I 

108TH CONGRESS 

2D SESSION H. R. 4974 

To provide health services for individuals assisting with the response to 

the terrorist attacks in New York City on September 11, 2001, and 

for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 22, 2004 

Mr. MEEKS of New York introduced the following bill; which was referred to 

the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined 

by the Speaker, in each case for consideration of such provisions as fall 

within the jurisdiction of the committee concerned 

A BILL 

To provide health services for individuals assisting with the 

response to the terrorist attacks in New York City on 

September 11, 2001, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Post 9/11 Health Pro5 tection Act of 2004’’. 

6 SEC. 2. FINDINGS. 

7 The Congress finds as follows: 
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1 (1) On September 11, 2001, in New York City, 

2 firefighters, paramedics, emergency medical techni3 cians, police officers, laborers, survivors, and others 

4 risked their lives far and beyond what was expected 

5 of them. They took upon themselves a burden that 

6 weighed so heavily that they still carry the repercus7 sions almost three years later. 

8 (2) It is not only necessary but obligatory upon 

9 our Nation to address the health consequences from 

10 the environmental exposures these individuals experi11 enced after the World Trade Centers disaster, which 

12 are, as demonstrated by extensive research, directly 

13 associated with significant adverse effects on health. 

14 (3) The dust from the disaster produced bron15 chial hyperactivity, persistent cough, and increased 

16 risk of asthma, as well as plausible causes of ob17 served increase in the number of infants with lower 

18 birthweights. 

19 (4) Substantial research has in addition dem20 onstrated that these individuals have an increased 

21 future risk of mesothelioma, especially those exposed 

22 to asbestos. 

23 (5) According to the National Institutes of 

24 Health, the attacks have confirmed a ‘‘positive rela25 tionship between the intensity of their exposure to 
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1 airborne pollutants and the severity of their pul2 monary symptoms.’’. 

3 (6) In an article published September 5, 2003, 

4 the Agency for Toxic Substances and Disease Reg5 istry stated that ‘‘The effects of 9/11 are still being 

6 felt today by all New Yorkers, and all Americans.’’. 

7 In that article, Dr. Frieden stated that ‘‘Hundreds 

8 of thousands of people from all walks of life were in 

9 the vicinity of the twin towers when they collapsed, 

10 and were exposed to a combination of smoke, dust, 

11 and debris.’’. 

12 (7) Research has proved that the smoke and de13 bris have been detrimental in that they have caused 

14 various health ailments such as respiratory prob15 lems, birth defects, and cancer. 

16 (8) Out of 10,116 firefighters, 332 have dis17 played persistent cough accompanied by other res18 piratory symptoms severe enough to require up to 

19 four weeks leave of absence. Among the firefighters 

20 without a cough, many were diagnosed with bron21 chial hyperactivity. 

22 (9) Of iron workers that were involved in clean23 ing and recovery, approximately 1/3 have a chronic 

24 cough, 24 percent have reported a new onset of 
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1 phlegm production, and more than 17 percent have 

2 complained of a new onset of wheeze. 

3 (10) One of the greater health risks has been 

4 exposure to asbestos, which was found in the rubble 

5 in concentrations as high as 20 percent. This mate6 rial may cause lung cancer and malignant mesothe7 lioma. 

8 (11) Researchers studied 187 pregnant women, 

9 and discovered that, for women within a half mile of 

10 ground zero who inhaled the soot, pulverized glass, 

11 and other toxins, the effects were detrimental 

12 enough to result in the delivery of infants who aver13 aged a half-pound lighter than infants of unexposed 

14 mothers, a condition known as smaller-for-gesta15 tional-age (‘‘SGA’’). 

16 (12) In the Journal of the American Medical 

17 Association, researchers of Mount Sinai Medical 

18 Center explained the pollutants as a toxic cocktail, 

19 with a potential for long-term adverse health effects. 

20 Other studies have associated the pollutants with a 

21 direct connection to heart disease and an array of 

22 chronic disorders. One example is the condition 

23 known as the World Trade Center cough; fire24 fighters and other rescue workers have complained 

25 of this persistent respiratory illness. 
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1 (13) According to Inter Press Service, 2.5 years 

2 after the attacks laborers are still suffering from se3 vere breathing problems, skin rashes, nausea, de4 pression, or anxiety. 

5 (14) Of emergency respondents, 80 percent 

6 have reported of having at least one respiratory 

7 symptom, such as sore throat, chest tightness, or 

8 cough and wheezing. One half complained of having 

9 problems one year later. 

10 (15) Dr. Rafael de la Hoz noted that, of about 

11 150 day workers examined at Mount Sinai Medical 

12 Center, about 75 percent are suffering from upper 

13 airway diseases, and some have reported aggravated 

14 asthma or bronchial disease, back and musculo15 skeletal pain, or psychological problems such as post 

16 traumatic stress syndrome. 

17 SEC. 2. SEPTEMBER 11 EMERGENCY PERSONNEL TRUST 

18 FUND. 

19 (a) ADDITIONAL TAX ON HIGH INCOME TAX20 PAYERS.—Section 1 of the Internal Revenue Code of 1986 

21 is amended by adding at the end the following new sub22 section: 

23 ‘‘(j) ADDITIONAL TAX ON HIGH INCOME TAX24 PAYERS.—The amount determined under subsection (a), 

25 (b), (c), or (d), as the case may be, shall be increased by 
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1 1 percent of so much of adjusted gross income as exceeds 

2 $1,000,000 in the case of individuals to whom subsection 

3 (a) applies ($500,000 in any other case).’’. 

4 (b) SEPTEMBER 11 EMERGENCY PERSONNEL TRUST

5 FUND.—Subchapter A of chapter 98 of the Internal Rev6 enue Code of 1986 (relating to trust fund code) is amend7 ed by adding at the end the following new section: 

8 ‘‘SEC. 9511. SEPTEMBER 11 EMERGENCY PERSONNEL 

9 TRUST FUND. 

10 ‘‘(a) CREATION OF TRUST FUND.—There is estab11 lished in the Treasury of the United States a trust fund 

12 to be known as the ‘September 11 Emergency Personnel 

13 Trust Fund’, consisting of such amounts as may be appro14 priated or credited to such Trust Fund as provided in this 

15 section or section 9602(b). 

16 ‘‘(b) TRANSFERS TO TRUST FUND.—There are here17 by appropriated to the September 11 Emergency Per18 sonnel Trust Fund amounts equivalent to the taxes re19 ceived in the Treasury under section 1(j). 

20 ‘‘(c) EXPENDITURES.—Amounts in the September 11 

21 Emergency Personnel Trust Fund shall be available to 

22 carry out sections 317T and 409J of the Public Health 

23 Service Act.’’. 
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1 (c) CLERICAL AMENDMENT.—The table of sections 

2 for such subchapter is amended by adding at the end 

3 thereof the following new item: 

‘‘Sec. 9511. September 11 Emergency Personnel Trust Fund.’’. 

4 (d) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply to taxable years beginning after 

6 December 31, 2004. 

7 SEC. 3. CERTAIN HEALTH SERVICES FOR INDIVIDUALS AS8 SISTING WITH RESPONSE TO SEPTEMBER 11 

9 TERRORIST ATTACKS IN NEW YORK CITY. 

10 (a) IN GENERAL.—Part B of title III of the Public 

11 Health Service Act (42 U.S.C. 243 et seq.) is amended 

12 by inserting after section 317S the following section: 

13 ‘‘SEC. 317T. CERTAIN HEALTH SERVICES FOR INDIVIDUALS 

14 ASSISTING WITH RESPONSE TO SEPTEMBER 

15 11 TERRORIST ATTACKS IN NEW YORK CITY. 

16 ‘‘(a) IN GENERAL.—From the September 11 Emer17 gency Personnel Trust Fund under section 9511 of the 

18 Internal Revenue Code of 1986, the Secretary, acting 

19 through the Director of the Centers for Disease Control 

20 and Prevention, shall make awards of grants or coopera21 tive agreements for the purpose of carrying out baseline 

22 and follow-up screening and clinical examinations, and 

23 long-term health monitoring and analysis, for covered indi24 viduals who meet the eligibility criteria under subsection 

25 (d). 
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1 ‘‘(b) COVERED INDIVIDUALS.—For purposes of this 

2 section, the term ‘covered individuals’ means— 

3 ‘‘(1) emergency service personnel and rescue 

4 and recovery personnel who responded to the ter5 rorist attacks that occurred on September 11, 2001, 

6 in New York City, in the State of New York, any 

7 time during the period of September 11, 2001, 

8 through August 31, 2002; 

9 ‘‘(2) any other worker or volunteer who re10 sponded to such attacks, including— 

11 ‘‘(A) a police officer; 

12 ‘‘(B) a firefighter; 

13 ‘‘(C) an emergency medical technician; 

14 ‘‘(D) a transit worker; 

15 ‘‘(E) any participating member of an 

16 urban search and rescue team; 

17 ‘‘(F) Federal and State employees; 

18 ‘‘(G) a person who worked to recover 

19 human remains; 

20 ‘‘(H) a person who worked on the criminal 

21 investigation; and 

22 ‘‘(I) any other relief or rescue worker or 

23 volunteer whom the Secretary determines to be 

24 appropriate; 
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1 ‘‘(3) a worker who responded to such attacks by 

2 assisting in the cleanup or restoration of critical in3 frastructure in and around; 

4 ‘‘(4) a person whose place of residence is in the 

5 declared disaster area; 

6 ‘‘(5) a person who is employed in or attends 

7 school, child care, or adult day care in a building lo8 cated in the declared disaster area; and 

9 ‘‘(6) any other person whom the Secretary de10 termines to be appropriate. 

11 ‘‘(c) AWARD RECIPIENT.— 

12 ‘‘(1) IN GENERAL.—Subject to the submission 

13 of an application satisfactory to the Secretary, 

14 awards under subsection (a) shall be made only to— 

15 ‘‘(A) the consortium of medical entities 

16 that, pursuant to the program referred to in 

17 subsection (g), provided health services de18 scribed in subsection (a) during fiscal year 

19 2003 for the personnel described in subsection 

20 (b)(1), subject to the consortium meeting the 

21 criteria established in paragraph (2); and 

22 ‘‘(B) the separate program carried out by 

23 the New York City Fire Department. 

24 ‘‘(2) CRITERIA.—For purposes of paragraph 

25 (1)(A), the criteria described in this paragraph for 
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1 the consortium referred to in such paragraph are 

2 that the consortium has appropriate experience in 

3 the areas of environmental or occupational health, 

4 toxicology, and safety, including experience in—

5 ‘‘(A) developing clinical protocols and con6 ducting clinical health examinations, including 

7 mental health assessments; 

8 ‘‘(B) conducting long-term health moni9 toring and epidemiological studies; 

10 ‘‘(C) conducting long-term mental health 

11 studies; and 

12 ‘‘(D) establishing and maintaining medical 

13 surveillance programs and environmental expo14 sure or disease registries. 

15 ‘‘(d) ELIGIBILITY OF COVERED INDIVIDUALS.—The 

16 Secretary shall determine eligibility criteria for covered in17 dividuals to receive health services under subsection (a). 

18 Such criteria shall include the requirement that a covered 

19 individual may not receive services through the program 

20 under such section unless the individual enrolls in the pro21 gram. 

22 ‘‘(e) CERTAIN PROGRAM REQUIREMENTS.—With re23 spect to the program under subsection (a), the Secretary 

24 shall provide for the following: 
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1 ‘‘(1) Awards under subsection (a) shall des2 ignate an amount to be available only for covered in3 dividuals who— 

4 ‘‘(A) are active or retired firefighters of 

5 New York City; and 

6 ‘‘(B) in responding to the terrorist attacks 

7 of September 11, 2001, provided services in the 

8 immediate vicinity of the World Trade Center. 

9 ‘‘(2) A covered individual enrolled in the pro10 gram may not receive services under the program for 

11 a period exceeding 20 years after the date on which 

12 the individual first receives services under the pro13 gram, except that the Secretary may designate a 

14 longer period if the Secretary determines that a 

15 longer period is appropriate with respect to the 

16 health of covered individuals. 

17 ‘‘(3) The program may not establish a max18 imum enrollment number of fewer than 40,000 cov19 ered individuals. 

20 ‘‘(f) AUTHORITY REGARDING TREATMENT.—The 

21 Secretary may, to the extent determined appropriate by 

22 the Secretary, authorize the program under subsection (a) 

23 to provide treatment services to covered individuals who 

24 have no other means of obtaining treatment. 
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1 ‘‘(g) RELATION TO CERTAIN PROGRAM.—Effective 

2 on and after the date of the enactment of the Remember 

3 9/11 Health Act, the two programs carried out pursuant 

4 to the appropriation of $90,000,000 made in Public Law 

5 107–206 under the heading ‘Public Health and Social 

6 Services Emergency Fund’, which programs provide 

7 health services described in subsection (a) for the per8 sonnel described in subsection (b)(1), shall be considered 

9 to be carried out under authority of this section and shall 

10 be subject to the requirements of this section, except for 

11 any period of transition determined appropriate by the 

12 Secretary, not to exceed one year after such date of enact13 ment.’’. 

14 (b) PROGRAMS REGARDING ATTACK AT PEN15 TAGON.—The Secretary of Health and Human Services 

16 may, to the extent determined appropriate by the Sec17 retary, establish with respect to the terrorist attack at the 

18 Pentagon on September 11, 2001, programs similar to the 

19 programs that are established in sections 317T and 409J 

20 of the Public Health Service Act with respect to the ter21 rorist attacks on such date in New York City, in the State 

22 of New York. 
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1 SEC. 4. RESEARCH REGARDING CERTAIN HEALTH CONDI2 TIONS. 

3 Part B of title IV of the Public Health Service Act 

4 (42 U.S.C. 284 et seq.) is amended by inserting after sec5 tion 409I the following section: 

6 ‘‘SEC. 409J. RESEARCH REGARDING CERTAIN HEALTH CON7 DITIONS OF INDIVIDUALS ASSISTING WITH 

8 RESPONSE TO SEPTEMBER 11 TERRORIST AT9 TACKS IN NEW YORK CITY. 

10 ‘‘(a) IN GENERAL.—With respect to covered individ11 uals as defined in section 317T, the Director of NIH shall 

12 conduct or support— 

13 ‘‘(1) diagnostic research on qualifying health 

14 conditions of such individuals, in the case of condi15 tions for which there has been diagnostic uncer16 tainty; and 

17 ‘‘(2) research on treating qualifying health con18 ditions of such individuals, in the case of conditions 

19 for which there has been treatment uncertainty. 

20 ‘‘(b) QUALIFYING HEALTH CONDITIONS.—For pur21 poses of this section, the term ‘qualifying health condi22 tions’ means adverse health conditions that are considered 

23 by the Secretary to be associated with exposure to one or 

24 more of the sites of the terrorist attacks that occurred on 

25 September 11, 2001, in New York City, in the State of 

26 New York. 
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1 ‘‘(c) CONSULTATION WITH CERTAIN MEDICAL CON2 SORTIUM.—The Secretary shall carry out this section in 

3 consultation with— 

4 ‘‘(1) the consortium of medicine entities re5 ferred to in section 317T(c)(1); and 

6 ‘‘(2) the firefighters department of New York 

7 City, and the union for the firefighters of such de8 partment. 

9 ‘‘(d) ANNUAL REPORT.—The Director of NIH shall 

10 annually submit to the Congress a report describing the 

11 findings of research under subsection (a). 

12 ‘‘(e) FUNDING.—Amounts in the September 11 

13 Emergency Personnel Trust Fund under section 9511 of 

14 the Internal Revenue Code of 1986 are available to the 

15 Director of NIH for the purpose of research under this 

16 section.’’. 

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