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Appalachia's health care story

The Struggle for Coal Miners’ Health Care and Pension Benefits Continues



Coal miner Scottie Stinson, left, talks with foreman Scott Tiller outside a mine in Welch, W.Va., on May 12, 2016, as he prepares to enter a mine 40 inches high. Photo: David Goldman/AP Photo

Coal mining continues to be one of the most hazardous professions in our society. Even today, while the number of large-scale mining disasters and the number of deaths have certainly declined, coal miners continue to face a work environment that is inherently toxic and unhealthy. Coal miners who survive the mines walk away from their profession with significant health impairments and shorter life expectancies than most other Americans.

Yet for centuries, miners have braved dangers for the promise of better lives for their families. And since 1946 they have been supported by a compact between miners, owners and the federal government, that made health care and pensions an integral part of the profession in this country.

However, structural changes in the U.S. economy have strained, if not unraveled, this compact. And mine owners have consistently sought to shed their obligations towards miners and their families. Most recently, a judge allowed the bankrupt Westmoreland Coal Company to abandon its promise of paying for the health care of retired union workers as well as its union contracts. The company announced March 4, 2019 that a bankruptcy court has approved the sale of many of its assets to creditors and that business will “continue operating in the normal course.”

Except that it won’t for coal miners, of course, who will lose many of their benefits even as creditors at least get some of the company’s assets. And Westmoreland is hardly the only mining company eagerly reneging on its decades-old promises.

Coal miners have literally provided the fuel for the unprecedented industrialization of this country. Living in West Virginia and having written about the plight of coal workers’ health care as a public policy scholar, I believe the way forward involves the nation honoring its commitment to past and current miners. Yet, it also involves an honest acknowledgment that nation’s energy mix of the future will likely feature a diminished role for coal.

The changing fortunes of the coal industry

Coal miners about to descend into a mine in Maidsville, W.Va. in 1938. Photo: Everett Historical/

At the heart of the current situation is an agreement between the federal government and the United Coal Miners of America dating from 1946. Faced with a series of strikes across different industries after World War II, President Truman, in line with a long line of federal interventions in the coal industry, took control over the nation’s coal mines in order to keep them operating. The conflict was ultimately settled by the Krug-Lewis Agreement of 1946 which, among other things, established health care and pension funds for union miners.

For several decades, with a large number of union miners contributing, the health care and pension trust funds were sufficiently funded in general. However, over time both trust funds started to incur structural deficits for a variety of reasons.

For one, employment in the coal industry has been shrinking steadily over the past few decades, from more than 850,000 in the 1920s to just over 50,000 today. Employment reductions have been driven by efficiency gains, mechanization, a shift toward surface mining, and lower demand.

Moreover, of those miners remaining, a vast majority are not union members. As a result, there are only a few thousand union coal miners left to pay into these funds, while roughly 12 times as many are currently drawing health care and pension benefits.

The Great Recession aggravated the situation. Faced with mounting obligation and declining markets, some of the nation’s largest coal companies declared bankruptcy. This allowed them to shed their obligations to their former employees. The situation has shown few signs of abatement under the Trump administration.

As result, both health care and pension benefits are no longer financially sustainable, potentially affecting more than 100,000 retired miners and their families.

Was there or was there not a federal guarantee?

There is a debate about the nature of the original compact from 1946. The issue centers around the question whether the federal government made a permanent commitment to coal miners and their families. This is the position of coal miners and the United Mine Workers of America. Ultimately, this would entail the federal government serving as a payer of last resort should coal companies and unions be unable to sustain their financial commitment.

Others, like the conservative think tank The Heritage Foundation, have argued that the intervention by the federal government was merely temporary. Moreover, they argue that the UMWA has repeatedly violated the agreement and pushed for changes that accelerated the current funding crisis.

Unquestionably, the issue is complex. However, to my eye the evidence seems to favor the former interpretation, as the agreement was repeatedly reaffirmed by the federal government. This occurred most prominently through the legislation in 1996 and 2006.

As the Dole Commission, appointed under President Bush in 1989 to evaluate coal miners’ benefits, put it: “The UMWA Health and Retirement Funds is as much a creature of government as it is of collective bargaining … In a way, the original Krug-Lewis agreement predisposed, if not predetermined, the system that evolved.”

American Miners Act of 2019

The structural imbalances of the UMWA trust funds described above have inevitably led to a number of periodic crises in which pension and health care benefits for miners came under immediate threat of running out. So far, Congress has been able to patch together mostly temporary solutions without comprehensively addressing the problems in their entirety.

Earlier this year, Sen. Joe Manchin, a Democrat from West Virginia, introduced the American Miners Act of 2019 to shore up pension and health care benefits. The act as introduced also seeks to preserve the Black Lung Disability Trust Fund, providing medical and pension benefits to miners suffering from pneumoconiosis. This fund is also teetering on financial insolvency if scheduled cuts to the federal excise tax on coal are implemented.

If Congress fails to act, trust funds will ultimately run out of funds, with dire benefits for miners and their families. For one, miners would lose their small pensions, which currently only average US$560 per month. Miners would also need to seek alternative sources of health coverage, or go without. Government would then be on the hook for tens of millions of dollars for those miners qualifying for Medicaid, Medicare or ACA marketplace coverage. Equally crucial, the demise of the historically underfunded Black Lung Disability Trust Fund paying for pensions and medical expenses would be devastating.

Moving forward

Child coal worker Lewis Hine pictured in 1908. Photo: Everett Historical/

After the most recent midterm elections, a group of Democratic lawmakers in Washington, D.C., has begun to push energetically for a Green New Deal. While details remain unclear, it is based on a turn away from fossil fuel energy. Unquestionably, we should acknowledge the significant externalities inherent in coal mining and coal-based power production. These affect not only miners but their entire communities and society at large through water and air pollution as well as global climate change.

Given the vast negative effects of coal, it seems prudent to transition to healthier sources of energy production. Yet in this process, we should not forget about coal miners and their families who have brought us to where we are today. The bipartisan support for the American Miners Act of 2019 and similar bills in the past in the often-polarized U.S. Congress is indicative of this recognition. Republican leadership in Congress should end their opposition to a permanent fix.

I believe that any program moving the nation toward greener energy sources must include a lasting solution for coal miners, their families and their communities. This includes both guaranteeing long-term funding for pension, health care and medical programs as well as transitional programs to help them adapt to an economy with a smaller role for coal mining.

Simon F. Haeder, Assistant Professor of Political Science, West Virginia University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Appalachia's health care story

Drug Company Gilead Gives $11M To Halt Hep C Rise In Ohio Valley



This July 9, 2015, file photo shows the headquarters of Gilead Sciences in Foster City, Calif. Photo: AP/ Eric Risberg, File

This article was originally published by Ohio Valley ReSource.

Drug maker Gilead Sciences will give $11.3 million to help prevent and treat hepatitis C in Kentucky, Indiana, West Virginia, Tennessee and North Carolina. That money is part of a five-year project aimed at a region that’s been hit hard by the viral disease.

About 43,000 people in Kentucky have hepatitis C, according to recent estimates from Emory University.

A 2017 report showed Kentucky, Tennessee, West Virginia and Indiana are among seven states with rates of hepatitis C infections that are twice the national rate. Nationwide, the number of new hepatitis C cases increased by about 300 percent from 2010 to 2015, according to the Centers for Disease Control and Prevention.

That increase was mainly driven by the use of heroin and other injection drugs. And that increase in incidence also led to more deaths from diseases of the liver that develop because of hep C. About 300 Kentuckians died in 2016 from causes related to hep C.

The money from Gilead will go toward programs that give people who use drugs clean needles and syringes, hep C screenings, and treatment. It may also go to health education about hep C and reducing the stigma that patients might face in seeking care.

Harm Reduction

Gov. Matt Bevin spoke at the event Thursday announcing the funding. He addressed people who may object to providing clean needles, screening and treatment for those who contracted hepatitis C from drug use. 

Kentucky Gov. Matt Bevin at an event announcing the donation. Photo courtesy of Gilead Sciences

“For the crass, money-pinching people who only care about what it’s costing them and their tax dollars, think about this: the vast majority of people with hep C are on some sort of governmental assistance,” Bevin said, noting that the cumulative costs for medical services for patients with hep C that is left untreated can exceed $200,000.

“We think we can’t afford to deal with this, we can’t afford not to deal with it,” he said.

The national Harm Reduction Coalition and Gilead will hold meetings with stakeholders in states to better assess needs in specific communities. Harm Reduction Coalition Capacity Building Services Director Emma Roberts said her group will put out requests for proposals to get a chunk of the money in the fall, with awards expected to flow shortly after.

“We’re really going to let the needs dictate that specific funding piece and organizations will submit budgets,” Roberts said.

Roberts said an example of a project could be a syringe exchange that might expand services into HIV and hep C testing.

Emma Roberts of the National Harm Reduction Coalition. Photo courtesy of Gilead Sciences.

“If it’s a health department that’s already providing the testing services, how can they maybe integrate a syringe service program?” Roberts said. “Because this is new for a lot of people in this region, they’re still learning about the best practices and the ways to do this.”

In 2017 Kentucky’s Medicaid program eliminated a requirement that enrollees who needed hep C treatment must first be drug-free. Roberts with the Harm Reduction Coalition said that’s a pretty common requirement in other states. This, she said, just leads to greater spread by denying service to people in addiction.

Gilead brought the first hep C treatment, Sovaldi, to market in 2014. Even with Medicaid paying for treatment, the drug is expensive. Sovaldi cures most patients but at a steep price: $55,000 to $95,000 for the course of treatment that lasts about a year. Last fall the drug company announced it would sell a generic version that would cost $24,000.

Last year Gilead also donated $50 million in its hep C treatment to the University of Kentucky, which received a federal grant to decrease the rate of hep C in Perry County.

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Appalachia's health care story

Rural People With Disabilities are Still Struggling to Recover from the Recession



After the devastating losses of the Great Recession, the U.S. has enjoyed one of the longest expansions in its recorded history. For nearly 100 straight months, the U.S. economy has added jobs.

But not all groups have shared equally in the recovery. African-Americans and people in rural communities have been particularly slow to recover, compared to their white and urban peers.

Our team at the University of Montana’s Research and Training Center on Disability in Rural Communities published a new analysis on Jan. 10. Our research shows that people with disabilities, particularly those in rural areas, have also experienced a longer, deeper recession and a much slower recovery.

In December, the U.S. Census released new American Community Survey data, aggregating data from the years 2013 to 2017, for public use. Comparing these new data with summary data from 2008 to 2012 gave us the opportunity to see how employment rates have changed over time for rural people with disabilities in the context of changing economic conditions. We considered people across disability type, including sensory, physical and mental disabilities.

For the U.S. as a whole, rates of employment increased across those two five-year study periods for people with and without disabilities. However, people without disabilities increased by 1.7 percentage points, while those with disabilities increased by just 0.8.

What’s more, people with disabilities are already much less employed than people without disabilities. We found that this difference is widening over time.

When it came to looking at rural and urban areas, the results from our analysis were bleak. We define rural and urban following the Office of Management and Budget’s metropolitan classification. Urban counties are defined as being part of a metropolitan area of 50,000 or more people. Rural counties are defined as micropolitan – where the largest town has 10,000 to 49,999 people – or non-core, if they only have towns of less than 10,000 people.

While urban counties reveal employment gains across the board, rural counties experienced significant declines in employment for people with disabilities. Between each five-year period in metropolitan counties, the most urban areas, employment for people with disabilities increased by 1.01 percentage points. However, rates decreased in rural counties.

Rates varied significantly for different parts of the country. While people without disabilities experienced positive rate changes across nearly all U.S. Census divisions, people with disabilities living in rural counties did not.

In fact, employment decreased for rural people with disabilities in over half of the U.S. divisions, with rates in the most rural counties dropping by more than 2 percentage points in the New England, West South Central, Mountain and Pacific divisions.

These results clearly indicate that people with disabilities in rural areas are being left behind. Rural people with disabilities already experience high poverty rates, less access to health care and specialty services, and other barriers that prevent them from participating in their communities. Depressed employment rates can have dire consequences for this group.

The Conversation

These lower rates lead to less access to health insurance, retirement benefits and other financial resources, which all threaten to further marginalize people with disabilities in rural communities.

Lillie Greiman, Project Director, RTC: Rural, The University of Montana; Andrew Myers, Project Director, RTC: Rural, The University of Montana; Bryce Ward, Research Associate, The University of Montana, and Catherine Ipsen, Principal Investigator, RTC:Rural, The University of Montana

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Appalachia's health care story

Amid Black Lung Surge, Kentucky Changes Benefits Process for Miners



William McCool is a 64-year-old former coal miner from Letcher County, Kentucky, with an advanced form of black lung disease. Health experts say the condition is entirely preventable with dust control measures in mines. But today, more miners in Appalachia are being diagnosed with severe black lung than ever before.

“I’ve worked all my life, I’ve seen a lot of coal go down the beltline,” McCool said, pausing to catch his breath between phrases. “Somebody’s made money, but the cheapest thing the company’s got is the worker. Everything else costs them all kinds of money but they can get workers.”

Black lung is a disabling condition caused by the work environment, so miners like McCool are eligible for benefits. The state and federal government both have systems that allow miners to make a claim against their employer for medical expenses and a small stipend. Getting approved can be a long process.

Mackie Branham views a lung X-ray with Dr. James Brandon Crum, who was among the first physicians to note an uptick in black lung diagnoses.
Photo credit Howard Berkes/NPR

“State black lung compensation took about 2 years, then probably 5 or 6 years I got my federal black lung,” he said.

Some miners have waited over a decade for a decision on federal black lung benefits. Many die before they receive them. State benefits have traditionally been quicker. But black lung attorney Evan Smith at the Appalachian Citizens’ Law Center said that’s been changing.

“The idea was that these federal laws were going to be a national baseline, then many states would grant additional protections to treat their workers better than was the minimum required,” Smith said. “What’s ended up happening, especially in recent years, is states have ended up having a race to the bottom.”

Amid a historic surge in black lung cases in Appalachia, the Kentucky legislature this week approved sweeping changes to the state’s workers’ compensation programs, including changes to the process miners must use to qualify for black lung benefits. Miners and advocates warn the changes may shift the balance in favor of coal companies, and make it harder for those with black lung to get benefits.

Ruling Out Radiologists

Phillip Wheeler is an attorney in Pikeville, Kentucky, who represents clients seeking state black lung benefits. Wheeler has been very critical of Kentucky’s workers’ compensation reform bill, known as House Bill 2.

“On its face the amendments in relation to black lung law may seem very benign,” Wheeler said. “But they have a very nefarious purpose.”

Wheeler and other critics say the bill will make it harder for sick miners to get state benefits by restricting the pool of doctors who can determine a miner’s eligibility for state benefits and tilt the process in favor of coal companies.

“I do believe the coal industry is writing this bill to exclude certain doctors that they don’t like,” Wheeler explained. “Essentially it’ll be limited to approximately five doctors in Kentucky.”

Among those excluded is radiologist James Brandon Crum. He’s the doctor who first alerted federal researchers to the spike in cases of severe black lung, which has since been confirmed as the largest cluster of the disease ever documented.

Clinicians who are certified to read chest X-rays for work-related diseases like black lung are known as B-readers. Among B-readers, radiologists like Crum are generally considered to be the most qualified doctors, since the entirety of their training centers on reading X-rays and other diagnostic images. Yet the Kentucky legislation would bar radiologists from providing diagnoses for state benefits claims. Instead, the legislation requires that B-readers also be certified pulmonologists in order to diagnose patients for the state black lung benefits system.

Crum said the move to push radiologists out of the process caught him by surprise.

“Throughout the United States I know of nowhere where radiologists are taken completely out of the evaluation for potential black lung disease,” he said. “That’s what we’re primarily trained in.”

Dr. Kathleen DePonte was also surprised. DePonte is a board-certified diagnostic radiologist and B reader in Norton, Virginia, with more than 20 years of experience in practice.

“It strikes me as odd that radiologists are excluded in part of the process,” she said. “It is curious to me that the legislators feel that the pulmonologist is more qualified to interpret a chest radiograph than a radiologist is. This is very much what radiologists do.”

William McCool said he thinks the change in eligible doctors would have made his claims process much more difficult.

“It’d be pretty much impossible,” McCool said. “I’ve had lung doctors tell me I don’t have black lung.”

Debate in Frankfort

In debate on the bill, Letcher County Democratic Representative Angie Hatton warned the measure could hurt miners.

“When we’re finding increased amounts of this illness it seems to me that this is when they need us the most,” Hatton said. “Why are we making it tougher for them to prove their illness?”

Adam Koenig is a Republican from Kenton County, and the bill’s lead sponsor. He defended the changes as necessary to fix constitutional issues with the state’s existing system stemming from a 2011 state supreme court decision in a case known as Vision Mining. The court ruled the state system at that time was unconstitutional because miners faced tougher requirements than did people who contracted pneumoconiosis apart from mining.

“No one here is trying to deny anyone who does that work from getting their black lung claims,” Koenig said, “But the fact of the matter is the way we’re doing it now is not constitutional, so we’re trying to fix it.”

Phillip Wheeler, the black lung attorney, said he believes that the newly passed bill is itself unconstitutional. He plans to contest the legislation.

“If it’s anything like we expect it will operate, then you betcha we’re gonna file some challenges,” he said.

The bill awaits Governor Matt Bevin’s signature. Its provisions include a period of up to 6 months for implementation. Miners who file for benefits before then may still be able to use the current system.

This article was originally published on Ohio Valley Resource.

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