A historic expansion of veterans benefits for millions who were exposed to toxins during their military service is on a glide path to becoming law after it cleared the Senate on Thursday.
The Senate voted 84-14 on Thursday to approve the Sergeant First Class Heath Robinson Honoring Our PACT Act, which would extend health care and disability benefits to an estimated 3.5 million veterans exposed to burn pits and other airborne hazards. All of the "no" votes came from Republicans.
The bill must still pass the House and be signed by President Joe Biden before becoming law. But the Senate was seen as the biggest hurdle to the bill making it into law after some lawmakers in that chamber balked at the price tag of an earlier version of the bill, meaning it is now expected to sail to the finish line.
The bill, which is named in honor of a veteran who died of lung cancer after being exposed to burn pits in Iraq, would designate 23 diseases as presumed to be linked to military service, including hypertension, brain cancer, chronic bronchitis and more.
The bill is "about righting a wrong that has been ignored for too damn long," Senate Veterans Affairs Committee Chairman Jon Tester, D-Mont., said during floor debate on the measure. "There's always a cost of war, and that cost is never fully paid when the war ends."
The Department of Veterans Affairs already treats asthma, rhinitis, sinusitis and nine types of respiratory cancers as presumed to be linked to military service. But for any other ailment, veterans must prove the disease is linked to their time in uniform, an effort that is often futile because of spotty Defense Department recordkeeping or what the VA says is a lack of scientific data proving a disease is caused by burn pits.
In addition to expanding the list of presumptive diseases, the PACT Act would create a streamlined process to add more illnesses to the list in the future, something lawmakers hope will prevent the need to pass more legislation should other toxic exposure-related ailments emerge.
While much of the bill is focused on post-9/11 veterans exposed to the massive trash fires known as burn pits that were a staple in the wars in Iraq and Afghanistan, there are also several provisions to help prior generations exposed to other toxins, including broadening coverage for veterans exposed to radiation during nuclear waste cleanup in the 1960s and for Vietnam-era veterans exposed to Agent Orange.
The Congressional Budget Office, or CBO, estimates the bill could cost $278.5 billion over a decade.
Republicans had previously balked at the high price tag of expanding benefits for toxic-exposed veterans. But most GOP senators came on board after a compromise by Tester and Senate Veterans Affairs Committee ranking member Sen. Jerry Moran, R-Kan., shaved off some of the cost when compared to a similar, House-passed bill.
"This country is good at recognizing the physical wounds of war. And we are getting better at recognizing the mental wounds of war," Moran said on the Senate floor last week. "No longer can we ignore the wounds of war from toxic exposure -- the wounds, like Agent Orange before it, that may not arrive until years later."
The Senate bill has a lower cost than the House's $321.7 billion bill in part because it would take longer to phase in some benefits and presumptive illnesses, pushing some costs to outside the 10-year window covered in the CBO's estimate. The Senate bill would also expand options for veterans to seek care at non-VA facilities.
The bill would also add claims processor and health care staff to the VA to address Republican concerns that expanding the pool of veterans eligible for benefits would overwhelm an already stressed system and delay care for all veterans.
Asked at a Senate hearing Tuesday about the department's ability to implement the PACT Act, VA Secretary Denis McDonough expressed confidence the agency is in a "good position" to handle changes in the first year but acknowledged full implementation could be hard.
"I think it could be very difficult to implement," he said. "But oftentimes, the most important things are difficult."
The bill will now bounce back to the House, which passed the similar, slightly more expensive legislation by 256-174 in March.
House Speaker Nancy Pelosi, D-Calif., has promised her chamber will take up the bill "as soon as the Senate passes this legislation." Biden, who suspects his son Beau's fatal brain cancer was caused by burn pits in Iraq and Kosovo, has also vowed to sign it "immediately" after it gets to his desk.
-- Rebecca Kheel can be reached at email@example.com. Follow her on Twitter @reporterkheel.