ASPS Maintains Support for ELSA in 117th Congress
A longtime federal priority for ASPS, the Ensuring Lasting Smiles Act (ELSA), was reintroduced in the US House and Senate on March 16 by Senators Tammy Baldwin (D-WI) and Joni Ernst (R-IA), and Representatives Anna Eshoo (D-CA) and Drew Ferguson IV, DDS (R-GA). While ELSA has still faces numerous hurdles to enactment, the current iteration of the legislation starts the 117th Congress with strong bipartisan support and remains one of the Society's top priorities.
The need
While many private health insurance companies cover initial reconstructive procedures, they routinely deny and delay follow-up and corrective procedures by claiming that they are cosmetic in nature. This seriously undermines the quality of care and quality of life of these children because delays in medically necessary care can negatively impact a child's developmental milestones and overall health.
Additionally, insurance coverage denials of a child's reconstructive care can force patient families to turn to Medicaid, SCHIP, or other government safety net programs for health care coverage. If they cannot receive coverage through those programs, they are often forced to incur significant out-of-pocket costs or forgo care.
About the bill
The Ensuring Lasting Smiles Act (H.R. 1916/S.754) would require all private group and individual health plans (including plans regulated by the Employee Retirement Income Security Act of 1974 (ERISA)) to cover medically necessary items or services as a result of congenital anomalies or birth defects. It also stipulates that such coverage includes items and services to functionally improve, repair, or restore any body part that is medically necessary to achieve normal body functioning or appearance, and clarify the inclusion of adjunctive dental, orthodontic or prosthodontic support.
ASPS efforts
For more than a decade, ASPS has been a leading advocate in Congress on the issue of coverage for congenital anomalies. Prior to ELSA, ASPS advocated for a similar bill, the Children's Access to Reconstructive Evaluation and Surgery (CARES) Act. The coverage provisions of the CARES Act were ultimately included as part of the essential health benefits package created by the Affordable Care Act for insurance products sold on federal health insurance exchanges, leading to the legislation not being re-introduced after 2008. However, ASPS had another opportunity to lead on the issue in 2018 when approached by Senator Tammy Baldwin (D-WI) regarding the introduction of legislation to address coverage of congenital anomalies.
Under the leadership of Dr. Arun Gosain – then president of the Plastic Surgery Foundation (PSF) and a Wisconsin plastic surgeon specializing in surgical correction of craniofacial and vascular anomalies – ASPS worked with Senator Baldwin to craft the legislative concept that would become ELSA.
Later in 2018, the Society formed the ELSA Coalition with the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the National Foundation for Ectodermal Dysplasia (NFED). The Coalition's membership has now grown to more than 35 patient advocacy and medical groups.
Since the introduction of ELSA, ASPS has worked extensively to advance the legislation.
The Society has executed dozens of formal communications and grassroots campaigns that connected hundreds of ASPS members with their representatives; conducted more than 200 face-to-face meetings with members of Congress and their staff; educated dozens of members of Congress about the issue through PlastyPAC member meetings; partnered with state plastic surgery societies to support the legislation through letters and written testimony; and continued to work with the sponsors and committee staff to identify studies and key data to help the Congressional Budget Office (CBO) accurately score the bill's financial impact.
Ongoing advocacy
During the 116th Congress, the Coalition executed a targeted grassroots campaign that was instrumental in the legislation passing out of the House Energy and Commerce Committee.
While ELSA was not passed in the 116th Congress, its progress was critical in providing a foundation for the bill's reintroduction. The legislation currently has 133 original cosponsors in the House and 28 in the Senate. ASPS has formally endorsed the legislation and has begun strategizing with fellow members of the ELSA Coalition on efforts to support the bill, such as cosponsor outreach, updating advocacy collateral, and letters of support.
ASPS remains committed to ensuring children have adequate insurance coverage to treat congenital or birth abnormalities and will continue to work closely with lawmakers, staff, and coalition partners to advance ELSA and provide much needed relief to families dealing with congenital anomalies.