Ensuring Lasting Smiles Act

Bill Number

S. 1677

Origin Chamber

Senate

Congress

119th Congress, Session 1

Policy Area

Health

Status

Introduced

Latest Action

2026-03-19: Committee on Health, Education, Labor, and Pensions. Hearings held.

Last Updated

2026-05-20T11:03:28Z

AI-Generated Summary

Purpose

The Ensuring Lasting Smiles Act (S. 1677) aims to ensure that health insurance plans cover medical diagnosis and treatment for congenital anomalies or birth defects—conditions present at birth that affect the structure or function of body parts. Specifically, it targets anomalies primarily impacting the eyes, ears, teeth, mouth, or jaw, requiring coverage for reconstructive and related services to improve function or appearance.

Key Provisions

• Mandatory Coverage: Group health plans and health insurance issuers (companies offering health coverage) must provide outpatient (non-hospital) and inpatient (hospital-based) services for diagnosing and treating these congenital anomalies. This includes:
• Medically necessary procedures to repair, restore, or approximate normal function or appearance of affected body parts.
• Treatments for missing or abnormal parts, such as teeth or oral structures.
• Reconstructive surgeries, handling of complications from those surgeries, dental/orthodontic/prosthodontic support (e.g., braces or dental prosthetics) from birth until treatment is complete, and follow-up care for related secondary conditions.
• Cost-Sharing Limits: Any patient costs (like deductibles, copayments, or coinsurance—shares of costs paid by the insured) cannot be more burdensome than those for most other medical or surgical benefits under the plan.
• Exceptions: Coverage does not extend to cosmetic surgery (procedures to alter normal body structures for aesthetic reasons, like improving self-esteem) unless directly tied to a medically determined congenital anomaly.
• Notice Requirement: Starting January 1, 2026, plans and insurers must inform participants (enrollees) and beneficiaries (dependents) about this coverage in plan documents, following guidelines from the Secretary of Health and Human Services (HHS).
• Definition of Congenital Anomaly or Birth Defect: A prenatal structural or functional issue, identifiable before, at, or after birth, caused by genetics, environment, nutrition, inheritance, or unknown factors. It can appear as abnormal structures, disabilities (physical, sensory, or cognitive), syndromes, diseases, or combinations thereof.
• Study and Report: HHS must study access to providers (network adequacy) and cost changes for these services, then report to Congress by December 31, 2027. The report will assess provider networks under health plans and shifts in patient out-of-pocket costs and overall procedure expenses.
• Legal Amendments: Adds new sections to three key laws:
• Public Health Service Act (governs health insurance standards).
• Employee Retirement Income Security Act (ERISA, regulates employer-sponsored plans).
• Internal Revenue Code (applies tax rules to group health plans).
• Effective Date: Applies to plan years starting on or after January 1, 2026.

Significant Changes to Existing Law

• Introduces specific mandates for coverage of congenital anomalies affecting craniofacial areas (head and face), which were previously often excluded or limited under dental or cosmetic clauses in plans.
• Overrides typical exclusions for dental, orthodontic, or prosthodontic services when they relate to these birth defects, even if plans restrict such coverage for other conditions like injuries.
• Aligns with but expands the Affordable Care Act's (ACA) essential health benefits framework by adding this targeted requirement, without altering broader ACA rules.
• Requires a federal study on implementation, a new oversight mechanism not previously in place for these specific conditions.

Potential Impacts

• On Citizens: Improves access to timely treatments for individuals with congenital anomalies, potentially reducing financial barriers and long-term health issues. Families may face lower out-of-pocket costs for lifelong care, enhancing quality of life and reducing disparities for affected children.
• On Government Agencies: HHS gains responsibilities for regulating notices, conducting the study, and reporting to Congress, which could inform future policy adjustments.
• On Health Insurers and Employers: Plans must expand benefits, possibly increasing premiums or administrative costs, but cost-sharing parity may limit excessive burdens. Employers offering group plans will need to update benefits and notify employees.
• On Healthcare Providers: Specialists in ophthalmology (eye care), otolaryngology (ear/nose/throat), dentistry, and oral surgery may see higher demand, improving service availability if networks expand.
• No direct impacts on international relations, as this is a domestic health insurance reform.

Main Stakeholders Affected

• Individuals and Families: Primarily children and adults with congenital anomalies or birth defects affecting eyes, ears, teeth, mouth, or jaw, including those needing reconstructive or dental care.
• Health Insurers and Plans: Companies and self-insured employer groups responsible for compliance and coverage expansion.
• Healthcare Providers: Doctors, dentists, surgeons, and specialists treating these conditions, who benefit from ensured reimbursements.
• Employers: Sponsors of group health plans, impacted by compliance and potential cost increases.
• Government: HHS for enforcement and study; Congress for oversight via the report.
• Advocacy Groups: Organizations supporting birth defect awareness and patient rights, likely to monitor implementation.

Notable Legal, Constitutional, or Political Implications

• Legal: Strengthens patient protections under federal health laws by clarifying "medically necessary" coverage (determined by treating physicians, as defined in Social Security Act rules for Medicare providers). Enforceable through existing ACA and ERISA mechanisms, with potential for lawsuits if plans violate mandates. The cosmetic exception prevents overreach into elective procedures.
• Constitutional: Aligns with Congress's authority to regulate interstate commerce and health insurance markets; no apparent conflicts with free speech, privacy, or equal protection principles.
• Political: Bipartisan sponsorship (13 senators from both parties) suggests broad support for pediatric and reconstructive care. Could set precedent for expanding coverage of rare conditions, influencing future debates on essential benefits or dental integration in health plans, without major fiscal offsets specified.

This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.

Sponsor

Sen. Baldwin, Tammy [D-WI]

Cosponsors (48)

Sen. Ernst, Joni [R-IA], Sen. Klobuchar, Amy [D-MN], Sen. Murkowski, Lisa [R-AK], Sen. Luján, Ben Ray [D-NM], Sen. Tillis, Thomas [R-NC], Sen. King, Angus S., Jr. [I-ME], Sen. Marshall, Roger [R-KS], Sen. Reed, Jack [D-RI], Sen. Grassley, Chuck [R-IA], Sen. Blumenthal, Richard [D-CT], Sen. Booker, Cory A. [D-NJ], Sen. Merkley, Jeff [D-OR], Sen. Kelly, Mark [D-AZ], Sen. Boozman, John [R-AR], Sen. Daines, Steve [R-MT], Sen. Warren, Elizabeth [D-MA], Sen. Gallego, Ruben [D-AZ], Sen. Alsobrooks, Angela D. [D-MD], Sen. Sullivan, Dan [R-AK], Sen. Capito, Shelley Moore [R-WV], Sen. Van Hollen, Chris [D-MD], Sen. Markey, Edward J. [D-MA], Sen. Warnock, Raphael G. [D-GA], Sen. Rosen, Jacky [D-NV], Sen. Justice, James C. [R-WV], Sen. Coons, Christopher A. [D-DE], Sen. Gillibrand, Kirsten E. [D-NY], Sen. Fetterman, John [D-PA], Sen. Welch, Peter [D-VT], Sen. Slotkin, Elissa [D-MI], Sen. Collins, Susan M. [R-ME], Sen. Scott, Rick [R-FL], Sen. Whitehouse, Sheldon [D-RI], Sen. Wyden, Ron [D-OR], Sen. Schiff, Adam B. [D-CA], Sen. Duckworth, Tammy [D-IL], Sen. Padilla, Alex [D-CA], Sen. Bennet, Michael F. [D-CO], Sen. Cramer, Kevin [R-ND], Sen. Hyde-Smith, Cindy [R-MS], Sen. Cantwell, Maria [D-WA], Sen. Blunt Rochester, Lisa [D-DE], Sen. Shaheen, Jeanne [D-NH], Sen. Smith, Tina [D-MN], Sen. Peters, Gary C. [D-MI], Sen. Hirono, Mazie K. [D-HI], Sen. Murphy, Christopher [D-CT], Sen. Heinrich, Martin [D-NM]

Recent Actions

• 2026-03-19: Committee on Health, Education, Labor, and Pensions. Hearings held.
• 2025-05-08: Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
• 2025-05-08: Introduced in Senate

Bill Versions

• Ensuring Lasting Smiles Act — issued 2025-05-08 — PDF (16 pages)

Related Bills

• H.R. 3277 (119th Congress)