|Sponsor||Rep. Maloney, Carolyn B.|
|Committee||Energy and Commerce|
|Date||December 22, 2010 (111th Congress, 2nd Session)|
|Staff Contact||Andy Koenig|
The Senate Amendment to H.R. 847 is expected to be considered on the floor of the House on Wednesday, December 22, 2010, under a closed rule. H.R. 847 was introduced in the House of Representatives by Rep. Maloney (D-NY) on February 4, 2009. On July 29, 2010, the House considered H.R. 847 under a suspension of the rules, and it did not garner the necessary votes for approval. On September 29, 2010, the House, under a closed rule, approved H.R. 847 by a vote of 268 to 160. The bill was amended by the Senate and approved on December 22, 2010, by unanimous consent.
Title I—World Trade Center Health Program
Title I of the Senate Amendment to H.R. 847 would create a mandatory World Trade Center Health Program (WTC program) within the National Institute for Occupational Safety and Health (NIOSH). The WTC program would provide the following: (1) medical monitoring and treatment benefits to eligible emergency responders and recovery and cleanup workers who responded to the World Trade Center terrorist attacks on September 11, 2001, and (2) initial health evaluation, monitoring, and treatment benefits to residents and other building occupants and area workers who were directly impacted and adversely affected by such attacks.
The funding would be a new entitlement over the next 10 years for 90 percent of the costs of operating the new program. The remaining 10 percent of the costs of the program would be the responsibility of the City of New York for fiscal years 2011 to 2018. For fiscal years 2019 and 2020, City of New York would be responsible for only 1/9th of the cost. The federal government’s contribution would be capped at the lower of 90 percent of the costs or a specified amount each fiscal year beginning in FY2011 and ending in FY2020. Over this 10-year period, federal spending could not exceed $3.35 billion. No federal funds would be available for the program after FY2020. (Construction and capital projects are excluded from health care spending.)
In addition, Title I would authorize the WTC program administrator to do the following: (1) implement a quality assurance program, (2) establish the WTC Health Program Scientific/Technical Advisory Committee, (3) establish the WTC Responders Steering Committee and the WTC Community Program Steering Committee, (4) provide for education and outreach on services under the WTC program, (5) collect data related to WTC-related health conditions, which must provide accountability and the opportunity for oversight, including GAO reports, (6) conduct research on physical and mental health conditions that may be related to the September 11 terrorist attacks, (7) extend and expand arrangements with the New York City Department of Health and Mental Hygiene to provide for the World Trade Center Health Registry, and (8) modify payment amounts to providers to improve quality and efficient delivery of services. To ensure accountability, the bill would direct the Inspector General of Health and Human Services (HHS) to review the program’s expenditures to detect fraudulent or duplicate billing, payment for inappropriate services, or unreasonable administrative costs.
The Senate Amendment to H.R. 847 would prohibit the disbursement of any federal funds for the program unless the City of New York has entered into an enforceable contract with the WTC Program Administrator, in which it agrees to pay its share of program costs on a timely basis. Payment would not be made for treatment services unless they are medically necessary as determined under regulations issued by the WTC Program Administrator. In addition, treatment services would be consistent with protocols developed by the Data Centers and approved by the Administrator. Monitoring services would also be consistent with protocols approved by the Administrator in order to qualify for payment.
The Senate Amendment to H.R. 847 would attempt to strengthen the federal government’s commitment to uniform data collection through Data Centers designated by the Program Administrator, epidemiological surveillance through the WTC Registry, and ongoing research into health conditions that may be related to exposures to the toxic dust at the World Trade Center site.
In addition, the Senate Amendment to H.R. 847 would establish formal eligibility requirements based on a person’s activities after September 11, 2001, and current health conditions. Health benefits would be provided by a national network of providers, and the program would be administered by HHS.
Title II—Victims Compensation Fund
The Senate Amendment to H.R. 847 would amend the Air Transportation Safety and System Stabilization Act: (1) to reopen the September 11 Victim Compensation Fund of 2001 (VCF) to provide monetary compensation to eligible individuals as a result of debris removal, (2) to extend the deadline for making a claim for compensation, and (3) to extend the life of the VCF for 5 years. The original bill kept the VCF open through 2031, making it extremely susceptible to waste, fraud and abuse and incurring significant long-term costs. The fund is now open only through 2016 and has language to expressly say that it is permanently closed at after 5 years.
The legislation would establish broader eligibility rules for compensation than those established for the VCF under the Air Transportation Safety and System Stabilization Act. Under the Senate Amendment to H.R. 847, total payments would be capped at $2.7 billion through 2016. Changes in eligibility include the following: (1) time present at site, (2) expansion of the geographic definition related to the location of the attacks, (3) and extended claims filing timeline. The legislation places a cap on attorney fees at 10 percent of the total amount and allows the Special Master to reduce attorney fees believed to be excessive. In addition, the Special Master would include workers compensation benefits in collateral sources of benefits that must offset compensation amounts.
Title I—World Trade Center Health Program
In the wake of the September 11, 2001 terrorist attack on New York City, Congress passed appropriations to provide health screening and treatment services to people involved in rescue, recovery, and cleanup operations around the site of the World Trade Center. This program, now known as the World Trade Center (WTC) Medical Monitoring and Treatment Program (MMTP), is not authorized in statute. Since its inception in FY2002, the MMTP has received approximately $475 million in federal funds, and more than 57,000 responders and community members have met initial eligibility requirements for the program.
The programs are administered by the National Institute for Occupational Safety and Health (NIOSH), an agency of the Centers for Disease Control and Prevention (CDC) within HHS. NIOSH supports six clinical centers and two data coordination centers as well as the WTC Health Registry. A total of $71 million is appropriated in FY2010 to support these activities. The President’s budget requested $150 million in FY2011. Since FY2003, a total of $326 million has been obligated for these purposes.
There are three WTC Responder programs.
As of March 31, 2010, a total of 52,700 individuals were enrolled in the WTC Responders programs (about 4,500 of these were enrolled in the national program). During the previous year, 24,100 of these enrolled responders received monitoring exams, and 13,300 received treatment through five clinical centers of excellence. These clinical centers are supported by two data and coordination centers.
The Responder programs have been funded by the federal government since FY2003. In FY2009, $104 million was obligated for the program. Federal funding for the WTC Community Program began in September 2008. The program is operated by the New York City Health and Hospitals Corporation through three locations. About 4,600 individuals were enrolled in the WTC Community Program as of March 31, 2010. Of these, 1,200 received monitoring exams and 2,600 received treatment during the previous year. In FY2009, $10 million was obligated for the Community Program. In addition to providing initial screening, monitoring, and treatment services, the WTC Health Programs have supported research on the health effects of exposure to the toxic dust cloud by rescue workers and others at the World Trade Center site. This developing science is used to inform the treatment of enrollees in the Responder and Community programs and is posted on the NIOSH website. In addition, the New York City Department of Health and Mental Hygiene established the WTC Health Registry, which includes individuals at risk for possible near and long term physical and mental health effects from the attacks. Before it closed to new registrants in 2004, the WTC Health Registry had enrolled more than 70,000 residents, workers, students, and responders. NIOSH funding helps to support the Registry.
Title II—Victims Compensation Fund
Eight days after September 11, the United States Congress created the September 11 Victims Compensation Fund (VCF) in the Air Transportation Safety and System Stabilization Act (Public Law 107-42) as an administrative alternative to litigation. The VCF provided compensation to any individual (or relatives of a deceased individual) that was physically injured or killed as a result of the terrorist attacks. Through 2004, the VCF made 2,880 death and 2,680 injury awards, which totaled more than $7 billion (about $6 billion was for death awards). In addition to creating the VCF, PL 107-42 created a Special Master, who determined the compensation levels based on specified eligibility criteria and subsequent regulations. Public Law 107-42 did not cap the number or amount of awards that could be issued by the Special Master.
CBO estimates that enacting the Senate Amendment to H.R. 847 would increase spending by $4.2 billion over ten years and raise $4.2 billion in fees/taxes.
The legislation adds a 2 percent excise fee on foreign manufacturers/companies located in countries where the U.S. does not have an international procurement agreement receiving government disbursements made under future procurement agreements. In addition, the bill would extend fees on H-1B and L-1 visas until 2015.
Some Members may be concerned about the following issues:
1. The Senate Amendment to H.R. 847 would create a new entitlement program.
2. The Senate Amendment would be paid for with a tax increase on U.S. companies that want to sell good s in foreign countries. In addition, the fees on the visas appear to unfairly target India, which could worsen bilateral relations with the country.
3. The Senate Amendment to H.R. 847 would not be means tested.
4. NIOSH does not have expertise in administering a health care payment program. The current program is a block-grant program, but pursuant to the legislation NIOSH would negotiate contracts and approve treatment protocols.
5. The Senate Amendment to H.R. 847 would increase hospital reimbursement rates to 140 percent of Medicare reimbursement rates on average for New York City hospitals while ObamaCare cuts $150 billion in payments to hospitals around the country.
6. The bill would not reward hospitals and providers for improving health care. The hospitals would be reimbursed based on each service performed, which will encourage overutilization and increase health care spending.
7. Currently, several programs receive federal funding for medical monitoring and treatment programs. Those programs include the following: Fire Department of New York WTC Medical Monitoring Program, New York/New Jersey WTC Consortium, WTC Health Registry, WTC Federal Responder Screening Program, Project COPE, and POPPA (Police Organization Providing Peer Assistance) program.
8. Limited oversight fails to ensure taxpayer funds are spent properly and effectively. Government health care programs, such as Medicare, have a significant amount of fraud.
9. The legislation would extend the geographic scope of the original September 11 Fund and gives the Special Master discretion to extend it even farther.
Below is a funding history of September 11, health programs:
Fiscal Year 2002:
Fiscal Year 2003:
Fiscal Year 2006:
Fiscal Year 2007:
Fiscal Year 2008:
Fiscal Year 2009:
Fiscal Year 2010: