As firefighters battled the catastrophic blazes in Los Angeles County in January, California’s U.S. senators, Adam Schiff and Alex Padilla, both Democrats, signed on to legislation with a simple aim: provide federal assistance to first responders diagnosed with service-related cancer.

The Honoring Our Fallen Heroes Act is considered crucial by its supporters, with climate change fueling an increase in wildfire frequency and firefighting deemed carcinogenic by the World Health Organization. Firefighters have a 14% higher chance of dying from cancer than the general population, according to a 2024 study, and the disease was responsible for 66% of career firefighter line-of-duty deaths from 2002 to 2019.

The Los Angeles wildfires brought the fear generated by these statistics into bold relief. As homes, businesses and cars — and the products within them — were incinerated, gases, chemicals, asbestos and other toxic pollutants were released into the air, often settling into soil and dust. First responders working at close range, often without adequate respiratory protection, were at higher risk of developing adverse health conditions.

Just days after the fires were contained, researchers tested a group of 20 firefighters who had come from Northern California to help battle the flames, and found dangerously elevated levels of lead and mercury in their blood. The results are part of a longer-term study tracking the health impacts of the January fires on people exposed to the toxic emissions. The team includes researchers from Harvard, UCLA, UC Davis, the University of Texas at Austin and the USC Keck School of Medicine.

“Firefighters and first responders put their lives on the line without a second thought to protect California communities from the devastating Southern California fires,” Padilla said in a statement. “When they sacrifice their lives or face severe disabilities due to service-related cancers, we have a shared duty to help get their families back on their feet.”

But although the Honoring Our Fallen Heroes Act has bipartisan support, it still faces a rough road politically, and those who have spent years dealing with similar government-run programs warn of major implementation issues should the measure become law.

The Senate Judiciary Committee passed a similar bill in 2024, but the measure didn’t advance to a vote on the floor. And with legislators pondering potentially massive federal budget cuts, its fate in Congress this year is far from clear. What is clear is that, for legislation tying benefits to service-related health conditions, the devil is in the details.

“Getting the piece of legislation passed is not as hard as guarding it,” said John Feal, who was injured at the 9/11 ground zero site while working as a demolition supervisor. He has since become a fierce advocate for first responders and military veterans.

“You will watch the legislation mature, as more and more people who need the assistance come forward,” Feal said. At that point, he added, the program’s capacity to grow — and to successfully process the applications of those who have come forward for help — may become a challenge.

That, Feal said, is what happened with the various government programs created after the 9/11 attacks to provide monetary compensation and healthcare to injured first responders, including some later diagnosed with cancer. Both the September 11th Victim Compensation Fund and the World Trade Center Health Program encountered substantial funding issues and were beset by logistical failures.

The structure of the Honoring Our Fallen Heroes Act, sponsored by Sen. Amy Klobuchar (D-Minn.), might allow it to sidestep some funding pitfalls. Rather than create a new benefit program, the bill would grant firefighters who have non-9/11 cancer-related conditions access to the long-standing Public Safety Officers’ Benefits Program, which provides monetary death, disability and education benefits to line-of-duty responders and surviving family members.

Death benefits in such programs are considered mandatory spending and are funded regardless of congressional budget decisions. Funding for disability and education benefits, however, depends on annual appropriations.

Even with full funding, the legislation could face implementation problems similar to those plaguing the 9/11 programs, including complex eligibility criteria, difficulty documenting that illnesses are service-related, and — more recently — long waits to enroll amid seesawing federal attempts at cutbacks.

Attorney Michael Barasch represented the late New York police detective James Zadroga, who developed pulmonary fibrosis from toxic exposure at the World Trade Center site and for whom the 9/11 Health and Compensation Act is named. Barasch, who still represents 9/11 victims and lobbies Congress for program improvements and funding, said the Honoring Our Fallen Heroes Act should streamline the process for first responders to document that their cancers are related to fighting wildfires.

“In my experience representing more than 40,000 members of the 9/11 community, any similar program should have a clear set of standards to determine eligibility,” Barasch told KFF Health News. “Needless complexity creates a serious risk that responders who should have been eligible might not have access to benefits.”

Feal added that lawmakers should be ready to bolster funding to adequately staff the Public Safety Officers’ Benefits Program if it adds to the conditions currently covered, noting that the 9/11 programs have swelled as more first responders have presented service-related conditions.

“There were 75,000 people in the program in 2015. There’s now close to 140,000,” Feal said. “There’s a backlog on enrollment into the WTC program because they’re understaffed, and there’s also a backlog on getting your illnesses certified so you can get compensated.”

As the Public Safety Officers’ Benefits Program is currently implemented, firefighters and other first responders are eligible for support for physical injuries they incur in the line of duty or for deaths from duty-related heart attacks, strokes, mental health conditions and 9/11-related illnesses. The bill would add provisions for those who die or become permanently disabled from other service-related cancers.

The Honoring Our Fallen Heroes Act was introduced in 2023 and reintroduced on Jan. 23 of this year, with Klobuchar referencing the California wildfires in her news release. The Congressional Budget Office estimated last year that the bill would cost about $250 million annually from 2024 to 2034; it has not weighed in since the measure was reintroduced.

“Cancer’s grip on the fire service is undeniable,” said Edward Kelly, president of the International Assn. of Fire Fighters. “When a firefighter dies from occupational cancer, we owe it to them to ensure their families get the line-of-duty death benefits they are owed.”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues.