A coal miner works at a Wellmore mine in Buchanan County, Virginia, in 2016. Photo: Benjamin Lowy/Getty Images

In 15 days, the coal industry will receive a late Christmas gift. The federal government is scheduled to reduce an excise tax on coal production by 55 percent on December 31, a move that industry representatives welcome. But what is good for the coal industry is often bad for coal miners themselves. If the tax cut takes effect as planned, the Black Lung Disability Trust Fund will lose a significant source of its funding. Currently, the government levies a tax of $1.10 per ton of coal produced. That tax goes into the fund, which defrays the significant costs associated with black lung disease. Unless Congress takes action this month, the tax will revert to its 1977 rate of 50 cents per ton.

The fund won’t die immediately without this money, but it will gradually wither. The Government Accountability Office reported in June that if the tax cut proceeds, the fund will need a bailout worth billions of dollars if it’s to continue subsidizing care for black lung patients. “With the scheduled 2019 tax rate decrease, our moderate case simulation suggests that expected revenue will likely be insufficient to cover combined black lung benefit payments and administrative costs, as well as debt repayment expenditures,” the GAO explained. Bruce Watzman, head of regulatory affairs for the National Mining Association, countered at the time that the fund had been abused anyway. “More often than not, we are being called upon to provide compensation for previous or current smokers,” he said.

In fact, rates of black lung are on the rise — though the industry steadfastly denies this. The National Institute for Occupational Safety and Health (NIOSH) reported in July that as many as one in five miners in central Appalachia suffer from black lung, the highest rate in 25 years. Nationwide, the condition now afflicts one in ten miners, an increase of 3 percent since 2012.

This is new data, but it appears black lung cases have been increasing for years, despite the introduction of regulations intended to reduce the condition’s prevalence. In 2012, a joint investigation by NPR and the Center for Public Integrity “found widespread and persistent gaming of the system designed to measure and control exposure.” According to NPR and CPI, cases initially ticked upward in the 1990s, mostly in eastern Kentucky, southern West Virginia, and southwestern Virginia. Sometimes coal operators commit outright fraud, by sampling air outside their own mines. Sometimes they simply fail to meet certain safety standards (this is why Don Blankenship spent spent a year in prison after 29 miners died in an explosion in his Massey Energy mine). In other cases, operators exploit perfectly legal loopholes. “The law permits sampling at only 50 percent of average production, when miners have as little as half the exposure,” Howard Berkes reported for NPR, adding, “Sampling is required only eight hours a day even though miners work at least 10 hours a day on average. That amounts to about 600 hours of exposure a year that is not measured in the sampling.”

Thus, black lung, and more of it. But though its miners are getting sicker, the coal industry does not appear to feel much responsibility for their health needs. “Earlier this year, Kentucky’s Republican-led legislature passed House Bill-2 (HB-2), which curtails worker’s compensation, including black lung benefits, to 15 years,” the Guardian’s Elyssa East reported. HB-2 also severely restricted the number of pulmonogists the state authorizes to diagnose black lung and approve patients for benefits; there are now only four doctors permitted to do so, and three of the four also consult for the coal industry. East reported HB-2 also looks like an act of political retaliation against one radiologist, Brandon Crum, who initially reported an increase in black lung cases coming through his eastern Kentucky practice. The coal industry disputes many of these diagnoses, claiming instead that they are caused by sarcoidosis or by complications from smoking. Most miners in central Appalachia, however, are white, and sarcoidosis is rare among white men.

There is only one way to contract black lung, NIOSH says, and that is to breathe in coal dust. Once you breathe in that dust, it is part of you. Breathe it daily, for years, and it begins to change you. The healthy tissue of your lungs will scar, and you will find it more and more difficult to breathe, until one day you can’t. East described the process with particular clarity: “Continued exposure to dust will grow into scar tissue or fibrosis culminating in the complicated form of the disease. In time, the scars will become as big as a grain of rice. A dime. A quarter. A half dollar. Lung capacity declines. Hypoxemia (low blood oxygen levels) sets in.” Black lung is terminal, and it is a slow murderer. The Black Lung Disability Trust Fund doesn’t cure anyone because no cure exists, but it does provide oxygen tanks and help pay for lung transplants that can extend a miner’s lifespan. It relieves some financial pressure and preserves some quality of life.

Earlier this month, retired Appalachian miners traveled to Washington to beg Congress to keep the excise tax at its current levels. They appealed, specifically, to Senator Mitch McConnell, who represents many of them in Congress. “They stood in the United States Capitol and told their stories to McConnell’s staff: how they dedicated their lives to coal mining, struggled to keep their jobs during the boom-and-bust cycles, and what it’s like to die from a disease that is entirely preventable,” wrote Lindsey Gilpin for Southerly magazine.

In October, McConnell suggested he would find a way to preserve funding for the Black Lung Disability Trust Fund. “That’ll be taken care of before we get into an expiration situation,” McConnell said. “It just won’t be allowed to be unfunded.”

But now McConnell appears to be walking back that statement, according to the ReSource. The majority leader did not answer detailed questions about how he plans to resolve the issue in the coming days. Instead, McConnell said in a written statement, “It is a top priority of mine to maintain and protect benefits for those suffering from black lung disease.”

Despite McConnell and other coal country lawmakers’ stated commitment to protecting coal miners, the truth is there probably won’t be dire political consequences if they let the coal tax rate expire. Republicans will still control the Senate, and everyone knows President Trump loves coal — or “beautiful, clean coal,” as he called it. That’s music to the coal industry, which still grips not just the economic fortunes of struggling regions like Appalachia, but the hearts and minds of many coalfield voters, too. Coal jobs are still jobs.

Starving the nation’s black lung fund won’t make coal deadlier, but it could shorten life spans and make deaths less dignified and more painful. Neglect is slower than a gunshot, but it will kill you all the same.