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gain and again, President-elect Donald Trump presented himself as the coal miners’ candidate. During the campaign, he promised to bring coal back into the economy, and jobs back into struggling Appalachian towns.

But now some in coal country are worried that instead of helping, Trump’s first actions will deprive miners — and their widows and children — of the compensation they can receive if they are disabled by respiratory problems linked to breathing coal mine dust.

That’s because buried in the Affordable Care Act are three sentences that made it much easier to access these benefits. If Trump repeals Obamacare — as he vowed to do before the election — and does not keep that section on the books, the miners will be back to where they were in 2009, when it was exceedingly difficult to be awarded compensation for “black lung” disease.

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“You couldn’t ever win back then,” said Sue Toler, a coal miner’s widow in Huntsville, Tenn., of claims for black lung benefits. “It didn’t matter what kind of evidence you had.”

Of the 27 years her husband Arvis worked for Eastern Associated Coal in Kopperston, W.Va., 16 of them were spent underground. When he had to stop working because of breathing trouble, a doctor ordered chest X-rays and saw the telltale dark scars on his lungs. His doctor’s diagnosis, his widow said, was coal workers’ pneumoconiosis — or black lung.

That was in 1993. Five years later, after two appeals and innumerable examinations with doctors chosen by the coal company, Toler was denied benefits, in part because he’d smoked cigarettes before his diagnosis.

At the time, to qualify for benefits, miners had to prove not only that they were disabled because of breathing problems, and that they had coal workers’ black lung, but that their disability was caused by their years in the mine.

It was “almost impossible,” said Phil Smith, a spokesman for the United Mine Workers of America. “The vast majority of people were denied benefits. People would take these cases through the black lung court system and they would be denied because the companies could sow the shadow of a seed of a doubt.”

The Affordable Care Act changed that. Under “Miscellaneous Provisions” is a small section sponsored by a self-proclaimed “child of the Appalachian coalfields,” the late West Virginia Democratic Senator Robert Byrd.

The Byrd Amendments shifted the burden of proof from the miners onto the mining companies. If a miner has spent 15 years or more underground and can prove respiratory disability, then it is presumed to be black lung related to mine work, unless the company can prove otherwise.

“Often the person whose job it is to do the convincing loses,” said Evan Smith, a lawyer for the nonprofit Appalachian Citizens’ Law Center, who represents many miners affected by black lung. That change had a significant impact: In 2009, 19 percent of claims for black lung benefits were successful; in 2015, that percentage had jumped to 28.

The Byrd Amendments also had a huge effect on the families relying on that compensation. Before their enactment, when a miner died, his widow would keep getting compensation only if she could prove that her husband died because of black lung — a process that often took years, if it was successful.

Now, with a bit of paperwork, she keeps getting a portion of the money the family got when her husband was alive. The amount changes according to the number of family members dependent on the coal miner or widow. At the top end, a beneficiary with three or more dependents gets $1,289 a month, while a single beneficiary gets $644.50.

These changes in the Affordable Care Act not only meant that Arvis Toler ended up being awarded benefits shortly before he died in 2015, but also that his 70-year-old widow, Sue, has continued to receive compensation every month.

The coal industry opposes these rules. “Our concern back then, which continues today is that … compensation is not based on occupational disease, but rather this is becoming a supplemental pension program, and that was not what it was ever intended to be,” said Bruce Watzman, vice president of the National Mining Association.

But, he said, industry representatives have other priorities than undoing Byrd’s changes, such as reversing what he called “Obama’s war on coal.”

Even so, many coal miners and their advocates are concerned that their fates are tied to a piece of legislation that has, in a certain sense, just lost an election, especially in coal-producing states such as Kentucky and West Virginia. Lawyers working on this issue are worried that repeal of the ACA could mean no compensation for new claimants and the potential loss of benefits for anyone who won them since the law passed.

The Trump transition team did not respond to STAT’s request for comment. Since the election, though, Trump has softened his rhetoric about completely doing away with Obamacare, and miners have advocates in the House and the Senate. “Repealing and replacing Obamacare will be a top priority for the new Congress, but Congressman Rogers has advocated for a piecemeal approach … many Members of Congress have acknowledged that some portions of the law are worthy of continuation, such as critical protections for coal miners,” said a spokesperson for US Representative Hal Rogers, a Kentucky Republican who chairs the powerful House Appropriations Committee.

The offices of Democratic Senators Joe Manchin of West Virginia and Bob Casey of Pennsylvania said they would fight any attempt to remove these protections from coal miners. A spokesperson for Kentucky Republican and Senate Majority Leader Mitch McConnell said by email that the senator has no “announcements on any legislative action for next Congress.”

Evan Smith, the attorney, warned against complacency. “I want to make sure that coal country doesn’t assume that they are going to be taken care of just because a lot of our political leaders have voiced support for our region,” he said. “I wish I could be more optimistic that they truly would keep their promise.”

Dr. Cecile Rose, director of the Miners Clinic of Colorado and a professor at National Jewish Health in Denver, noted that black lung benefits can be especially vital for the many former miners who don’t have pensions. “Retired miners, a lot of them have also lost their pensions because of the bankruptcies that many of the coal mines have declared,” she said. “They may be hanging on by a thread.”

The uncertainty about these benefits is even more worrisome to her because of evidence showing an increase in both the prevalence and severity of black lung cases.

Sue Toler takes issue with Trump’s way of talking, and she isn’t sure about his plan to get miners back to work. “I’ve got mixed feelings about that … I watched my husband suffer,” she said. “But if it’s good for the country, then I’m all for it.”

To her, though, it would be sad if black lung benefits like her husband’s got taken away after the 22 years of suffering that preceded his death.

“He couldn’t breathe, and that just kept getting worse. He just died a little bit every day, and there was nothing you could do about it,” she said. “Words can’t describe what somebody goes through when they are dealing with black lung.”

Her brother-in-law is “dealing with that now,” she added. “I’ve seen him walk through the house when it looked like he was going to draw his last breath, and I had held my own breath until he was able to set down.”

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  • What the head doesn’t regulate..the body suffers through. Those miners were conned into believing that Obama Care was bad for them. Now reality will be staring them right in the face.

  • Elections have consequences. You were not lied to. You voted for Trump with your eyes wide open and gave his party total control. This means certain death to ACA and “vouchers” for Medicare. Good luck.

  • Coal will never come back in respect to the good old days. Mountaintop removal is the practice now and it devastates communities permanently without employing locals.

  • The main benefit that all are missing in coal country is education. I pray they don’t lose their benefits with the ACA. I hope that they don’t lose their social security benefits also. Trump and the republican party have no heart. Money has to be taken out of politics because both parties are serving the corporations exclusively.

  • There, there…..Just shut up and drink the kool-aid…. all will be well…..sweet, sweet slumber…..said the Republicons….

    • Not nice. Understand your sentiment, but perhaps they will recognize the irony in time. They only know two things: what they experience and what they’ve been told. Wait until they realize that they lose the Black Lung benefit AND their jobs aren’t coming back – should take about 3 years and the R’s will keep telling them to be patient.

    • Sorry Cldsml, too soon. As anyone with Trump voting friends knows, these people are exhausting with their casual racism and their resentments and their quarter-baked ideas of how government should be run. It takes a great deal of patience to spend time with them and avoid challenging their world view in any way because it’s just not worth the conflict. Election night was the breaking point for me. The thing is, they’re not going to understand the irony, ever. When the policies of Trump and an unfettered Republican congress erode their quality of life, they’ll just double down on blaming liberals and furriners and gays and gubmint for it all.

  • Call me petty; I sincerely hope they *do* lose their benefits.

    A study was done last year that showed that while people hated “Obamacare”, they loved the provisions that directly applied to them and liked the idea of many of the provisions that didn’t.

    They just hated “Obamacare”.

    And this is why this particular East Coaster is sick unto death of hearing about the “forgotten people” of the flyover states. Maybe, just maybe, they’re forgotten because they’re forgettable, and maybe they’re forgettable because of the unwise choices they themselves have made and continue to make even in the face over overwhelming facts.

    • The Republicans were very smart to call it “Obamacare”. After all, calling it “Hillarycare” worked so well for them in 1994. I honestly can’t believe no one else saw it coming.

    • Jim in nyc
      I am from Eastern KY the heart of coal country. My father suffers everyday from black lung. Xray after Xray proves he has stage 3 black lung. He has fought for over 15 years to get benefits, after working over 20 years in the mines. He finally got his benefits 2 months (filled again in July of 2015) due to the provisions in the ACA. My mother and father both depend on medicare. And you guessed it proud Trump voters and supporters. I know wtf right. The county i live in went Trump 80% average for most counties. That being said I agree with you 100%. Maybe if they have to reap what they sow, have everything taken away, they will “get it”. This is why I no longer teach here just think about it lol. I am finished helping and feeling sorry for people, they wanted change right?

    • I agree with your sentiments. However, not everyone in these red “flyover states” are Regugnicans. There are even liberal, progressive, gay, socialist, pro-Bernie/Hillary voters (like myself) here. The county I live in here in SW MO voted 72% for Trump. That means that there are still 28% of us here who voted for Hillary. Certainly not enough to win an election, but still it’s not like it’s 100% pro-Trump in even the reddest of the red states.

  • Hard to sympathetic when they keep re-electing McConnell who keeps promising to do away with the ACA and when the state went for Trump. I hate that black lung has decimated their lives and taken their loved ones. But when the politicians tell you that they plan to do away with healthcare and privatize social security then why in the world would you vote for them.

    • I’m far more cynical about this. The republicans merely fought Obamacare because it generated votes from their racist voters. Now that they have control, they will fix this legislation so that it works and they will take credit for it. If it doesn’t work, they will still get to blame other people and look like they are trying to help the american people. If it does work – well, the republican voter will be smug at being so intelligent and never realize that they were played like the fools they were.

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