![\"Gary](\"https:\/\/grist.org\/wp-content\/uploads\/2022\/06\/Gary-Hairston-testifying-at-Senate-panel-web-g.jpg\")
The federal Black Lung Program was enacted in 1969, and since 1977, the Black Lung Disability Trust Fund has provided benefits when liable companies can\u2019t be determined, or if a company goes bankrupt\u2014an increasingly common<\/a> occurrence in coal country. But in 2021, Congress failed to extend the excise tax on coal, which provides the fund\u2019s sole source of income\u2014jeopardizing the fund\u2019s long term viability, and the support it offers for thousands of former miners afflicted with black lung disease. <\/p>\n\n\n\n Since its inception, the fund has been in debt to the federal treasury because so many miners needed assistance. In the past 50 years, over 79,000 miners have died of black lung disease. Today, new cases are higher than half a century ago, with the illness afflicting one in five<\/a> miners in central Appalachia.<\/p>\n\n\n\n \u201cThe companies don’t want to pay, they’ve never wanted to pay,\u201d says Rebecca Shelton, the director of policy and organizing at the Appalachian Citizens\u2019 Law Center. The nonprofit provides free legal services to sick coal miners as they navigate what can be years-long battles to get benefits from former employers. Shelton adds, \u201cThe [companies] will fight tooth and nail to make an argument that they are not responsible for that miner’s disease.\u201d<\/p>\n\n\n\n Many miners work for multiple companies over the course of their career, complicating efforts to hold employers liable for workers\u2019 illnesses. Even in cases where an employer is held accountable, cases can take years and years, Shelton says. \u201cIt\u2019s a complicated process, and it can be very drawn out.\u201d<\/p>\n\n\n\n Without a clear clinical definition of black lung disease, miners\u2019 claims are often challenged. <\/p>\n\n\n\n The Department of Labor reviews medical documentation, but that isn\u2019t always a straightforward process. Miners have to prove that they have black lung disease by submitting X-rays and breathing test results that show they are actually disabled by the disease, and that it can be attributed to workplace exposure.<\/p>\n\n\n\n Hairston recounts that in his case, after submitting X-rays to the federal government, he got a call telling him to rush to the hospital because his lungs were so damaged. Yet simultaneously, a state reviewer said he wasn\u2019t sick enough to qualify for benefits in West Virginia. Even though he had a biopsy that confirmed his illness, Hairston says that when he went to see a doctor in Charleston, \u201cthe doctor told me, said \u2018Mr. Hairston, I know you got black lung, but it ain\u2019t up to me.\u2019\u201d<\/p>\n\n\n\n When a miner\u2019s benefit claim lands in court, \u201cit’s kind of one doctor’s interpretation and testing against another’s,\u201d Shelton says. In 2021, researchers at University of Illinois Chicago\u2019s Mining Education and Resource Center documented that the people reviewing miners\u2019 claims frequently had financial conflicts<\/a> of interest, including coal industry affiliations. <\/p>\n\n\n\n The industry\u2019s unwillingness to accept responsibility makes it critical to secure long term funding and enact new policies that shore up oversight. The problem is only getting worse as mine operators continue to shed liability onto the federal government. A 2020 Government Accountability Office<\/a> (GAO) report found that from 2014 through 2016, bankruptcies of self-insured companies heaped an estimated $865 million of responsibility onto the Black Lung Disability Trust Fund.<\/p>\n\n\n\n The fund\u2019s future faces an array of challenges, but ultimately, Chelsea Barnes, the legislative director of Appalachian Voices, says the path to making these crucial changes is fairly straightforward. \u201cCongress needs to act,\u201d she says. <\/p>\n\n\n\n In 2022, after several temporary extensions, Congress again failed to approve a long-term rate, costing the Black Lung Disability Trust Fund millions of dollars per week. The Build Back Better bill would have offered a four-year extension of the higher tax rate, but failed to move forward without the support of Senator Joe Manchin of West Virginia. \u201cWe used to go to Washington so they could see us,\u201d Hairston says, but the pandemic made that impossible, adding, \u201cWe can\u2019t even get [senators] on Zoom.\u201d In May, advocates started a \u201cWe\u2019re Counting on You, Joe\u201d campaign, placing digital and radio ads in West Virginia to encourage Manchin to take action.<\/p>\n\n\n\n Still, new proposed policy <\/em>called the <\/em>Black Lung Benefits Improvement Act<\/a> could help shore up protections for miners. The proposed House bill would create a legal framework to define black lung disease, help miners secure legal and medical representation, marginally increase benefits to reflect rising living expenses, and more closely regulate the bankruptcy process to prevent coal companies from shedding liability. But even if it passes, this legislation won\u2019t alleviate the many hurdles sick miners face. The coal industry is contracting, and the fund\u2019s revenue decreased by more than half<\/a> from 2015 to 2020. <\/p>\n\n\n\n Legislation simply hasn\u2019t kept pace with how the industry has changed. But a declining coal industry doesn\u2019t mean a \u201cdecline in the number of people who need black lung benefits,\u201d says Shelton. <\/p>\n\n\n\n![\"Large](\"https:\/\/grist.org\/wp-content\/uploads\/2022\/06\/July-BLA-Demonstration-g.jpg\")