HR-1410-119
Referred to the House Committee on Energy and Commerce.
Sponsored by Andrew Garbarino (R-NY)
What it does
This bill would make several changes to the World Trade Center (WTC) Health Program, which provides medical monitoring and treatment to people who responded to or were affected by the September 11, 2001 attacks. It would allow licensed mental health providers — not just physicians — to conduct evaluations and certify mental health conditions for program enrollment. It would also adjust the program's funding formula, starting with a 25% spending increase in fiscal year 2026 and then tying future annual increases to a 7% growth rate multiplied by enrollment changes through fiscal year 2090. Additionally, it would exclude deceased enrollees from enrollment counts used to calculate funding, extend the review period for adding new health conditions from 90 to 180 days, and require HHS to submit a long-range budget report to Congress within three years.
Who benefits
The approximately 120,000 currently enrolled WTC Health Program participants — including firefighters, police officers, construction workers, volunteers, and survivors who lived or worked near Ground Zero — who would gain access to more mental health providers and potentially more stable long-term funding. Licensed mental health providers such as psychologists, licensed clinical social workers, and licensed professional counselors who would become eligible to conduct program evaluations. Program administrators who would gain a more accurate enrollment count by excluding deceased individuals. Future 9/11-affected individuals who may seek enrollment as new conditions are recognized.
Who is hurt
Taxpayers who would bear the cost of a 25% funding increase in FY2026 and compounding annual increases through 2090. Physicians who currently hold exclusive authority to certify mental health conditions and may see their role reduced. Competing federal health programs that may face indirect budget pressure as WTC program funding grows over decades. Individuals whose conditions are under review may face longer waits due to the extension of the review period from 90 to 180 days.
Supporters argue
Supporters argue that the WTC Health Program faces a documented funding shortfall — the existing formula has not kept pace with actual expenditures, leaving the program at risk of running out of money before its 2090 authorization expires. They contend that requiring physician-only evaluations for mental health conditions creates an unnecessary bottleneck, given that psychologists and licensed clinical social workers are the specialists most trained to diagnose conditions like PTSD, which affects a disproportionately high share of 9/11 responders. Extending access to qualified mental health providers and correcting the funding formula, they argue, fulfills the federal commitment made to those who risked their lives in the aftermath of the attacks.
Opponents argue
Opponents argue that locking in a 7% annual compounding growth rate through fiscal year 2090 — on top of an immediate 25% funding boost — creates an open-ended, multi-decade spending commitment with limited congressional oversight and no sunset mechanism. They contend that tying future appropriations to enrollment-adjusted automatic increases removes Congress's ability to reassess program costs as circumstances change, and that the CBO has not yet scored the long-term fiscal impact of this formula, making it difficult to evaluate the true budgetary commitment being made. Critics may also argue that expanding the pool of certifying providers without clear credentialing standards could increase the risk of improper enrollments.
Constitutional context
Congress funds the WTC Health Program under its Taxing and Spending Clause authority (Art. I, §8, cl. 1). The bill modifies mandatory spending formulas and delegates rulemaking authority to the WTC Program Administrator, which is consistent with established congressional practice. No active constitutional tension is implicated — this is a modification of an existing, congressionally authorized program with no novel enumerated powers question.
Checks and balances
Congress retains authority over the program's statutory framework; the executive branch (HHS/WTC Program Administrator) gains expanded rulemaking authority to define qualifying mental health provider categories, subject to notice-and-comment rulemaking and post-Loper Bright judicial review of any agency interpretations.
Historical precedent
The James Zadroga 9/11 Health and Compensation Act of 2010 originally established the WTC Health Program, and the Zadroga Act Reauthorization of 2015 extended it through 2090 with a structured funding formula — this bill would amend that formula to address gaps between projected and actual expenditures.