What is ELSA?

The Ensuring Lasting Smiles Act (ELSA) (H.R.3277/S.1677) is a bipartisan, bicameral bill led by Senate sponsors Senator Tammy Baldwin (D-WI) and Senator Joni Ernst (R-IA) and House sponsors Congresswoman Kim Schrier (D-WA-8) and Congressman Neal Dunn (R-FL-2).

ELSA would require a health plans and insurers to provide coverage for outpatient and inpatient items and services related to the diagnosis and treatment of a congenital anomaly or birth defect, including any medically necessary procedure or service to achieve normal functioning. Importantly, ELSA includes dental, orthodontic and prosthetic support from birth until function is restored, including coverage for post-adolescence procedures.

In the 117th Congress, ELSA gained strong bipartisan support from 62 US Senate cosponsors, 317 US House cosponsors, and it passed in the House of Representatives with a 310-110 vote. For its reintroduction to the 119th Congress, the bill sponsors and a broad coalition of patient-focused and professional medical organizations worked together to strengthen ELSA’s language by addressing feedback and incorporating recommendations. ELSA was reintroduced on May 8, 2025 and is endorsed by over 70 national health care professional and patient advocacy organizations including ACPA.

Why is ELSA important?

Our members and families are acutely aware of the financial and emotional burden of the numerous medically necessary interventions for people with cleft and craniofacial anomalies. Health plans systematically and routinely deny or delay claims and appeals for treatment of many congenital anomalies by wrongfully categorizing certain treatments or body parts as cosmetic or not medically necessary. This common practice leaves families with the burden of paying 100% of the cost for their child’s medically necessary treatments. And individuals who do not receive timely, continuous care for their congenital anomalies face long-term physical and psychological injuries.

ELSA will close loopholes and ensure that group and individual health plans do not deny or delay medically necessary treatments of congenital anomalies, alleviating the financial hardship for people with cleft and craniofacial anomalies and ensuring they have continued support for medical and dental needs beyond childhood.

What ELSA does NOT do?

ELSA does not include cosmetic surgery performed to reshape normal structures of the body to improve appearance or self-esteem.

How can I help?

Please join us by using our email tool to send letters to your legislators asking them to support ELSA! We encourage you to include your personal story or video in our prepared letter. You may also tag your members of Congress in your social media posts about ELSA encouraging them to co-sponsor – be sure to use the hashtag #EnsuringLastingSmiles.

Visit NFED’s website for additional resources on how you can advocate for ELSA.