House Bill Requires Coverage For Congenital Abnormalities

April 5, 2022
In The News

All individual and group health plans would be required to cover medically necessary treatments and services needed to address congenital abnormalities or birth defects under legislation that passed the House 310-110 on Monday (April 4).

The bill’s sponsors said they will continue to work to get the bill through the Senate, where a sister bill sponsored by Tammy Baldwin (D-WI) and Joni Ernst (R-IA), has 40 co-sponsors.

Energy & Commerce health subcommittee Chair Anna Eshoo (D-CA) and Rep. Drew Ferguson (R-GA) introduced the House bill last year with 132 original co-sponsors.

“The bipartisan, bicameral Ensuring Lasting Smiles Act is one of the most popular bills in the House for good reason--it will keep America’s children healthy and smiling,” Eshoo said in a release. “I became the champion of this legislation after I heard from a family in my district who, despite having health insurance, had to pay $4,000 out-of-pocket in just a few months for treatment for their infant daughter Rosie’s congenital cataracts. In a country as rich and great as America, we can’t allow insurance red tape to put medically necessary treatments out of reach for children and their families.”

“I am thrilled to see the House take this critical action to ensure procedures needed to correct congenital anomalies or birth defects in our children are covered by insurance,” Ferguson added. “By eliminating existing burdens that deny medical coverage for diagnosis, treatments and other services, families will no longer need to haggle with insurance companies for their children’s medical need,” he said.

According to the Congressional Budget Office, the legislation would increase the deficit by about $2.5 billion over the next 10 years. CBO also expects it would increase the budget by more than $5 billion in at least one of the four consecutive decades after 2032, and so it is subject to pay-go.

Under current law, insurers cover treatment for many but not all congenital abnormalities, CBO says. If the bill is enacted about 200,000 adults and 30,000 children would have access to the treatment under their existing insurance, about 90% of whom are in employer coverage and 10% in nongroup ACA plans. The agency expects insurers would spend an average $4,000 per person on the coverage, leading to a cost increase of about $6 per person for both group and non-group plans.

CBO expects premiums would by about 0.1% higher each year compared to current law. The cost estimates arise from the increased federal spending on ACA subsidies as well as from reduced taxable wages from the employer-based insurance. CBO also says that the bill would be considered an unfunded mandate on private insurers that averages about $700 million annually and would not be fully offset by increased premiums.