Zadroga Act: Permanent Care for 9/11 Responders

In December 2015, Congress passed the James Zadroga 9/11 Health and Compensation Reauthorization Act, making permanent the healthcare program for first responders and survivors who developed illnesses from exposure to the toxic dust at Ground Zero. President Obama signed the legislation on December 18, 2015, as part of the Consolidated Appropriations Act of 2016.

What the Law Accomplished

The reauthorization accomplished two major goals:

Made the World Trade Center Health Program permanent: The original Zadroga Act, passed in 2010, had authorized the health program through 2015. Without reauthorization, tens of thousands of first responders and survivors would have lost access to monitoring and treatment for 9/11-related illnesses.

Extended the September 11th Victim Compensation Fund: The VCF, which provides financial compensation for 9/11-related injuries and deaths, was extended through 2090—effectively making it permanent for the lifetime of anyone affected by the attacks.

Why Reauthorization Mattered

The collapse of the World Trade Center towers released a massive cloud of toxic debris containing asbestos, pulverized concrete, heavy metals, and other hazardous materials. In the days and weeks following September 11, 2001, thousands of first responders worked at Ground Zero, often without adequate respiratory protection.

The health consequences were severe and ongoing:

• More than 120,000 people enrolled in the World Trade Center Health Program
• Over 16,000 cancers linked to 9/11 exposure had been certified by 2015
• Respiratory diseases, including asbestosis and COPD, affected thousands
• Mesothelioma cases began appearing as the latency period progressed

The Asbestos Connection

The World Trade Center towers contained an estimated 400 tons of asbestos in fireproofing materials, primarily in the lower floors of the North Tower. When the buildings collapsed, this asbestos was pulverized and dispersed throughout Lower Manhattan.

Unlike most asbestos exposures, which occur over years of occupational contact, 9/11 responders experienced intense, concentrated exposure over days or weeks. Scientists continue to study whether this exposure pattern affects disease development differently than traditional occupational exposure.

By 2015, approximately 70 cases of mesothelioma had been confirmed among 9/11 responders—a number expected to rise significantly given the disease’s typical 20- to 50-year latency period. The reauthorization ensured these responders would have continued access to treatment as mesothelioma and other cancers emerged.

The Fight for Reauthorization

Passage of the reauthorization required sustained advocacy by first responders, survivors, and their supporters. The bill faced opposition from some lawmakers over its cost, estimated at approximately $8 billion over 75 years.

Advocates, including comedian Jon Stewart, testified before Congress and conducted media campaigns highlighting the plight of ailing responders. The juxtaposition of honoring 9/11 heroes in speeches while potentially denying them healthcare proved politically untenable.

The final legislation passed with bipartisan support, though the funding levels and duration were negotiated down from initial proposals.

Program Funding and Structure

The reauthorization provided:

• $3.5 billion over 75 years for the World Trade Center Health Program
• $4.6 billion for the September 11th Victim Compensation Fund
• Coverage for monitoring and treatment of certified 9/11-related conditions
• Compensation for economic losses, pain and suffering, and loss of life

The World Trade Center Health Program operates clinical centers of excellence that specialize in 9/11-related conditions. These centers provide both medical treatment and research into the health effects of the attacks.

Covered Conditions

The program covers a defined list of conditions linked to 9/11 exposure, including:

• Mesothelioma and other asbestos-related diseases
• Various cancers (added to covered conditions in 2012)
• Respiratory diseases including asthma, COPD, and interstitial lung disease
• Mental health conditions including PTSD and depression
• Musculoskeletal disorders

New conditions can be added through a petition process as scientific evidence establishes links to 9/11 exposure.

Legacy of James Zadroga

The law is named for James Zadroga, an NYPD detective who worked at Ground Zero for over 450 hours in the aftermath of the attacks. He developed respiratory illness and died in 2006 at age 34. While his death was initially attributed to 9/11 exposure, the medical examiner later found other contributing factors.

Regardless of the controversy over Zadroga’s specific cause of death, his name became associated with the broader struggle for recognition and healthcare for thousands of responders who undeniably became ill from their service at Ground Zero.

Continued Vigilance

The 2015 reauthorization did not end the advocacy. In 2019, Congress would again need to act when the Victim Compensation Fund faced depletion due to higher-than-expected claims. The Never Forget the Heroes: James Zadroga, Ray Pfeifer, and Luis Alvarez Permanent Authorization of the September 11th Victim Compensation Fund Act made the VCF permanent and fully funded.

The continuing health needs of 9/11 responders underscore that the consequences of the attacks extend far beyond that single day, affecting thousands of people for the rest of their lives.