[Congressional Record Volume 148, Number 93 (Thursday, July 11, 2002)]
[House]
[Page H4522]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                   RECONSTRUCTIVE SURGERY ACT OF 2002

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from Arkansas (Mr. Ross) is recognized for 5 minutes.
  Mr. ROSS. Mr. Speaker, I rise this afternoon to share with my 
colleagues the heartbreaking story of a constituent of mine. After 
hearing of the challenges she has faced and still faces today in order 
to try and live a normal life, I introduced the Reconstructive Surgery 
Act of 2002, H.R. 4959.
  This bill requires health insurance plans to cover medically 
necessary reconstructive surgery for congenital defects, developmental 
abnormalities, infection, trauma or disease.
  As an infant, Wendelyn Osborne was diagnosed with a rare, congenital 
bone disease, craniometaphysial dysplasia, or CMD, which involves an 
overgrowth of facial bone that never deteriorates.
  At the time of her diagnosis, she was the sixteenth CMD case in the 
world in medical history. Doctors told her parents that she would not 
live past the age of 10. After many surgeries, starting at the age of 
6, Wendelyn has lived to be 36 years old. But she is not free of the 
harmful effects of her disease. Her facial muscles are paralyzed. Her 
optic nerve is damaged, and she must wear a hearing aid in order to 
hear properly. The severity of her abnormalities requires further 
orthognathic surgeries so she may continue to be able to eat properly. 
Yet, Mrs. Osborne's insurance company will not cover this procedure 
because it is considered cosmetic.
  Mr. Speaker, I am pleased to have my colleague from Arkansas (Mr. 
Berry) as a cosponsor on this legislation with me. I yield to the 
gentleman.
  Mr. BERRY. Mr. Speaker, I want to thank my colleague from the Fourth 
District of Arkansas (Mr. Ross) for his leadership on this matter. 
Clearly, the bill that he has introduced and I cosponsored, H.R. 4959, 
that requires health insurance to cover medically necessary 
reconstructive surgery for congenital defects, developmental 
abnormalities, trauma or disease is the right thing to do.

                              {time}  1330

  People that are so unfortunate that they would be faced with a 
situation like this and desperately need insurance coverage should be 
respected by the insurance companies that choose to take advantage of a 
situation and refuse to pay for the care that these people need.
  My colleague from the 4th District has already referred to Ms. 
Osborne, an Arkansas resident who was diagnosed with a rare, life-
threatening congenital bone disease as a child. This should not be 
something that the insurance companies are allowed to take advantage 
of. It is time that this House does the right thing. It is time that we 
make it possible for Ms. Osborne and others that have been unfortunate 
enough to need this kind of treatment, that they will be allowed and 
that they will have the opportunity and that the insurance companies 
will provide the necessary coverage for their treatment.
  Mr. ROSS. Mr. Speaker, I appreciate the gentleman from Arkansas (Mr. 
Berry) for joining me here today in our fight in trying to correct the 
wrong by the big insurance companies.
  They covered the surgeries that Wendelyn needed until she was about 
18, maybe 21. Then it is like they are saying she was not supposed to 
live this long so we will not cover her operations any more. That is 
wrong.
  The Reconstructive Surgery Act that we have written defines medically 
necessary reconstructive surgery as surgery performed to correct or 
repair abnormal structures of the body caused by congenital defects, 
developmental abnormalities, trauma, infection, tumors or disease. The 
surgery must be designed to improve functions or to give the patient a 
normal appearance to the extent possible in the judgment of the 
physician performing the surgery.
  It specifically excludes cosmetic procedures defined as surgery that 
is performed to alter or reshape the normal structures of the body in 
order to improve appearance.
  This bill draws a line between improving looks and improving life, 
oftentimes, as in Wendelyn's case, perhaps saving a life. Several 
States have a law requiring insurance coverage of medically necessary 
reconstructive surgery up to the age of 18. The Reconstructive Surgery 
Act is an effort to build upon what the States have started as well as 
address the apparent arbitrary decision-making of some big insurance 
plans that refuse coverage and question physicians' judgments when 
patients like Wendelyn Osborne try to get coverage under the plan for 
which they pay premiums every month.
  The Reconstructive Surgery Act is endorsed by the National 
Organization for Rare Disorders, National Foundation for Facial 
Reconstruction, Easter Seals and the March of Dimes.
  I am going to fight to move this legislation forward, to help people 
like Wendelyn Osborne get the reconstructive surgeries that they must 
have to stay alive and to live as normal and healthy a life as 
possible, and I urge my colleagues to join me in this fight.
  According to one Harvard researcher, there have been CMD sufferers in 
their 50's and 60's who continue to need surgery to prevent conditions 
such as this, procedures that will allow them to continue eating and 
breathing, yet orthognathic surgery is considered cosmetic.
  Many of you remember the movie ``Mask'' in which Cher played the 
mother of a boy named Rocky who died from a disease similar to CMD. 
That movie was based on a true story. Rocky died because his mother 
couldn't afford the life-saving reconstructive surgeries he needed.
  Ms. Osborne has never met another person who suffers from CMD, but 
she has met countless people who struggle with trying to get the 
reconstructive surgeries they need. People born with cleft lips and 
palates, with missing pectoral muscles that cause chest deformities, 
even burn victims--all cases where reconstructive surgery is considered 
merely cosmetic.
  For these people, falling into the wrong category means denial of 
coverage for their medical needs.

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