Expanding care to troops harmed by toxic burn pits has become an increasingly bipartisan cause.
Members of both parties have introduced a flurry of bills that would make it easier for veterans exposed to the fumes from overseas military bases' trash burning sites—where munitions, batteries, and medical waste were incinerated in open pits—to claim health benefits for a wide variety of conditions.
But the particulars of a largely-Democrat supported burn pit bill racing through Congress are attracting criticism for their hefty price tag and exceptionally wide eligibility criteria that could see the federal government take on billions in debt to cover veterans' conditions unconnected to their military service.
On Monday, the Congressional Budget Office (CBO) released an analysis of the Senate-amended version of the Honoring our Promise to Address Comprehensive Toxics Act (PACT) of 2021. The CBO found that the bill would create an additional $667 billion in entitlement spending and increase overall spending by $277 billion.
"This seems like a blatant attempt to find an excuse to rope more of the population into a government-run health care system with absolutely no attempts to pay for it," says David Ditch, a policy analyst at the Heritage Foundation of the PACT Act.
Former military service members are generally able to get their healthcare expenses covered by the Department of Veterans Affairs (V.A.) for conditions they developed as a result of their service. Often that requires proving that a particular condition was a result of one's service.
Veterans' advocates and their allies in Congress have long argued that the current system makes it too difficult to receive coverage for ailments caused by the toxic fumes of burn pits, which might only manifest years after someone has left the military.
To fix this problem, the PACT Act would create a "presumption of service connection" for 23 conditions—including several types of cancer, leukemia, and bronchitis—for veterans who were stationed in 17 countries during particular times, including in Iraq during the Gulf Wars and Afghanistan following 9/11.
The Secretary of Veterans Affairs would have the power to add more conditions and countries that would qualify for this "presumption of service connection."
The bill would relieve veterans of having to prove that any of those conditions were linked to their service in order to get V.A. coverage for them.
That's obviously a pretty expansive set of eligibility criteria. Someone who served in Iraq and is diagnosed with lung cancer decades later will be eligible for federally funded health care under the PACT Act, even if they were never exposed to a burn pit and were also a lifelong smoker.
The breadth of the people who would qualify for benefits under those criteria, and the number of conditions covered, is a welcomed feature for many veteran advocates. A coalition of 42 veterans' groups said the PACT Act's scope made it their preferred piece of burn pit legislation in a February letter to House leaders.
President Joe Biden, who blames burn pits for causing his son Beau's fatal brain cancer, has endorsed the bill as well. So has comedian Jon Stewart.
Ditch counters that there should be some minimal effort to establish a link between one's medical condition and exposure to a burn pit before awarding them government-sponsored benefits.
He also takes issue with the fiscal design of the bill, which he says will create new, effectively limitless entitlements. Most V.A. programs are covered by discretionary spending that has to be periodically reauthorized by Congress and is subject to annual budget caps.
That puts some outer bounds on the amount of money going out the door, even as Congress and the V.A. have made it easier for more people to lay claim to a broader set of benefits.
"To guarantee the money goes out of the door, they are shifting a huge chunk of the V.A. system from the subject-to-caps spending and moving it to the mandatory category so that it can grow on autopilot without anyone needing to worry about it," he tells Reason, an arrangement he says inappropriate in light of rising national debt and inflation.
Biden has argued that reducing the deficit is key to fighting inflation and has touted his own administration's success at shrinking it. Yet, the burn pit bill he's endorsed would only add to the national debt. By his logic, it would make inflation worse too.
The PACT Act passed the House on a mostly party-line vote in March 2022 and could be voted on by the Senate later this year.