AR • R
Sponsored 6/9/2025
Steve Daines
MT • R
Sponsored 6/16/2025
Elizabeth Warren
MA • D
Sponsored 6/24/2025
Ruben Gallego
AZ • D
Sponsored 6/25/2025
Angela Alsobrooks
MD • D
Sponsored 7/22/2025
Dan Sullivan
AK • R
Sponsored 7/23/2025
Shelley Capito
WV • R
Sponsored 7/23/2025
Chris Van Hollen
MD • D
Sponsored 9/2/2025
Edward Markey
MA • D
Sponsored 9/8/2025
Raphael Warnock
GA • D
Sponsored 9/9/2025
Jacky Rosen
NV • D
Sponsored 9/17/2025
James Justice
WV • R
Sponsored 9/29/2025
Christopher Coons
DE • D
Sponsored 9/29/2025
Kirsten Gillibrand
NY • D
Sponsored 9/29/2025
John Fetterman
PA • D
Sponsored 9/29/2025
Peter Welch
VT • D
Sponsored 10/1/2025
Elissa Slotkin
MI • D
Sponsored 10/29/2025
Susan Collins
ME • R
Sponsored 11/4/2025
Rick Scott
FL • R
Sponsored 11/5/2025
Sheldon Whitehouse
RI • D
Sponsored 11/6/2025
Ron Wyden
OR • D
Sponsored 11/18/2025
Adam Schiff
CA • D
Sponsored 12/3/2025
Tammy Duckworth
IL • D
Sponsored 12/3/2025
Alex Padilla
CA • D
Sponsored 12/9/2025
Michael Bennet
CO • D
Sponsored 1/5/2026
Kevin Cramer
ND • R
Sponsored 1/29/2026
Cindy Hyde-Smith
MS • R
Sponsored 2/10/2026
Maria Cantwell
WA • D
Sponsored 3/2/2026
Lisa Blunt Rochester
DE • D
Sponsored 3/2/2026
Jeanne Shaheen
NH • D
Sponsored 3/3/2026
Tina Smith
MN • D
Sponsored 3/3/2026
Gary Peters
MI • D
Sponsored 3/4/2026
Mazie Hirono
HI • D
Sponsored 3/11/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in