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Ground zero workers still lack adequate healthcare, according to a recent report from the Government Accountability Office (GAO), an arm of Congress. The report, which criticizes the Department of Health and Human Services' WTC Federal Responder Screening Program as well as the Centers for Disease Control and Prevention's (CDC) National Institute for Occupational Safety and Health (NIOSH), indicates a particularly glaring lack of care for nonfederal workers who live outside of New York City.

According to the report, from August 2004 until June 2005, no services were available for workers outside of the metropolitan area. After a temporary resumption, they were again suspended in January of 2007. In May, NIOSH began making some services available, and decided to pursue an independent contractor to take over the worker's care. However, NIOSH's agreement with QTC Management Inc. only covers screenings, not treatment.

For those workers in New York City, the report does not paint an encouraging picture. A large number of workers remain unscreened and untreated, and those who have registered for the program find services are often unavailable. In April 2006, for instance, the WTC Federal Responder Screening Program stopped scheduling specialty diagnostic services, and from January 2007 to March 2007 the program stopped offering screenings; the GAO's report attributes these disruptions to poor management, specifically a change in administration, as well as problematic interagency communication.

Inaccurate estimates of the cost of the programs have also led to failures. The GAO's newest estimate puts the annual cost of monitoring and treatment services for workers at between $428 million and $712 million, though the final figure could fluctuate depending on the number of participants. Earlier estimates had put the figure at $250 million (a figure the GAO had approved). The GAO's report indicates that because the programs' activities were so intermittent, even the best attempts at estimating the cost of the programs would run up against a lack of data.

The first appropriations for healthcare of ground zero workers were part of the $8.8 billion FEMA allocated for repair and recovery. President Bush's proposed 2008 budget includes $25 million for HHS to treat the workers.

The plight of the first responders has led to renewed calls for comprehensive legislation addressing all 9/11 health issues. To that end, Representative Jerrold Nadler (D-NY) has re-introduced two pieces of legislation: H.R. 1247, the 9/11 Comprehensive Health Benefits Act of 2007, and H.R. 1414, the 9/11 Heroes Health Improvement Act of 2007. Nadler's bills would extend Medicare coverage to ground zero workers as well as residents and students. President Bush is pushing a similar bill, though his version does not cover residents, students, or non-first responder workers.

The GAO report has also brought back familiar questions, including why the EPA certified the air was safe, and why, even when a certain danger was acknowledged, most workers did not wear protective masks. The EPA has attempted to answer critics by revealing that interference from the White House Council on Environmental Quality led it to remove cautionary wording from its statements. And other federal agencies have stated that Rudy Guiliani, then Mayor, placed such an emphasis on recovery that safety and health concerns were often ignored.