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CIVIC HERALD
HR 3277 · 119th Congress · HouseIn committee

Ensuring Lasting Smiles Act

In plain language: Starting in 2026, commercial and employer-sponsored health insurance plans must cover inpatient and outpatient care for birth defects affecting the eyes, ears, teeth, mouth, or jaw. This mandate requires coverage for reconstructive procedures, follow-up care, and related dental or orthodontic treatment, regardless of standard dental exclusions. Insurers may not impose higher copays, deductibles, or coinsurance for these services than they do for standard medical and surgical benefits. Coverage does not extend to cosmetic surgeries performed on normal body structures for reasons unrelated to a diagnosed birth defect.

Provisional: our plain-language summary, pending review.

Provisionalunreviewed: impact, issue tags, provisions, stakeholders, summary
People affected—not determinable from the text provided; applies broadly to participants and beneficiaries in group and individual health plans diagnosed with qualifying congenital anomalies, but no specific population numbers are cited
Fiscal magnitude—no CBO estimate published
Reach55provisional · pending reviewrigor: heuristic llm
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Issues

What this bill touches.

Market protections+30Government role in coverage+30

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Who it affects

Who it helps · who it burdens.

Who it helps

  • Individuals with craniofacial and related congenital anomalies or birth defectsGain guaranteed health insurance coverage for inpatient and outpatient diagnosis and treatment (including reconstructive surgery and adjunctive dental, orthodontic, and prosthodontic care) of congenital anomalies affecting the eyes, ears, teeth, mouth, or jaw, subject to standard cost-sharing limits (Sec. 2(a)–(c)).provisional

Who it burdens

  • Group health plans and health insurance issuersAre mandated to cover medically necessary reconstructive, dental, orthodontic, and prosthodontic services for congenital anomalies regardless of standard dental exclusions, limit cost-sharing to general medical benefit levels, and issue coverage notices to enrollees by January 1, 2026 (Sec. 2(a)–(c), (e)).provisional
  • Department of Health and Human ServicesMust conduct a study and submit a report to Congress by December 31, 2027, evaluating provider network adequacy, changes in out-of-pocket costs, and overall procedure costs for covered congenital anomaly services (Sec. 2(d)).provisional

Dollar-level funding (FEC sector totals) is coming in a later phase.

What it does

The provisions, in plain language.

  1. Requires group health plans and health insurance issuers to cover inpatient and outpatient items and services to diagnose and treat congenital anomalies or birth defects that primarily impact the eyes, ears, teeth, mouth, or jaw, starting with plan years on or after January 1, 2026.

    Sec. 2(a)–(c), (e)provisional

  2. Mandates coverage for medically necessary reconstructive procedures, complication care, secondary conditions, and adjunctive dental, orthodontic, or prosthodontic treatments needed to restore function or appearance, overriding standard plan exclusions for dental care.

    Sec. 2(a)–(c)provisional

  3. Prohibits health plans and insurers from imposing cost-sharing (such as copayments, coinsurance, or deductibles) on congenital anomaly treatments that is more restrictive than the predominant cost-sharing applied to general medical and surgical benefits.

    Sec. 2(a)–(c)provisional

  4. Directs the Department of Health and Human Services to study and report to Congress by December 31, 2027, on provider network adequacy, patient out-of-pocket costs, and overall treatment costs related to covered congenital anomaly services.

    Sec. 2(d)provisional

How your members of Congress line up

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Timeline

How it moved.

  1. May 8, 2025Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Workforce, and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
  2. May 8, 2025Introduced in House
  3. May 8, 2025Introduced in House

The original text

Read it for yourself.

Read the original text →

Sources & provenance

Congress.govrefreshed 9 days ago

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