The U.S. House of Representatives will vote next week on landmark legislation that would expedite health care and disability payments to millions of veterans exposed to burn pits and other military environmental exposures.

The $282 billion Honoring Our Promise to Address Comprehensive Toxics, or PACT, Act would designate 23 illnesses as likely linked to battlefield pollutants, paving the way for veterans diagnosed with these diseases to receive Department of Veterans Affairs benefits.

If it became law, the bill would be the most comprehensive legislation to address combat environmental exposures since the Agent Orange Act of 1991, which declared that defoliants used during the Vietnam War likely caused at least a dozen types of illnesses in veterans.

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Currently, the VA decides post-9/11 exposure claims on a case-by-case basis, with the exception of those filed for asthma, rhinitis or sinusitis. Affected veterans must prove a connection between their illnesses and their military service, either demonstrating exposure or bringing in experts to support their claims.

Kate Hendricks Thomas, a Marine Corps veteran diagnosed at age 38 with stage 4 breast cancer, had her claim approved after many years of fighting, but not before she spent thousands to treat the cancer she said has spread from “her skull to her toes.”

“I was exposed to burn pits in Baghdad, in Fallujah, all over the country,” Thomas said on a Tuesday call in which several lawmakers and veterans spoke with reporters. “I remember seeing [them] as I was out running. We would clean our air conditioning units, and there would be black particulate matter in the filter. I knew that I was exposed to that, but I didn’t really understand it.”

House Veterans Affairs Committee Chairman Mark Takano, D-Calif., expressed confidence that the PACT bill would pass the House with bipartisan support.

Takano, the bill’s sponsor, said the legislation would fulfill a promise made to U.S. service members when they deployed.

“For too long, America’s message to toxic-exposed service members and veterans has been simple: We thank you for your service, but the price tag for addressing your exposure is just too high,” Takano said.

He described a $1 billion bill passed in the Senate last week that would expand health benefits to nearly 1 million more post-9/11 deployed veterans as a “legislative half measure that narrows benefits for some veterans and excludes others altogether.”

That bill, sponsored by Sen. Jon Tester, D-Mont., and Sen. Jerry Moran, R-Kan., would give all post-9/11 combat veterans up to 10 years to enroll in VA health care after they transitioned from military service and create a one-year enrollment period for those not already receiving VA health care.

It does not include a list of diseases that would automatically qualify veterans for expedited benefits or award compensation to survivors of veterans who have died from those illnesses.

Tester and Moran have pledged, however, that their proposal, considered more palatable to fiscal conservatives than Takano’s bill or a different $233 billion proposal from Tester known as the Comprehensive and Overdue Support for Troops, or COST of War, Act, would be the first of three burn pit-related bills that eventually would designate diseases as linked to deployment exposures.

The Senate’s proposed phased approach has infuriated advocacy groups and activists, including Burn Pits 360 and comedian-turned-advocate Jon Stewart.

“The reality is the PACT Act and [Tester’s original COST of War bill] are the acts that actually deal with toxic exposure,” Stewart said during the call. “The bastards are sneaky. They are going to try and sneak around and go, ‘Hey man, for a billion dollars, you can get away with this and maybe everybody will leave us alone.'”

Afghanistan veteran Jen Burch said that, after she arrived home from deployment, she went straight to the hospital, where she was diagnosed with chronic bronchitis and pneumonia.

Her health problems — and the lack of support she received — deteriorated to a point in 2013 when she attempted suicide, she said.

“You have a veteran who has medical problems from toxic exposures getting denied benefits in health care from the VA, and they might not be able to work because of their medical problems,” Burch said. “Now they’re financially hurting, they can’t get the health care, they can’t support their family. … The next thing you know, they’re another statistic because they took their life because they couldn’t handle it.”

Since 2007, with some modifications and exceptions, bills in the House are required to include a way to cover their cost so they have little to no impact on the federal deficit or a surplus when one exists.

The PACT act, which would cost $85 billion in the first five years after passing and $282 billion over 10 years, doesn’t currently include a way to cover its cost.

Takano said, however, that he has been talking with legislators who hold the congressional purse strings and would request a waiver to the rules if a solution isn’t found.

“I think the American people would go along with the idea that we have a debt we need to reckon with our veterans,” he said.

The Senate bill and Takano’s proposal both have broad support from veterans service organizations, including the Military Officers Association of America, the American Legion, Veterans of Foreign Wars, Disabled American Veterans, Wounded Warrior Project, and Iraq and Afghanistan Veterans of America.

Takano expressed hope that his bill would receive a strong vote in the House, paving the way for the Senate to consider it in lieu of Tester and Moran’s phased plan.

“I can’t emphasize enough about the importance of these presumptions,” Takano said. “Agreeing to a strong list of presumptions is at the heart of removing the burden of proof from the veterans to the benefit of the doubt being extended to them.”

— Patricia Kime can be reached at [email protected]. Follow her on twitter @patriciakime

Related: Law Aimed at Helping Millions Exposed to Burn Pits and Toxins Would Cost at Least $282 Billion

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