House Democrats teed up final passage of the biggest expansion of veterans benefits in decades, after turning back a GOP effort to dramatically narrow the measure to mirror a Senate-passed bill Republicans said could hit President Joe Biden’s desk as soon as this week.

The underlying bill, from House Veterans’ Affairs Chairman Mark Takano, D-Calif., expected to pass Thursday, would overhaul the VA’s creaky process for granting disability compensation and health care services for veterans exposed to toxic substances during their tours of duty.

But despite heavy lobbying and emotional pleas from veterans advocates, it’s not clear whether the 50-50 Senate will take up the measure anytime soon.

The House bill seeks to end the decadeslong debate over whether it can be assumed that a veteran got sick as a result of military service, be it through exposure to Agent Orange in Vietnam, oil well fires in the Gulf War, open air burn pits in Afghanistan or other instances.

Instead of the cumbersome VA system of determining which illnesses are presumed to be connected to military service and lengthy reviews of individual veterans’ status, the bill would codify a host of respiratory diseases and cancers as service-connected and remove the burden of proof from veterans filing claims.

For instance, it would create a presumption of service connection for about 490,000 Agent Orange-exposed Vietnam veterans suffering from hypertension and a condition known as Monoclonal gammopathy of undetermined significance, which in some cases progresses to diseases like blood cancer.

And veterans who served in certain locations during defined periods would gain eligibility for hospital care, medical services and nursing home care over a phase-in period depending on when they served.

Biden gave the measure a boost during his State of the Union address on the eve of House debate, something veterans groups said was the result of a number of conversations with White House staff. But it was already top of mind for Biden, whose son Beau, an Iraq War veteran, died of brain cancer; the president suggested Beau’s condition possibly arose from burn pit exposure.

“You know the most expensive real estate in Washington, D.C.? It’s like one inch in the State of the Union address, to just get that piece in there,” Speaker Nancy Pelosi said at a Wednesday press conference outside the Capitol to promote the bill. “And the president spent so much time on this.”

The sweeping House bill is pretty expensive, too: Direct benefit payments for disability compensation would increase by $208 billion over a decade, the Congressional Budget Office found. And the provision of new health care benefits, which is financed through the annual appropriations process, plus VA administrative costs could require another $114 billion.

The uncertainty associated with costs appropriators might ultimately need to bear led Takano to add an open-ended commitment in a managers’ amendment to, starting in fiscal 2023, create a new mandatory “Veterans Toxic Exposures Fund” that wouldn’t come from annual appropriations.

Instead the Treasury would pay “such sums as may be necessary” to finance “any expenses incident to the delivery of veterans’ health care and benefits associated with exposure to environmental hazards in service, including administrative expenses, such as claims processing and appeals, and for medical research related to hazardous exposures.”

‘Too goddamn expensive’

House Republicans criticized the bill during initial debate Wednesday as more costly than nine Cabinet departments combined. Democrats ripped such concerns, arguing Republicans had no trouble deficit-spending on the wars that sent servicemembers into harm’s way to begin with.

“Why don’t you just tell them it’s too goddamn expensive?” Rep. Joaquin Castro, D-Texas, said during floor debate.

But Democrats’ decision to lob the partisan package over to the evenly divided Senate is a risky one that could potentially backfire on vulnerable lawmakers who were front and center during the House debate, such as “Frontline” program members Elaine Luria of Virginia, Chris Pappas of New Hampshire and Matt Cartwright of Pennsylvania.

The Senate has already passed, by voice vote, a smaller piece of the House package, a measure that would extend eligibility for health care services from five to 10 years after discharge for veterans who served after Sept. 11, 2001. All but four House Republicans voted for that measure as an amendment to the larger House Democratic bill on Wednesday; the amendment was rejected, 203-223.

Republicans said it was a relatively inexpensive — $1 billion over a decade — way to deliver aid to veterans that could be signed into law immediately, in what could be billed as a bipartisan win.

But Democrats said it would only help about 16,000 out of 3.5 million potentially eligible Iraq and Afghanistan veterans who served in proximity to burn pits, and was missing the key piece: clearly establishing that presumption of service connection so veterans wouldn’t need to fight for benefits.

“It’s not a secret: Carcinogens cause cancer,” Rep. Raul Ruiz, D-Calif., a physician, said during debate.

Speaking earlier in the day at the press conference with Pelosi, Ruiz and several veterans groups, comedian and advocate Jon Stewart called on lawmakers to reject the GOP-backed Senate alternative. “F— that. Not happening,” Stewart said.

“Make no mistake: We are at Congress. This is a place where what is necessary becomes what they can get away with,” Stewart said. “And we can’t allow that to happen in this final moment of their fight.”

John Feal, a retired construction worker and advocate who was injured during the rescue efforts at ground zero after 9/11, said Biden’s speech was “just words; it’s up to us to act on those words, and we have a lot more work to do.”

He urged Pelosi to set up a meeting for him, Stewart and Takano with Senate Majority Leader Charles E. Schumer, D-N.Y., to “let Chuck know that we want a bill compatible” to the House measure. “If he does not do that, then I will make his life miserable,” Feal said.

Stewart and Feal, who have long urged Congress to help 9/11 rescue workers, have also taken up the veterans’ cause.

‘Sort the men from the boys’

Senate Veterans’ Affairs Chairman Jon Tester, D-Mont., agreed to split his bill out of a broader package that’s similar to the comprehensive House legislation, given a lack of bipartisan support. He told the Billings Gazette last month that finding the votes to fund the expansive new program will “sort the men from the boys pretty quick because this is the one that delivers VA benefits.”

Rep. Mariannette Miller-Meeks, R-Iowa, a freshman who won by 6 votes in a heavily contested 2020 race, led the floor debate for her side of the aisle in pushing to pass the slimmer Tester bill as an alternative. Miller-Meeks said there was a bipartisan commitment to work out a viable program to extend benefits to toxic-exposed veterans, but that the current House bill would create such a huge backlog at the VA that claims wouldn’t be processed for many newly eligible veterans.

The Democrats’ bill is “unworkable” and will “stall without a clear path forward in the Senate,” Miller-Meeks said.

But for veterans groups that lined up to back Takano’s bill, they’ve already been fighting an uphill climb for decades and don’t intend to stop now. Veterans of Foreign Wars’ Fritz Mihelcic called the more comprehensive measure the VFW’s “top legislative priority” at Wednesday’s press conference.

“We servicemembers wrote a blank check to our nation,” added Jen Burch of Iraq and Afghanistan Veterans of America, who got sick from burn pit exposure during a tour in Afghanistan. “We are not asking the same in return — only what is owed to us.”