OAL CITY, W.Va. — The sandwich bag was stuffed with pill bottles, so full its sides bulged. Rickie Coalson took them out one by one: small shiny capsules for stomach problems, big granular ones for arthritis. Two different medications to keep his heart pumping, and two kinds of inhalers to help him breathe. Migraine pills and blood pressure pills, another lung medication, aspirin he needs to take daily.

Coalson, 59, is one of about 16,000 retired coal miners whose health care benefits will end in a few months if Congress does not replenish the funds that were supposed to keep these workers insured for the rest of their lives. He’s now wondering which of his medications — and doctor’s appointments — he’ll be able to live without.

“If my blood pressure’s not real high, maybe skip that, or if I can stand the arthritis pain, don’t take that for a while,” he said, kneeling on his living room floor surrounded by orange prescription vials. “You do what you have to do to survive. Coal miners are proud people, we won’t beg. But when they owe it to you, it’s not begging.”


These impossible choices are being considered all over coal country, and with them come a flood of resentment toward the coal companies, judges, and lawmakers that miners blame for their predicament. As coal companies have filed for bankruptcy, some have been allowed to stop paying into retired miners’ funds. Now, that money is running out.

Damon Tucker, a fellow retired miner visiting Coalson, his niece’s husband, is particularly angry at the judges who have made these rulings. “Sits on a bench, never been underground crawling in mud, water, slop,” he muttered.

This crisis has been on the horizon for years, and there’s a legislative answer: a bipartisan bill called the Miners Protection Act. If passed by Congress, it would take money from a fund to clean up the environmental mess of abandoned mines and put it toward retired miners’ health care benefits to the tune of $220 million a year, ensuring medical care for the rest of union miners’ lives.

Coal miners’ advocates say it would have passed easily this year — but Republican Senate Majority Leader Mitch McConnell of Kentucky stopped it from being voted on, asking why it didn’t include nonunion miners.

Instead, just before Congress broke on Dec. 9 for the holidays, a stopgap measure was passed, extending retired miners’ health care until April. “Addressing the miner health care crisis was the only action that could be completed given the brief time available to consider legislation in the lame duck,” a spokesperson for McConnell wrote to STAT by email.

“Would I have preferred that provision to be more generous? Of course I would have. My request to the House was to fund it for a full year. But we’ll be back at it in April. And I think it’s highly unlikely that we’ll take it away,” McConnell said on the Senate floor after the stopgap measure was passed.

But that does little to assuage the uncertainty of retired coal miners. Some are trying to schedule needed surgeries as soon as possible; others are scrambling to research both federal and private insurance. That landscape is an unsteady one in which to look for safe footing, though, given the promised repeal and replacement of the Affordable Care Act.

Many of them aren’t hopeful: They live check-to-check. Even those who qualify for Medicare cannot afford its copays without the benefits that were promised to them. So they are girding themselves for a retirement in which medical care is mostly out of reach.

Like many in their community, both Coalson and Tucker have needed open-heart surgery, and both suffer from coal miners’ black lung and wrecked backs. As the 62-year-old Tucker put it, “I get barely $700 a month for a pension. What am I going to choose? Am I going to choose hospitalization, or am I going to eat? If I don’t eat, I know I’m going to die.”

Coal miners
Rickie Coalson holds up a picture of himself and other miners at his home in Coal City, W.Va. He started coal mining in July 1975 and retired in December 2012. Sam Owens for STAT

Coal in the family

The spot where Coalson knelt to take out his medications could have been a living room anywhere, the floor covered in gray carpet, the walls decorated with fake roses. Yet this entire house was built — literally and figuratively — on coal.

Deep under that rug are four or five seams of the stuff, separated by layers of sandstone and shale-rock. The surrounding hills of Appalachian hardwood are hollow, the roads dotted with guard shacks blocking access to mine shafts. Even the local school is built on a mountaintop that had been blasted away to get at the coal underneath. And just about everything in this house, from the lamplight to the cookies in the kitchen, was paid for by the 37 1/2 years Coalson spent underground.

He started in 1975, working on a team led by his father. The younger Coalson got all the wettest, muddiest jobs. “If he didn’t, the men would complain,” he recalled. “I couldn’t say nothing at work, but I’d sure let him have it going home.”


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But he soon started working a roof-bolter, pinning steel and shooting glue up into the rock ceiling to prevent cave-ins. He couldn’t recognize the faces of the other men he worked with — they were too covered in coal dust. But he knew them by their voices and the idiosyncratic way each cocked his hat, and could get their attention with their mine-names: Bud, Rooster, Super Chicken, Hound Dog, Big John, Big Chew, Ears, Bull Dog.

A few decades in, though, in the 1990s, they started to get used to bankruptcies. Tucker remembers coming back from vacation in 1996 to find almost every miner in Coal City at the bank, outraged that their paychecks couldn’t be cashed because the mining company didn’t have the money to pay them. Instead, they went on unemployment.

“You just barely got by. Some didn’t. I know guys who had to file bankruptcy because they couldn’t pay their bills on unemployment. They lost their homes,” said Tucker. “Everything we’d worked for and accumulated they just took it away, changed names, and opened up again.”

The miners had to start up again at zero, as though they were new employees without decades already spent underground. Slowly they started to accumulate benefits again, sometimes accepting lower pay in order to get health care coverage. So they were devastated when they got letters from the United Mine Workers of America informing them that those benefits would be ending.

Coal - Coalson and Tucker
Coalson (left), 59, and Damon Tucker, 62, sit in Coalson’s backyard. Sam Owens for STAT

‘Miners don’t like to owe people’

At a black lung clinic in Scarbro, 20 miles north of Coal City, retired miners exercise to prevent their breathing from getting worse. Lester Burnette pulls out the letter he got in November, showing it to the program director, Brenda Marion.

“Whatever this Obama junk is, I didn’t think I would have to deal with it,” he said.

“He’s not the one who is going to have anything to do with it,” Marion responded.

Providers like Marion are trying to help the miners navigate the threat of their benefits ending — but they, too, feel powerless. They can help the miners file for federal compensation for the black lung they got in the mines, but that will only cover pulmonary care and provide a little more money each month.

Already, those benefits are hard to get, and the process may become harder still: The legal provisions that helped many miners obtain them in the first place are enshrined in the Affordable Care Act, key parts of which President-elect Trump has promised to repeal.

Even so, more and more miners are clamoring for black lung benefits so that at least one part of their health might be taken care of. “We see an increase in people filing and pursuing those benefits out of desperation because they have had another benefit taken from them,” said Laura Creager, a benefits counselor at the Coal Miners’ Respiratory Clinic in Greenville, Ky.

Coal mine - black lung clinic
Ernst Stone (center) and Jerry Taylor (right) work out during a pulmonary maintenance class at the Grace Anne Dorney Pulmonary Rehabilitation Center in Scarbro, W.Va. Sam Owens for STAT
Coal mine - black lung clinic
Elastic bands used for warm-up stretching hang on the wall below an old picture of coal miners at the rehabilitation center, where miners attend classes to learn how to do exercises and monitor their health. Sam Owens for STAT

Many of these clinics have sliding scales, to allow low-income patients to get medical care. Patients aren’t always willing to accept that, though. “Miners don’t like to owe people. You can’t hardly get them to come, if they don’t have any money to pay,” said Deborah Wills, the Valley Health Black Lung program coordinator. “They’ll put it off or do without a lot of things if they can’t afford to bring a copayment.”

Some are hopeful that Trump will not only bring jobs back into these towns, but also take care of coal miners more generally. But for now, Congress is no longer in session. Miners can march and meet with senators — but they will get no answers until at least January, and they may be waiting until months after that.

In the meantime, Coalson has scheduled a meeting with an insurance salesman in Beckley to see what his options are. He qualifies for Medicare, because he is disabled, but his wife will have no coverage at all if he loses his retired miner’s benefits. Even if it were just him, he doesn’t think he could afford Medicare’s copays, or the cost of prescriptions, which aren’t covered. He hopes the insurance salesman will have some kind of solution to offer. Besides that, there is little he and Tucker say they can do but pray. They both belong to the Teel Apostolic Church, attending three worship services a week.

“We just praise the Lord and go on with a better attitude,” Tucker said. “That’s what Christians do: turn the other cheek. But we’re human, we get awful frustrated when they keep whipping up on us, taking our benefits, something we’ve worked our whole lives for.”

One Sunday in mid-November, they started the service with a special prayer over the letter announcing the upcoming end of a miner’s health care. The pastor anointed it as he might a person who has fallen ill. He tipped a drop of olive oil from a bottle onto his finger, and dabbed it onto the printer paper.

Then they said a prayer for the Miners Protection Act. “We prayed that Mitch McConnell will change his mind and let it go through like it should,” said Tucker.

“You get aggravated … but you still pray for him,” Coalson said. “Judas betrayed the Lord, but he would have forgiven him.”

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  • Sorry about your Health Benefits. Did you listen to him? No!!!! He never told you the truth. He always said he was going to get rid of the HealthCare.

  • They voted for Trump even as he campaigned on repealing the ACA and now they are worried about losing their health benefits? What did they think was going to happen if he won? If they voted for Trump, I have zero sympathy for them if they lose their health benefits. The only thing I care about is the rest of us who have to live with the results of their stupidity.

  • Oh boo hoo! You are getting what you deserve. You voted for him now eat his crap! They should take Obamacare away from everyone who voted for him. Now they all want their cake and want to eat it too.

  • Wow…these people are that dumb to vote their own health care away? Even voting for Republican after the Republican congress wouldn’t pass the Miners Protection Act… You can’t help stupid…

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