Bill Overview
Title: Ensuring Lasting Smiles Act
Description: This bill requires private health insurance plans to cover diagnosis and treatment of congenital anomalies and birth defects, such as reconstructive services and items. Coverage must include services and items that functionally improve, repair, or restore any body part that is medically necessary for normal bodily functions or appearance, as determined by the treating physician. Coverage limits and cost-sharing requirements for such services and items may not be more restrictive than those applicable to all medical and surgical benefits under the plan.
Sponsors: Rep. Eshoo, Anna G. [D-CA-18]
Target Audience
Population: people with congenital anomalies and birth defects
Estimated Size: 10000000
- Congenital anomalies and birth defects affect roughly 3% of births globally according to WHO estimates, translating to approximately 7.9 million children annually.
- These conditions persist into adulthood for many, implying a large proportion of the global population could require treatment or services covered under this act.
- In the US, CDC reports congenital anomalies affect about 1 in 33 births or approximately 3% of infants.
- This legislation impacts individuals needing healthcare plans that cover congenital anomaly-related treatments, beyond government healthcare plans.
- Americans are predominantly covered by private insurance, the main target of this legislation, covering about 54% of the population.
Reasoning
- The policy primarily affects individuals with congenital anomalies and birth defects, who are not always a significant portion of the overall population but have specific and often substantial healthcare needs.
- Private insurance, which is the target of the policy, covers 54% of the US population, implying broad applicability within its bounds.
- Budget constraints limit the number of people who can be covered to around 1,000,000 annually, assuming an average cost of $1,000 per person.
- Given the duration of the impact (potentially life-long), the policy's benefits will most directly increase in value over time.
Simulated Interviews
Child - Kindergarten (Salt Lake City, UT)
Age: 5 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 10/20
Statement of Opinion:
- The policy will help my family afford the necessary surgeries and treatments without fearing unbearable costs.
- I hope this will mean fewer financial worries for my future medical needs as well.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 4 |
| Year 10 | 8 | 4 |
| Year 20 | 9 | 3 |
Manager (Chicago, IL)
Age: 45 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 8/20
Statement of Opinion:
- I feel relieved knowing that my condition will be adequately covered under my insurance.
- This policy will ensure that costs for my heart condition do not escalate and become unmanageable in the future.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 4 |
Freelance Designer (Miami, FL)
Age: 27 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 20.0 years
Commonness: 5/20
Statement of Opinion:
- The policy gives me hope that more of my medical needs will be covered, reducing financial strain.
- I expect my quality of life to slowly improve as my healthcare expenses decrease.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 9 | 5 |
Retired Electrician (Houston, TX)
Age: 60 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 4/20
Statement of Opinion:
- While I'm grateful for my current coverage, extending it to include ongoing maintenance and replacement of prosthetics is crucial.
- This policy would give peace of mind about my financial future related to healthcare needs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 6 |
| Year 20 | 7 | 5 |
High School Student (New York, NY)
Age: 15 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- This improved coverage will significantly ease my parent's worries about future treatment costs.
- It will allow me to focus more on my education rather than stressing about potential medical bills.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Software Engineer (Denver, CO)
Age: 33 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 8.0 years
Commonness: 7/20
Statement of Opinion:
- The policy can help secure financing for treatments I might need to maintain my work capabilities.
- This could potentially reduce the frequency of taking unpaid time off for medical reasons.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 6 | 5 |
| Year 20 | 5 | 4 |
Child - Elementary School (Seattle, WA)
Age: 9 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 12.0 years
Commonness: 5/20
Statement of Opinion:
- This makes a massive difference for my family's ability to provide for my health care.
- It ensures continuous treatment without worrying about the economic impact.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 8 | 3 |
| Year 20 | 7 | 3 |
Self-Employed Tailor (Phoenix, AZ)
Age: 52 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- The policy will prevent escalating costs related to ongoing reconstructive surgeries.
- Allows more focus on small business growth rather than healthcare costs.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 8 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 5 |
| Year 20 | 6 | 4 |
Social Media Manager (Los Angeles, CA)
Age: 24 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 7/20
Statement of Opinion:
- Ensuring coverage for my condition will reduce my stress and help me manage flare-ups efficiently.
- I'm hopeful this policy means better quality of care and fewer out-of-pocket expenses.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 7 | 5 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 5 |
Unemployed (Portland, OR)
Age: 29 | Gender: other
Wellbeing Before Policy: 4
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- Reducing the burden of treatment costs could help me secure a stable job and build savings.
- This policy gives me hope for better financial stability despite my condition.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 4 |
| Year 2 | 6 | 4 |
| Year 3 | 7 | 4 |
| Year 5 | 8 | 4 |
| Year 10 | 9 | 3 |
| Year 20 | 9 | 3 |
Cost Estimates
Year 1: $1000000000 (Low: $750000000, High: $1250000000)
Year 2: $1050000000 (Low: $787500000, High: $1312500000)
Year 3: $1102500000 (Low: $826875000, High: $1378125000)
Year 5: $1215500000 (Low: $910937500, High: $1519375000)
Year 10: $1551325000 (Low: $1163492187, High: $1939157813)
Year 100: $3000000000 (Low: $2250000000, High: $3750000000)
Key Considerations
- Demand for services under this act will likely lead to increased insurance premiums.
- Substantial upfront costs may be balanced by long-term savings in reduced catastrophic care costs.
- The overall economic impact could be positive due to enhanced workforce productivity from healthier individuals.