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

May 13, 2015

The September 11, 2001 Terrorist Attacks:

Reauthorization of Health and Injury Compensation Programs

Background

The September 11, 2001, terrorist attacks claimed nearly

3,000 lives that day, at the World Trade Center (WTC) in

New York City, the Pentagon, and a field in Shanksville,

Pennsylvania. Rescue, recovery, and clean-up operations

took more than a year and involved thousands of workers.

Figure 1. New York City Firefighters at WTC Site

September 14, 2001

WTCHP authority sunsets at the end of FY2015. However,

annual funding caps have not been met, and unexpended

funds may be carried into FY2016. Compensation under the

reopened VCF is available for applications filed by October

3, 2016. Awards under the reopened VCF are capped at

$2.775 billion in total. As of March 31, 2015, about $1

billion in total had been awarded.

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

Library, http://www.fema.gov/media-library.

Shortly after the attacks Congress established the

September 11th Victim Compensation Fund (VCF, P.L.

107-42, Title IV) to compensate families of those who died

in the attacks, and survivors who suffered disabling injury

during or in the immediate aftermath of the attacks.

Over time it became apparent that some people who worked

at the WTC site, or who lived or worked near it, had

become ill, possibly as a result of exposure to toxins and

other hazards in the aftermath of the attack. Starting in

2004, the Centers for Disease Control and Prevention

(CDC) provided grants to a group of occupational medicine

clinics in the New York City area to provide care for WTC

responders for these exposure-related illnesses.

In 2011 Congress passed the James Zadroga 9/11 Health

and Compensation Act (the Zadroga Act, P.L. 111-347). It

replaced the CDC grant program with the World Trade

Center Health Program (WTCHP). Through a mandatory

funding mechanism, the WTCHP funds a program of health

services for responders at the three crash sites, as well as for

residents and others in the vicinity of the WTC site (called

“survivors”), for health conditions related to exposures

from the attacks and the response. The Zadroga Act also

reopened the VCF to provide compensation for lost wages

and other economic losses experienced by these responders

and survivors.

Centers to provide medical services, develop treatment

protocols, and conduct research (among other activities),

and a nationwide program for responders and survivors

who live outside the New York City area.

 A Scientific/Technical Advisory Committee, data

analysis, research, outreach to eligible individuals,

quality assurance, continued support for the WTC

Health Registry (a roster of people directly exposed to

the WTC site), and other specified activities.

 A list of conditions that may be presumed to be related

to exposures after the attacks (depending on individual

circumstances), and procedures to list new conditions.

As enacted the list did not include any types of cancer,

but a number of types of cancer were subsequently listed

administratively. (See 42 C.F.R. §88.1 for current list.)

 Payment for medical services provided to enrollees, less

any payments available from workers’ compensation,

private health insurance, Medicaid, or the Children’s

Health Insurance Program (CHIP). The WTCHP

assumes all applicable costs for Medicare beneficiaries.

As of 2014, all enrollees must have health insurance

coverage pursuant to the Affordable Care Act (P.L. 111148, as amended).

 Mandatory funding, with annual and aggregate federal

spending caps, from the last quarter of FY2011 through

FY2015, and a 10% matching requirement for New

York City. If spending caps are not met, unexpended

funds may be carried into FY2016. (See Table 2.)

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The September 11, 2001 Terrorist Attacks:

Reauthorization of Health and Injury Compensation Programs

 Administration of most program functions by the

Director of the CDC National Institute of Occupational

Safety and Health (NIOSH). The Centers for Medicare

& Medicaid Services (CMS) disburses payments to

providers. (See 76 Fed. Reg. 31337.)

Survivors

in NYC

Nationwide

Enrollees

“Grandfathered”

50,693

4,697

5,654 61,044

Enrolled since July 1, 2011

4,449

3,152

2,307

Enrollees

Cap on new enrollees

(25,000)

Total enrollees

55,142

(25,000) Notea

7,849

Total

Responders

in NYC

Table 1. WTCHP Enrollment Data

As of December 31, 2014

9,908

—

7,961 70,952

Source: Prepared by CRS from WTCHP statistics at

http://www.cdc.gov/wtc/reports.html.

a.

Nationwide enrollees may be either responders or survivors.

Table 2. WTCHP Funding: Federal Contribution

(dollars in millions)

FY11

FY12

FY13

FY15

Total,

FY11FY15

FY16

382.0

431.0

1,556.0b

NAc

235.7d

243.4d

968.3b

267.7e

FY14

Authorized amounts

71.0a

318.0

354.0

Program expenditures

71.0a

187.6

230.7d

Source: Prepared by CRS from CDC congressional budget

justifications, http://www.cdc.gov/fmo/.

Notes: Amounts for FY2012 through FY2016 reflect a CDC budget

realignment and are comparable. The FY2011 amount is not

comparable to amounts for subsequent fiscal years.

a.

b.

c.

d.

e.

Final quarter of FY2011.

Because the statutory cap of $1.556 billion was not reached in

FY2015, unexpended funds may be carried into FY2016.

Not applicable. Funding authority sunsets when the statutory

cap of $1.556 billion is reached or at the end of FY2016,

whichever is sooner. (Public Health Service Act Sec. 3351)

Amounts reflect sequestration of mandatory funds.

Estimated amount for FY2016 is less than the unexpended

amount that could be carried over.

The Victim Compensation Fund

The VCF, as originally enacted, provided compensation for

physical injuries or death during or immediately following

the attacks, as an alternative to litigation. The original

program, which was not capped, stopped accepting claims

in December 2003.

As reopened by the Zadroga Act, the VCF will accept

claims through October 3, 2016, to compensate for prior

and future economic losses, and certain noneconomic

losses, resulting from physical illness, injury, or death

caused by exposures at sites of the attack over specified

periods of time. The reopened VCF, which is capped at

$2.775 billion, often uses the same definitions for eligibility

and the same list of presumptive WTC-related health

conditions as provided in law or regulation for the WTCHP.

(See the VCF final rule, 76 Red. Reg. 54112.)

As of March 31, 2015, the reopened VCF had received

11,771 actionable eligibility claims (i.e., claims having

adequate information) and had approved 10,549 (89.6%) of

them. Among eligible claimants, the VCF had received

5,881 actionable compensation claims, and had made

compensation decisions for 4,415 (75.1%) of them.

(Remaining compensation claims were pending. The VCF

had not denied compensation to any eligible claimant.) The

total value of compensation at that time was about $1.058

billion. Most of that amount ($973 million, or 92%) was

awarded to 3,775 responders to the WTC site. (See

http://www.vcf.gov/newsandreports.html.)

Reauthorization Bills

In April 2015, substantively identical bills (S. 928 and H.R.

1786) were introduced in each chamber to reauthorize the

Zadroga Act. The bills would, among other things,

permanently reauthorize the WTCHP in the amount of $431

million for FY2015, with amounts for subsequent years

indexed to medical inflation.

In addition, the bills would remove the statute of limitations

on filing claims under the VCF, and eliminate the cap on

total program payments.

Finally, the bills would exempt both the WTCHP and the

VCF from any sequestration ordered pursuant to the

Balanced Budget and Emergency Deficit Control Act of

1985(Title II of P.L. 99-177).

For More Information

CRS Report R41292, Comparison of the World Trade

Center Medical Monitoring and Treatment Program and

the World Trade Center Health Program Created by Title I

of P.L. 111-347, the James Zadroga 9/11 Health and

Compensation Act of 2010

WTCHP website: http://www.cdc.gov/wtc/index.html

WTC Health Registry website: http://www.nyc.gov/html/

doh/wtc/html/registry/registry.shtml

WTCHP regulations: 42 C.F.R. Part 88

VCF website: http://www.vcf.gov/

VCF regulations: 28 C.F.R. Part 104

Sarah A. Lister, Specialist in Public Health and

Epidemiology

https://crsreports.congress.gov

IF10227

The September 11, 2001 Terrorist Attacks:

Reauthorization of Health and Injury Compensation Programs

Disclaimer

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