Ensuring Lasting Smiles Act
Sponsored By: Senator Baldwin, Tammy [D-WI]
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.
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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
Baldwin, Tammy [D-WI]
WI • D
Cosponsors
Sen. Ernst, Joni [R-IA]
IA • R
Sponsored 5/8/2025
Amy Klobuchar
MN • D
Sponsored 5/8/2025
Sen. Murkowski, Lisa [R-AK]
AK • R
Sponsored 5/8/2025
Sen. Luján, Ben Ray [D-NM]
NM • D
Sponsored 5/8/2025
Sen. Tillis, Thomas [R-NC]
NC • R
Sponsored 5/8/2025
Sen. King, Angus S., Jr. [I-ME]
ME • I
Sponsored 5/8/2025
Sen. Marshall, Roger [R-KS]
KS • R
Sponsored 5/8/2025
Sen. Reed, Jack [D-RI]
RI • D
Sponsored 5/8/2025
Sen. Grassley, Chuck [R-IA]
IA • R
Sponsored 5/8/2025
Sen. Blumenthal, Richard [D-CT]
CT • D
Sponsored 5/8/2025
Sen. Booker, Cory A. [D-NJ]
NJ • D
Sponsored 5/8/2025
Sen. Merkley, Jeff [D-OR]
OR • D
Sponsored 5/8/2025
Sen. Kelly, Mark [D-AZ]
AZ • D
Sponsored 5/19/2025
John Boozman
AR • R
Sponsored 6/9/2025
Sen. Daines, Steve [R-MT]
MT • R
Sponsored 6/16/2025
Sen. Warren, Elizabeth [D-MA]
MA • D
Sponsored 6/24/2025
Sen. Gallego, Ruben [D-AZ]
AZ • D
Sponsored 6/25/2025
Sen. Alsobrooks, Angela D. [D-MD]
MD • D
Sponsored 7/22/2025
Dan Sullivan
AK • R
Sponsored 7/23/2025
Shelley Capito
WV • R
Sponsored 7/23/2025
Sen. Van Hollen, Chris [D-MD]
MD • D
Sponsored 9/2/2025
Sen. Markey, Edward J. [D-MA]
MA • D
Sponsored 9/8/2025
Raphael Warnock
GA • D
Sponsored 9/9/2025
Sen. Rosen, Jacky [D-NV]
NV • D
Sponsored 9/17/2025
Sen. Justice, James C. [R-WV]
WV • R
Sponsored 9/29/2025
Sen. Coons, Christopher A. [D-DE]
DE • D
Sponsored 9/29/2025
Sen. Gillibrand, Kirsten E. [D-NY]
NY • D
Sponsored 9/29/2025
Sen. Fetterman, John [D-PA]
PA • D
Sponsored 9/29/2025
Peter Welch
VT • D
Sponsored 10/1/2025
Elissa Slotkin
MI • D
Sponsored 10/29/2025
Sen. Collins, Susan M. [R-ME]
ME • R
Sponsored 11/4/2025
Sen. Scott, Rick [R-FL]
FL • R
Sponsored 11/5/2025
Sen. Whitehouse, Sheldon [D-RI]
RI • D
Sponsored 11/6/2025
Sen. Wyden, Ron [D-OR]
OR • D
Sponsored 11/18/2025
Sen. Schiff, Adam B. [D-CA]
CA • D
Sponsored 12/3/2025
Sen. Duckworth, Tammy [D-IL]
IL • D
Sponsored 12/3/2025
Sen. Padilla, Alex [D-CA]
CA • D
Sponsored 12/9/2025
Sen. Bennet, Michael F. [D-CO]
CO • D
Sponsored 1/5/2026
Sen. Cramer, Kevin [R-ND]
ND • R
Sponsored 1/29/2026
Cindy Hyde-Smith
MS • R
Sponsored 2/10/2026
Sen. Cantwell, Maria [D-WA]
WA • D
Sponsored 3/2/2026
Sen. Blunt Rochester, Lisa [D-DE]
DE • D
Sponsored 3/2/2026
Sen. Shaheen, Jeanne [D-NH]
NH • D
Sponsored 3/3/2026
Sen. Smith, Tina [D-MN]
MN • D
Sponsored 3/3/2026
Gary Peters
MI • D
Sponsored 3/4/2026
Sen. Hirono, Mazie K. [D-HI]
HI • D
Sponsored 3/11/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov