Ensuring Lasting Smiles Act
Floor Speech
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Mr. GRIFFITH. Madam Speaker, I yield myself such time as I may consume.
Madam Speaker, I am disappointed that all Members could not reach an agreement on this bill. I have an amendment that would specify the types of conditions required to be addressed by this bill, which would help clarify its intent for the implementing agencies.
Madam Speaker, I include in the Record the text of my proposed amendment.
In the heading of section 2, strike ``congenital anomaly or birth defect'' and insert ``craniofacial, oral, or maxillofacial congenital anomaly or birth defect''.
In section 2799A-11 of the Public Health Service Act, section 726 of the Employee Retirement Income Security Act of 1974, and section 9826 of the Internal Revenue Code of 1986, as proposed to be added by section 2--
(1) in the heading, strike ``congenital anomaly or birth defect'' and insert ``craniofacial, oral, or maxillofacial congenital anomaly or birth defect''; and
(2) in subsection (a), strike the term ``congenital anomaly or birth defect'' and insert ``craniofacial, oral, or maxillofacial congenital anomaly or birth defect'' each place such term appears.
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Mr. GRIFFITH. Madam Speaker, the stated goal of the bill is a good one, making sure those who, through no fault of their own, are born with a condition requiring extensive medical care can eat, drink, and thrive.
I would love to be able to tell families like the one in my district with two children experiencing ectodermal dysplasia that insurance would pay for the hundreds of thousands of dollars of surgery necessary to allow their teeth and mouths to function properly. But this bill needs more work, and my amendment could have addressed its most significant flaw.
Had the bill gone through regular order, I would have offered this corrective amendment.
The biggest problem here is that not one person can articulate which medical procedures or treatments would be required to be covered by insurance.
The bill is titled healthy smiles, referencing cleft palate, ectodermal dysplasia, et cetera, but not one person can articulate which medical procedures or treatments would be required to be covered by insurance. This is, in part, because the FDA has no statutory or regulatory definition of what a congenital anomaly or birth defect is.
Further, one part of the bill requires insurers to ``include any medically necessary item or service to . . . restore any body part to achieve normal body functioning or appearance,'' while another part provides that ``'treatment' shall not include cosmetic surgery.''
Technical comments from the Department of Labor support my belief that these two provisions ``seem to be in tension.'' There is a tension between the two sections.
Because the language is so vague, CBO found it difficult to estimate the cost. They expressed uncertainty around identifying the procedures and services that would be considered medically necessary. Nonetheless, they took a stab at it and guessed it would cost around $1.8 billion.
My amendment would resolve these concerns by replacing the phrase ``congenital anomaly or birth defect'' with ``craniofacial, oral, or maxillofacial congenital anomaly or birth defect'' to specify the types of conditions advocates of this bill have been discussing for months. Most of the people who signed on as cosponsors thought that was just what they were doing. They didn't know they were going to cover, as the gentlewoman has said, the 4 percent of children born with any kind of a birth defect.
Given that my amendment cannot be considered today, I will be voting ``no.''
Now, you may wonder, how did I come to this conclusion? When my oldest son was born 16 years ago, when I called my wife's father, his first question was, ``Does he have all his fingernails?'' because my wife was born with a congenital birth defect. She doesn't have fingernails on her index fingers. This has caused them to be injured numerous times over the years.
There is no question it qualifies under this bill for some kind of treatment, whether it be an implant to replace those nails--if this bill passes, we will be doing everything from the healthy smiles that the bill purports to do all the way down to fingernails.
Now, she is fine. She has grown up. She has adjusted. Everything is good. But the first question my father-in-law asked was, ``Does he have all his fingernails?'' because, for years, it was a concern to him as a father, as a parent.
This bill would deal with that, and that is why it is hard to say what it is going to cost because a lot of smaller defects like my wife's fingernails would be covered under this.
And if it is covered, by golly, you know they are going to fix it. The worst thing she has to do now is wear gloves when we take out the Christmas tree and try to be careful. But as a child, it was a bigger issue, and like I said, the tips of her index fingers are a little bulbous. She might be offended by this, but if you look closely, it looks a little bit like E.T.'s finger, though it is not quite as long and it doesn't light up. But it is a birth defect that this bill would cover at huge cost to the American public and to the American taxpayers.
This bill goes too far. I wish we had the opportunity to accept my amendment, which we can't do on a bill that is on suspension, because then we could make sure it dealt with the big items that only affect a much smaller part of the population and that truly do need to be dealt with.
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Mr. GRIFFITH. Madam Speaker, I yield myself the balance of my time.
Madam Speaker, I will submit that my amendment was not offered at the full committee. Two years ago, when we were taking this bill through regular order, at that time it was discussed that we would try to work on language that would narrow the scope before it came to the floor. I assumed that that would be done before this bill was brought up on a suspension; that has not happened. I would be more than happy, if we have to come to loggerheads over it, that we have that discussion where we can discuss all the potential costs, all the potential birth defects that might be covered, including the minor ones, the ones that don't have an effect on lasting smiles, which is also included in this.
Now, the gentlewoman's heart is in the right place, and I have great respect for her, and understand what she is trying to do. I just think that there is so much unknown cost for so many minor birth defects and small inconveniences that might be cosmetic or might not be, depending on which doctor makes that decision, because we don't have a good definition either in the bill or in the standard lingo of the FDA, et cetera.
I think we are buying a whole lot more expense, both to the American taxpayer, and, I believe, this is going to push up the cost of health insurance on families that are already having difficulties making those health insurance payments. All of that is correct.
And the chairman of the committee--also his heart is in the right place--mentioned ectodermal dysplasia. I have no problem with us treating that. It affects a small number of people. It is a huge cost on a handful of families out there--maybe a few more than a handful-- but it does affect people disproportionately who cannot afford to have that fixed, and it does create huge problems on eating, on talking, et cetera. Those are the things we want to go after.
What I want to make sure we are not doing is spending billions of dollars of American taxpayer dollars or raising the cost of health insurance because we are going to take care of everything down to two index finger fingernails missing, et cetera. That is my concern.
Madam Speaker, as you can tell, I feel passionately about this, and I yield back the balance of my time.
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Mr. GRIFFITH. Madam Speaker, on that I demand the yeas and nays.
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