None of us can shake the images from Sept. 11, 2001, like the dense plume of debris rolling down New York streets and the terrified people running away before it.

And like the firefighters, police and other rescue personnel running straight into the debris cloud, and the horrors within it.No one denies that those people are heroes. No one wants to deny them coverage for the health problems they suffer as a result of their exposure to toxins that day and in the months that followed.But now, a dozen years later, Pennsylvania municipalities are facing a steep increase in workers' compensation rates, tied to the 9/11 response, that's putting a damper on their efforts to support volunteer firefighters. In Tamaqua, for example, the workers' compensation premium for volunteer firefighters increased 40 percent."Yes it went up substantially," said Kevin Steigerwalt, Tamaqua borough manager. "We're lucky our carrier is continuing to provide it, because many private insurance companies have dropped it entirely."Tamaqua's cost for workers compensation for the borough employees was $136,190 in 2013 and increases to $184,607 for 2014. Included in those numbers is the increase for the volunteer firefighters, which is going from $12,450 to $17,487.Why the hike?The reason is tied to the 9/11 response."Volunteer firefighters are covered for workers' compensation by the law -the firefighters are considered to be employees of the entity and the municipality must provide coverage," Al Martynuska, president, Pennsylvania Professional Firefighters, explained. "Injuries and illnesses related to firefighting are covered, and they are entitled to workers' compensation benefits following an injury."The premium increases began after July 2011, and the state's adoption of Act 46, called the Firefighters Cancer Presumption Law. Prior to Act 46, cancer was a "rebuttable presumption," meaning that whoever filed the claim must prove the illness is a result of exposure to toxins while responding to a fire. After Act 46, the burden of proof switched to the municipalities' insurance carriers, who must prove that the illness is NOT a result of exposure to toxins as a firefighter.Also, under Act 46, the "look back" period for cancer and other illnesses was extended from 300 to 600 months. That's because health studies of those 9/11 heroes began to show cancer rates higher than those found in the general population.The insurance carriers assert that during that 600 months, they were not collecting higher premiums and building a reserve fund for claims so they're raising them now.Coverage notaffordableElam Herr, assistant executive director of the PA Association of Township Supervisors, testified in December before members of the House Veterans Affairs and Emergency Preparedness Committee. Herr said that two things are happening. The insurance carriers are either no longer providing workers' compensation coverage for firefighters, or they're raising the rates to a degree that makes the coverage unaffordable, especially for small townships."We began to get feedback about this problem during the summer of 2012, that although coverage was still available from the private sector and from the State Workers Insurance Fund (SWIF), the costs had increased substantially," Herr said. SWIF is a source of workers compensation insurance for Pennsylvania businesses and employees. "The insurance carriers said that it was due not to increased claims, but to the doubling of the look-back period, because they (insurance companies) didn't have the reserve to address those claims."Herr said that when municipalities go to a new workers' compensation insurance carrier, most often the new carrier requires that all firefighters get a physical to establish a baseline of their current health. The carriers may also require that each firefighter receive protection against getting Hepatitus B, which requires a series of three shots. The cost for the three-shot series is typically $225 or more. But who picks up the tab?"Under Act 46, it does spell out that municipalities can require physicals, but it doesn't spell out who pays for that," Herr said. "There's a lot of fall-out from Act 46 in Pennsylvania, and it's really putting municipalities in an awkward position how can they afford to keep their volunteer fire departments?Most volunteerfire departmentsIn fact, there are more volunteer fire departments in Pennsylvania than any other state. According to the latest statistics available, in 2012 the top five volunteer fire department states are Pennsylvania (1,800), New York (1,610), Texas (1,435), Ohio (1,143) and Illinois (1,081).But as the cost for providing workers' compensation coverage for volunteer firefighters goes higher, municipalities may have to make some tough choices in the future."The townships just aren't going to be able to afford to support volunteer fire companies," said Barry Messerschmidt, chief, Hometown Fire Company. "Eventually, it's going to push out the volunteer fire companies."