President Barack Obama signed a bipartisan bill last week that offers veterans and family members government-funded hospitalization and medical services for 15 specific ailments presumed linked to drinking water contamination at Camp Lejeune, N.C., over 31 years, ending in 1987.
The bill has several controversial features including a mandate that the Department of Veterans Affairs, rather than the military and its Tricare program, provide the care. The estimated cost for the first five years is $162 million to treat several thousand victims who are expected to qualify.
To be eligible, patients must show they spent at least 30 days at Lejeune between Jan. 1, 1957, and Dec. 31, 1987, or they were in utero during that period with mothers residing on base. They also must have one or more of the following: cancer of the esophagus, lung, breast, bladder or kidney; leukemia; multiple myeloma; myleodysplasic syndromes; renal toxicity; hepatic steatosis; female infertility; miscarriage; scleroderma; neurobehavioral effects or non-Hodgkin's lymphoma.
Family members of veterans also must show they have exhausted all other possible claims or remedies available, against other parties, for payment of care including employer or family health insurance plans.
Up to a million Marines and family members assigned to Lejeune could have been exposed to contaminated water, the Agency for Toxic Substances and Disease Registry estimates. Some of these families for years have blamed cancers, rare diseases, birth defects and early deaths on drinking water fouled by known carcinogens, including trichloroethylene, benzene and vinyl chloride – poisons they say were ignored for years by base officials.
After years of fighting the Navy, organizing fellow victims and lobbying Congress, advocates including retired Marine Corps Master Sgt. Jerry Ensminger see only a partial victory in the enactment of the Honoring America's Veterans and Caring For Camp Lejeune Families Act of 2012.
The short title for the portion of the law dealing with Lejeune families is the Janey Ensminger Act. It honors Ensminger and his daughter who, at age 9, died in 1985 from acute lymphoblastic leukemia, a rare ailment linked to the toxins found in water at Lejeune.
Victims and families don't fully understand what Congress has passed, Ensminger said in a phone interview. But they do know "this bill is a big step forward. It's the first step in achieving justice."
One major hurdle was getting Congress to act before completion of ongoing scientific studies that are expected to show more precisely levels of contamination and populations exposed. Another hurdle was finding budget dollars to provide VA medical services to a new population of veterans and family members.
As it flails to address the debt crisis, Congress isn't approving new entitlement spending. So money must be taken from existing programs.
The law covers health care for Lejeune victims by extending by one year higher fees veterans are paying to use the VA home loan guarantee program. Active duty members and veterans who seek a no-money-down VA home loan, for example, pay a funding fee today that equals to 2.15 percent on the value of the loan. That fee was set to drop to 1.4 percent Oct. 1, 2016. The new law extends the higher fee until Oct. 1, 2017.
Similar one-year extensions will keep higher fees in place on all types of VA home loans. Congress set them in the first place to pay for new VA benefits. It has extended them routinely to pay for more new services.
Several veterans' service organizations had a more important reason to withhold their support for the Lejeune bill. They see a dangerous precedent in saddling the VA with the cost of caring for ill family members.
"We certainly support the government's responsibility to take care of dependents harmed while living on military bases by environmental or toxic hazards," said Joseph Violante, legislative director for Disabled American Veterans. "But we believe it shouldn't be through VA, especially with Tricare (offering) insurance where they can go anywhere they want."
Until now, VA has offered private sector health care only to dependents of veterans who are 100-percent disabled through the VA's Civilian Health and Medical Program. The new law could swamp the program with victims from Lejeune, Violante said. But they could be followed by victims of contaminated air at Naval Air Facility Atsugi, Japan, victims of environmental hazards found at Fort McClellan, Ala., and at many other problem bases, he said.
Ensminger also objected to making VA first payer, calling it the law's biggest flaw. He fought to have the Department of Defense pick up the tab. It was the military that caused so many families to be exposed to carcinogens for so long. The armed services committees oversee Tricare and have resisted legislation that would have the military health care cover the Lejeune victims. They resist in part because studies ordered on levels of exposure and the populations likely harmed haven't been completed yet.
The law doesn't set a deadline for VA to start providing medical services to Lejeune victims. It could take months to write the regulations.
On signing the bill, the president said it "ends a decades-long struggle for those who served at Camp Lejeune." That is not Ensminger's view.
"This is not the epilogue," he said. "This is the end of the first act, because we still have not gotten the whole truth, nor the accountability of the people who were responsible for perpetrating this. That's next."
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