Fourteen years and two months have passed since the World Trade Center collapsed into a cloud of toxic dust, and that long passage of time has altered American politics in countless ways. The public, for example, is much more leery about going to war in the Middle East than it was in those initial months of anxiety and anger, or about giving up its privacy rights in the name of national security. And on Capitol Hill, finding a few billion dollars to care for the thousands of people who were poisoned by carcinogens at Ground Zero has become a much tougher sell.

In late 2010, Congress set up the World Trade Center Health Program to monitor and treat first responders and survivors suffering from respiratory and other illnesses—cancer, in many cases—as a result of their exposure to toxins in the weeks and months after September 11. With little notice outside of New York, the federal authorization for the program expired six weeks ago, and lawmakers are now rushing to renew it before patients begin losing access to their doctors and treatment centers.

“If this program is not reauthorized and adequately funded, people are going to die,” warned Representative Carolyn Maloney, a New York Democrat who authored the legislation creating the program. The treatment centers in New York and New Jersey can continue operating until the program spends its remaining money, which administrators believe will last well into 2016. But if the law is not renewed soon, patients will begin receiving letters informing them that they may have to seek treatment elsewhere. That in itself is a serious concern for advocates, since many of those in the program suffer from PTSD in addition to advanced cancer.  

There are more than 72,000 people enrolled in the program and 33,000 in treatment, including nearly 8,500 being monitored or treated outside the New York metropolitan area. More than 200 police officers and firefighters who worked at Ground Zero have died from 9/11-related illnesses, officials say. That tally now includes Marci Simms, an NYPD lieutenant who died last week from lung cancer that had been treated under the federal health program. She was 51 and had toiled at Ground Zero for four months during her first year as a cop.

The original law is named for James Zadroga, an NYPD officer who in 2006 became the first to die of respiratory disease linked to Ground Zero toxins. And it was hard enough for the New York delegation to get it through Congress in 2010. It took years of medical studies to establish a link between the respiratory illnesses that first responders were reporting and the weeks that they spent digging through the rubble of the Twin Towers. And only after an extended public shaming by Jon Stewart on “The Daily Show” did Democratic leaders push through the Zadroga Act over opposition from Republicans who worried about its cost. Five years later and with Republicans now in control of Congress, the push to extend and make it permanent is that much heavier a lift. “Let’s face it: The overwhelming majority of Republicans voted against it the first time,” said Representative Peter King, a Republican from the New York suburbs in Long Island.

With the raw emotions and the brief period of post-9/11 national unity having long since faded, King and his colleagues have had to fight the perception that the World Trade Center Health Program is a parochial concern. They cite the thousands of patients who live outside the Northeast, and the fact that the program is open to survivors of the simultaneous attack at the Pentagon and the crash of Flight 93 in Pennsylvania.

But the Congress of 2015 is not the Congress that locked arms and sang “God Bless America” on the Capitol steps in 2001—more than three-quarters of those serving in the House and Senate now were not in office on 9/11. “Much of that is diminished,” King said. “It’s like ancient history, like the Battle of the Bulge or Pearl Harbor.” He told me it’s not uncommon for him to run into first responders he had met years ago who are now carrying around oxygen tanks. Maloney told me something similar, recalling that she had kept in touch with survivors who were fine for years after the attacks. “Now they’re telling me they’re sick, they have six months to live,” she said. When Stewart returned to Capitol Hill to lobby for the legislation in mid-September, he told reporters that what most disturbed him was how many lawmakers treated the issue like “just another bill.

While senior Republicans in the House have proposed a five-year extension for the program, supporters are pushing to make it permanent for two main reasons. The first is simply that officials expect survivors to develop illnesses related to 9/11 for many more years. The second is that they are dreading the possibility that they will have to bring sick first responders back down to Washington in another five years to lobby for more funds, at a time when the political potency of 9/11 will have diminished even further.

If the legislation written by Maloney and King in the House were brought to a vote, it would pass. Nearly 250 lawmakers—nearly all Democrats plus dozens of Republicans—have signed on. The same is true in the Senate, where Kirsten Gillibrand of New York has secured support from a filibuster-proof 65 senators for an identical bill. Stewart’s appearance helped gather support, if not action. Yet supporters of a permanent extension are increasingly worried that the Republican leadership will side with committee chairmen who are backing much slimmer renewals of the program. A permanent extension would cost between $8 billion and $11 billion over the next decade, according to projections from the Congressional Budget Office. But a proposal from Bob Goodlatte, a Virginia Republican and chairman of the House Judiciary Committee, would extend the 9/11 health program for just five years and keep funding at its current level of about $2.77 billion. The bill also provides compensation to victims of the 1983 terrorist attacks against the U.S. embassy and Marine barracks in Beirut. “The bill is gravely inadequate,” Gillibrand said in a phone interview. “It’s cynical, and it’s simplistic.”

The committee said Goodlatte’s approach “balances the needs of the victims with the money available to Congress.” But advocates say it was introduced without consultation and only after it became clear that the permanent extension had gained enough support to pass. “There is a concern this was done to slow down our effort,” said Ben Chevat, the executive director of a group called Citizens for the Extension of the James Zadroga Act. Another proposal circulating from the House Energy and Commerce Committee would provide more funding but offset it with a cut to Medicare benefits that Democrats consider “an absolute nonstarter,” Maloney said.

AshLee Strong, a spokeswoman for Paul Ryan, said the new House speaker supports the program but would not commit to a particular proposal. “The program will be reauthorized and the committee is taking the lead,” she said in an email. The best hope for advocates is that renewal of the 9/11 law is attached to one of two bigger pieces of legislation that Congress must pass in the next several weeks—either the long-term highway bill or an omnibus spending package that funds the government through next September. “I’d say it has to be done by the end of the year,” King said.

The supporters of the 9/11 health program might be more willing to negotiate the dollars than the duration of the extension. Unlike other disaster recovery programs, this one has thus far been run efficiently, without widespread reports of fraud or abuse. And there is less risk of making it permanent because the population of potential claimants is limited. But advocates do not want to have come begging again in another five years, when the next renewal will be harder still. In the politics of tragedy, the enemy is almost always time.