Bill Overview
Title: Ensuring Lasting Smiles Act
Description: This bill requires private health insurance plans to cover the diagnosis and treatment of craniofacial, oral, or maxillofacial congenital anomalies and birth defects. 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. Dunn, Neal P. [R-FL-2]
Target Audience
Population: People with craniofacial, oral, or maxillofacial anomalies
Estimated Size: 1200000
- Craniofacial, oral, or maxillofacial congenital anomalies and birth defects can vary widely in severity and type, impacting numerous individuals globally.
- Such conditions can impact critical functions such as breathing, speaking, and eating, as well as appearance, therefore affecting not only health but psychological and social wellbeing.
- According to global data, the prevalence of congenital anomalies is around 1 in 33 births.
- Approximately 8 million children worldwide are born with serious birth defects annually, some of which include craniofacial anomalies.
- Individuals with these conditions often require surgical and medical interventions to improve quality of life.
Reasoning
- With a substantial budget for implementing the policy, a significant portion of the population with craniofacial, oral, or maxillofacial anomalies could receive treatment, greatly impacting their wellbeing.
- Not all individuals within this group will be equally affected; some may already have coverage or only have minor conditions requiring less intervention.
- The policy aims to improve not just physical health but also psychological and social wellbeing through improved appearance and function, impacting quality of life considerably.
- By including non-restrictive coverage limits, the policy ensures that individuals who might require multiple interventions or extended treatment periods can access necessary care.
- Even though the target estimate is high, the effects on the population will be varied based on the severity of their conditions and their current insurance coverage status.
Simulated Interviews
Student (Los Angeles, CA)
Age: 8 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 12.0 years
Commonness: 15/20
Statement of Opinion:
- I'm glad this policy is coming into place. It's been challenging dealing with partial coverage and not knowing if the next procedure will be covered.
- My parents often worry about medical bills more than they should.
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 | 9 | 6 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 5 |
Software Engineer (New York, NY)
Age: 32 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 5.0 years
Commonness: 12/20
Statement of Opinion:
- I might benefit from the policy, but I already have good coverage from my employer.
- It's excellent for those who need it more.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Retail Manager (Chicago, IL)
Age: 45 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 15.0 years
Commonness: 10/20
Statement of Opinion:
- This policy could significantly reduce our financial burden.
- It will allow us to seek better healthcare options and improve our child's quality of life.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 5 |
| Year 2 | 8 | 5 |
| Year 3 | 9 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 9 | 5 |
| Year 20 | 8 | 4 |
Artist (Houston, TX)
Age: 29 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 18/20
Statement of Opinion:
- I support the policy, as my nephew was born with a cleft palate.
- Anything that helps families deal with these conditions is welcome.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 7 | 7 |
Retired (Atlanta, GA)
Age: 55 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 0.0 years
Commonness: 14/20
Statement of Opinion:
- This policy would have helped my family immensely when I was growing up.
- It's a step towards more equitable healthcare access.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 7 | 6 |
| Year 10 | 6 | 6 |
| Year 20 | 6 | 6 |
Construction Worker (Miami, FL)
Age: 39 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 11/20
Statement of Opinion:
- Insurance has always treated my condition as cosmetic rather than functional, making coverage difficult to obtain.
- This policy could finally change that.
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 | 7 | 5 |
College Student (San Francisco, CA)
Age: 22 | Gender: other
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 9/20
Statement of Opinion:
- As a student, handling health insurance is daunting, especially for complex conditions. This policy can alleviate a lot of stress.
- It should have been passed sooner.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 6 |
| Year 2 | 8 | 6 |
| Year 3 | 9 | 6 |
| Year 5 | 9 | 6 |
| Year 10 | 8 | 5 |
| Year 20 | 7 | 5 |
High School Student (Dallas, TX)
Age: 16 | Gender: male
Wellbeing Before Policy: 4
Duration of Impact: 20.0 years
Commonness: 13/20
Statement of Opinion:
- I'm really hopeful that this means I can get the surgeries I need without my parents stressing about money.
- It sounds like it could help us massively.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 5 |
| Year 2 | 7 | 5 |
| Year 3 | 8 | 5 |
| Year 5 | 9 | 5 |
| Year 10 | 8 | 4 |
| Year 20 | 7 | 3 |
Self-Employed (Phoenix, AZ)
Age: 46 | Gender: female
Wellbeing Before Policy: 8
Duration of Impact: 0.0 years
Commonness: 20/20
Statement of Opinion:
- This is going to be a game-changer for a lot of families.
- We need more policies that address major health disparities like this.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 8 | 8 |
| Year 2 | 8 | 8 |
| Year 3 | 8 | 8 |
| Year 5 | 8 | 8 |
| Year 10 | 8 | 8 |
| Year 20 | 8 | 8 |
Retired Medical Professional (Seattle, WA)
Age: 60 | Gender: male
Wellbeing Before Policy: 9
Duration of Impact: 0.0 years
Commonness: 17/20
Statement of Opinion:
- I have seen firsthand how impactful such coverage could be.
- This will greatly improve accessibility to necessary procedures.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 9 | 9 |
| Year 2 | 9 | 9 |
| Year 3 | 9 | 9 |
| Year 5 | 9 | 8 |
| Year 10 | 9 | 8 |
| Year 20 | 8 | 8 |
Cost Estimates
Year 1: $1000000000 (Low: $800000000, High: $1200000000)
Year 2: $1020000000 (Low: $816000000, High: $1224000000)
Year 3: $1040400000 (Low: $832320000, High: $1248480000)
Year 5: $1082432160 (Low: $865945728, High: $1298916992)
Year 10: $1181495225 (Low: $945196180, High: $1423794270)
Year 100: $2853858691 (Low: $2283086953, High: $3424629429)
Key Considerations
- The potential impact on existing health insurance premiums as costs are distributed.
- The treatment variability among the target population means costs are not fixed per individual.
- The risk of increased insurance premiums causing coverage issues for some individuals.