The September 11, 2001 Terrorist Attacks: Reauthorization of Health and Injury Compensation Programs

The September 11, 2001 Terrorist Attacks: Reauthorization of Health and Injury Compensation Programs

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May 13, 2015
The September 11, 2001 Terrorist Attacks:
Reauthorization of Health and Injury Compensation Programs
Background
WTCHP authority sunsets at the end of FY2015. However,
The September 11, 2001, terrorist attacks claimed nearly
annual funding caps have not been met, and unexpended
3,000 lives that day, at the World Trade Center (WTC) in
funds may be carried into FY2016. Compensation under the
New York City, the Pentagon, and a field in Shanksville,
reopened VCF is available for applications filed by October
Pennsylvania. Rescue, recovery, and clean-up operations
3, 2016. Awards under the reopened VCF are capped at
took more than a year and involved thousands of workers.
$2.775 billion in total. As of March 31, 2015, about $1
billion in total had been awarded.
Figure 1. New York City Firefighters at WTC Site
September 14, 2001
The WTC Health Program (WTCHP)
The WTCHP consists of the following:
 Medical services for responders and survivors, including
(1) periodic medical monitoring for responders; (2)
initial health evaluation for survivors and medical
monitoring if indicated; and (3) medically necessary
treatment for WTC-related health conditions, including
mental health conditions, for responders and survivors.
 Caps on new enrollments (responders and survivors)
after enactment, and “grandfathering” of enrollees in the
original CDC program. (See Table 1.)

 A network of Clinical Centers of Excellence and Data
Source: Federal Emergency Management Agency (FEMA) Multimedia
Centers to provide medical services, develop treatment
Library, http://www.fema.gov/media-library.
protocols, and conduct research (among other activities),
and a nationwide program for responders and survivors
Shortly after the attacks Congress established the
who live outside the New York City area.
September 11th Victim Compensation Fund (VCF, P.L.
 A Scientific/Technical Advisory Committee, data
107-42, Title IV) to compensate families of those who died
analysis, research, outreach to eligible individuals,
in the attacks, and survivors who suffered disabling injury
quality assurance, continued support for the WTC
during or in the immediate aftermath of the attacks.
Health Registry (a roster of people directly exposed to
the WTC site), and other specified activities.
Over time it became apparent that some people who worked
at the WTC site, or who lived or worked near it, had
 A list of conditions that may be presumed to be related
become ill, possibly as a result of exposure to toxins and
to exposures after the attacks (depending on individual
other hazards in the aftermath of the attack. Starting in
circumstances), and procedures to list new conditions.
2004, the Centers for Disease Control and Prevention
As enacted the list did not include any types of cancer,
(CDC) provided grants to a group of occupational medicine
but a number of types of cancer were subsequently listed
clinics in the New York City area to provide care for WTC
administratively. (See 42 C.F.R. §88.1 for current list.)
responders for these exposure-related illnesses.
 Payment for medical services provided to enrollees, less
any payments available from workers’ compensation,
In 2011 Congress passed the James Zadroga 9/11 Health
private health insurance, Medicaid, or the Children’s
and Compensation Act (the Zadroga Act, P.L. 111-347). It
Health Insurance Program (CHIP). The WTCHP
replaced the CDC grant program with the World Trade
assumes all applicable costs for Medicare beneficiaries.
Center Health Program (WTCHP). Through a mandatory
As of 2014, all enrollees must have health insurance
funding mechanism, the WTCHP funds a program of health
coverage pursuant to the Affordable Care Act (P.L. 111-
services for responders at the three crash sites, as well as for
148, as amended).
residents and others in the vicinity of the WTC site (called
“survivors”), for health conditions related to exposures
 Mandatory funding, with annual and aggregate federal
from the attacks and the response. The Zadroga Act also
spending caps, from the last quarter of FY2011 through
reopened the VCF to provide compensation for lost wages
FY2015, and a 10% matching requirement for New
and other economic losses experienced by these responders
York City. If spending caps are not met, unexpended
and survivors.
funds may be carried into FY2016. (See Table 2.)
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Reauthorization of Health and Injury Compensation Programs
 Administration of most program functions by the
As reopened by the Zadroga Act, the VCF will accept
Director of the CDC National Institute of Occupational
claims through October 3, 2016, to compensate for prior
Safety and Health (NIOSH). The Centers for Medicare
and future economic losses, and certain noneconomic
& Medicaid Services (CMS) disburses payments to
losses, resulting from physical illness, injury, or death
providers. (See 76 Fed. Reg. 31337.)
caused by exposures at sites of the attack over specified
periods of time. The reopened VCF, which is capped at
Table 1. WTCHP Enrollment Data
$2.775 billion, often uses the same definitions for eligibility
As of December 31, 2014
and the same list of presumptive WTC-related health

conditions as provided in law or regulation for the WTCHP.
ers

s

(See the VCF final rule, 76 Red. Reg. 54112.)
d
es
l
YC
ivor
YC
wide
on
rolle
As of March 31, 2015, the reopened VCF had received
in N
in N
ti
Tota
Enrollees
espon
R
Surv
Na
En
11,771 actionable eligibility claims (i.e., claims having
adequate information) and had approved 10,549 (89.6%) of
“Grandfathered”
50,693
4,697 5,654 61,044 them. Among eligible claimants, the VCF had received
5,881 actionable compensation claims, and had made
Enrolled since July 1, 2011
4,449
3,152 2,307 9,908 compensation decisions for 4,415 (75.1%) of them.
Cap on new enrollees
(25,000) (25,000) Notea
—
(Remaining compensation claims were pending. The VCF
had not denied compensation to any eligible claimant.) The
Total enrollees
55,142
7,849 7,961 70,952 total value of compensation at that time was about $1.058
Source: Prepared by CRS from WTCHP statistics at
billion. Most of that amount ($973 million, or 92%) was
http://www.cdc.gov/wtc/reports.html.
awarded to 3,775 responders to the WTC site. (See
http://www.vcf.gov/newsandreports.html.)
a. Nationwide enrollees may be either responders or survivors.
Reauthorization Bills
Table 2. WTCHP Funding: Federal Contribution
In April 2015, substantively identical bills (S. 928 and H.R.
(dollars in millions)
1786) were introduced in each chamber to reauthorize the
Zadroga Act. The bills would, among other things,
Total,
permanently reauthorize the WTCHP in the amount of $431
FY11-
million for FY2015, with amounts for subsequent years
FY11
FY12
FY13
FY14
FY15
FY15
FY16
indexed to medical inflation.
Authorized amounts
In addition, the bills would remove the statute of limitations
71.0a
318.0
354.0
382.0
431.0 1,556.0b
NAc
on filing claims under the VCF, and eliminate the cap on
total program payments.
Program expenditures
71.0a
187.6 230.7d 235.7d 243.4d 968.3b
267.7e Finally, the bills would exempt both the WTCHP and the
VCF from any sequestration ordered pursuant to the
Source: Prepared by CRS from CDC congressional budget
Balanced Budget and Emergency Deficit Control Act of
justifications, http://www.cdc.gov/fmo/.
1985(Title II of P.L. 99-177).
Notes: Amounts for FY2012 through FY2016 reflect a CDC budget
For More Information
realignment and are comparable. The FY2011 amount is not
CRS Report R41292, Comparison of the World Trade
comparable to amounts for subsequent fiscal years.
Center Medical Monitoring and Treatment Program and
the World Trade Center Health Program Created by Title I
a. Final quarter of FY2011.
of P.L. 111-347, the James Zadroga 9/11 Health and
b. Because the statutory cap of $1.556 billion was not reached in
Compensation Act of 2010
FY2015, unexpended funds may be carried into FY2016.
c. Not applicable. Funding authority sunsets when the statutory
WTCHP website: http://www.cdc.gov/wtc/index.html
cap of $1.556 billion is reached or at the end of FY2016,
WTC Health Registry website: http://www.nyc.gov/html/
whichever is sooner. (Public Health Service Act Sec. 3351)
doh/wtc/html/registry/registry.shtml
d. Amounts reflect sequestration of mandatory funds.
WTCHP regulations: 42 C.F.R. Part 88
e. Estimated amount for FY2016 is less than the unexpended

amount that could be carried over.
VCF website: http://www.vcf.gov/
VCF regulations: 28 C.F.R. Part 104
The Victim Compensation Fund
The VCF, as originally enacted, provided compensation for
Sarah A. Lister, Specialist in Public Health and
physical injuries or death during or immediately following
Epidemiology
the attacks, as an alternative to litigation. The original
program, which was not capped, stopped accepting claims
IF10227
in December 2003.
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The September 11, 2001 Terrorist Attacks:
Reauthorization of Health and Injury Compensation Programs

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