Why Miners Need the Black Lung Benefits Improvement Act More Than Ever

SOURCE: aclc.org
DATE: 11/18/2022

The Inflation Reduction Act secured a permanent extension of funding for the Black Lung Disability Trust Fund – a resource that tens of thousands of miners who worked for bankrupt, dissolved, or disappeared companies can utilize to get health insurance coverage and a small living stipend. Tens of thousands more rely on black lung benefits legally required to be paid by their former employers. These small benefits are a lifeline to families across coal country – but historically, the claims process has been designed or administered to put miners at a disadvantage. Miners are fighting coal companies often single-handedly, while these companies have access to exponentially more financial and legal resources than the average American. If they are shut out of the system and ailing with a devastating respiratory disease, many miners would have to choose between paying for groceries and paying for their medicine. At the same time, if a miner is able to fight through this process to access benefits, the amount they receive typically is not adjusted for inflation. As prices rise, this puts them at a distinct disadvantage. But there are steps that Congress can take to help even the playing field and ensure miners can have access to the benefits they’ve earned.

The Black Lung Benefits Improvement Act helps solve a number of the problems these miners face and will ensure those who sacrificed their health working in the mines for coal companies to power our country get what they’ve earned.

This bill takes important steps forward to support miners, including:

  • Assisting miners in getting the medical evidence they are required to have to prove they have black lung – Right now, miners have to pay for medical examinations and procedures to show they have black lung disease. This bill makes those costs immediately reimbursable.
  • Ensures miners have representation through the claims process – Sick miners navigating complex corporate and federal bureaucracies shouldn’t have to do it alone. This bill ensures they have advocates and support when dealing with corporate lawyers and federal red tape.
  • Provides clarity on how to determine if a miner has complicated black lung disease– Currently, the law is interpreted differently across the federal circuit courts. That makes it such that the determination of whether a miner has the most serious form of the disease is evaluated differently depending on the state in which the miner last worked. This Act would standardize that process.
  • Calculates benefits based on the actual cost of living – This legislation determines benefit levels based on the cost of living adjustments that respond to high inflation instead of the current level, which is tied to federal employee pay scales.
  • Ensures Coal CEOs pay miners what they’re owed –  In recent years, many coal companies have filed for bankruptcy to shed their liabilities onto the Black Lung Disability Trust Fund, plunging the fund further into debt. This bill requires the Department of Labor to develop new, stronger requirements for coal companies to cover their own black lung liabilities.

However, in an effort to maximize their profits, coal companies and their political allies do not support this legislation. The concerns many express with the Black Lung Benefits Improvement Act show a fundamental lack of understanding of the very real and common struggles that coal miners living with black lung face.

This legislation is informed by Government Accountability Office (GAO) analysis of the benefits process and shaped by years of collaboration with miners and experts in the field. It addresses some of the serious barriers mining families face that prevent them from accessing life-giving care and a basic safety net.

1) How does the permanent extension of the Black Lung Excise Tax change the future stability of the fund? 

In the summer of 2022, we passed a permanent extension of the black lung excise tax, the only source of revenue for the Trust Fund. In addition, coal production and prices have increased over the past several months thereby increasing revenue for the fund.

Now that the resources are available to support miners, we need to be sure it can be accessed by those who’ve earned them. 

In addition to a historically insufficient excise tax rate, part of the Trust Fund’s solvency issues are attributed to coal companies that have dumped their black lung liabilities onto the Trust Fund, plunging it deeper into debt. A February of 2020 GAO report found $865 million in black lung liability was pushed from bankrupt “self-insured” coal companies to the Trust Fund just between 2014 and 2016, increasing costs to the Fund in spite of the Fund’s insolvency. The BLBIA requires the Department of Labor to develop new procedures to help ensure that coal operators remain accountable for paying the black lung benefits of their employees. This provision to address the Trust Fund’s solvency issues is complementary to the historic win in the Inflation Reduction Act that secured a permanent extension of the excise tax.

The CBO estimate for the BLBIA over ten years is only $74 million. The drivers of the costs include: 1) a small increase in monthly disability payments for existing beneficiaries 2) a higher number of miners (approximately 60 additional miners over a ten year period) who are able to access benefits due to increased access to medical examinations and legal services and 3) reimbursing attorneys for particular legal fees accrued by supporting miners through the bureaucratic process of securing benefits.

However, the reason that this bill costs anything at all is because miners and their families have to rely on the Trust Fund rather than the coal operators responsible for their condition to pay their benefits. This reliance on the Trust Fund is a result of past governance and regulations that allowed coal operators to shed their black lung liabilities. Miners and their families should not be punished for regulatory failures. Coal companies have to be accountable for the costs they have accrued and the impacts they’ve had on the lives of miners

2) How does supporting miners’ legal fees help ensure the miners receive their benefits? 

It is important to clarify why it is necessary to create a new reimbursement system for legal fees and what qualifies as reimbursable legal expenses.

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Under the current system, there are few incentives for lawyers to represent miners in black lung claims. The claims process is lengthy and costly.  According to the Department of Labor, in 2022 only 45% of claimants had attorney representation. An additional 24% had lay representation, (a representative who is not licensed to practice law), but over 1600 miners and their survivors who applied for benefits had no representation. Miners and their families seeking benefits lack financial resources for the development of medical and other evidence and the payment of attorneys’ fees is contingent on the success of cases. It is challenging for law firms to take on cases that are costly to litigate and that take years and years to conclude. Recent reporting looked at a sample of 200 black lung claims and found that, on average, it took 6.5 years to issue a decision. For some families the process takes over a decade.

In the BLBIA, up to $1500 in legal fees are to be reimbursed after a decision on the miner’s claim is issued by the Office of Workers’ Compensation Programs (OWCP). During that evaluation process, medical and employment information is provided by the miner. The responsible coal mine operator is also given an opportunity to submit evidence and contest the claim. OWCP then issues a decision. Only if OWCP makes a determination that the miner is disabled by black lung disease will the legal fees be reimbursed. The entity that would be contesting the decision from that point forward is the coal company. The company would appeal the decision to an Administrative Law Judge (ALJ). If, after an onerous legal process, the ALJ rules in favor of the miner, up to $1500 will be spent on reimbursing legal fees. Subsequently, the coal company operator will then be responsible for reimbursing all legal fees and nothing will have been paid by the Trust Fund. If OWCP or ALJ does not make a determination that the miner is disabled, then the legal fees will simply not be reimbursed.

Any mining family that has gone through the process of filing a black lung claim knows how frustrating it can be. This legislation ensures they have advocates who can help them fight through the red tape of government bureaucracy, have legal representation to stand a chance against the coal companies’ lawyers, and get what they’ve earned.

3) How does this bill affect coal companies that self-insure their black lung liabilities? 

Requiring that coal CEOs to have the money they need to pay for their liabilities is common sense. For too long, these executives have exploited legal loopholes to shed these costs and put the burden on the taxpayer. This requirement helps solve for that by requiring coal companies to carry adequate insurance to cover the costs created by putting miners’ health at serious risk. Moreover, the Department of Labor (DOL) has developed a proposal to provide oversight over this practice which can ensure no further loopholes are exploited by coal executives. Whether or not this legislation passes, these procedural changes are already underway at DOL.

4) Why is settling claims a bad deal for miners? 

When a miner receives their benefits, they are promised health care for their disease for the rest of their life as well as a small monthly stipend to help cover the cost of living. Black lung is a progressive disease. It gets worse over time. To be eligible for benefits, a miner must prove that they are disabled by the disease. But the point at which a miner is determined to be fully disabled is not the point at which they are most sick. They often get much sicker and the cost of their medical needs increases. There is also a tremendous amount of variability regarding the cost of medical care for a miner with black lung, making it difficult to project and calculate over time. For example, some individuals, such as those who receive a lung transplant, exceed a million dollars for their medical care in just a single year.

The industry wants miners – who are often under real economic pressure because they are disabled and no longer able to work – to accept compromises regarding benefits and medical care.

Because of the progressive nature of the disease, settling medical coverage will virtually always underpay the long-term costs and those costs will ultimately be left to the miner and their family, particularly in their later years. 

The industry knows that allowing settlements of federal black lung benefits claims are a good deal for them and a bad deal for miners and their families.

The extension of funding for the Black Lung Disability Trust Fund is a literal life line for thousands of miners across the country, but it only solves part of the problem they face. The Black Lung Benefits Improvement Act is a common-sense solution that ensures miners with black lung have the resources and the support they need to access the benefits they’ve earned. Of course, the National Mining Association is not supportive of this legislation and would prefer to have miners settle their claims and not get what they deserve. But this legislation would go a long way toward ensuring those miners who’ve sacrificed their health to help power those companies and our country have the basic safety net they’ve earned while they face debilitating black lung disease.

Labor Is Demanding an End to Wall Street Stock Buybacks

Source: Jacobin

November 20, 2022


Stock buybacks are a major way the rich can hoard their wealth instead of investing in workers — which is why a coalition of unions is demanding an end to such buybacks.

As gas prices at the pump continued to make national news and undercut voters’ confidence in the economy, Shell plc announced $4 billion in stock buybacks and increased dividend payments to its investors less than two weeks before the 2022 midterm elections. This prompted President Joe Biden to criticize the company’s decision and threaten a windfall profits tax on energy companies. Yet the reality of such legislation passing Congress was low. And only three days after President Biden’s statement, ConocoPhillips increased its existing share buyback authorization by $20 billion and boosted quarterly dividends by 11 percent.

Oil companies’ massive and record profits, together with an apparent disregard for the presidential threat of windfall tax legislation, highlight how the ability to affect economic change may not primarily lie with politicians at this point, but rather in the hands of US workers and their labor unions. Take the issue of oil company stock buybacks.

“We have serious concerns about the lack of investment back into facilities, particularly given the profits reported by the oil industry as a whole and the number of announced stock buybacks,” explained Mike Smith, chair of the United Steelworkers (USW) National Oil Bargaining Program.

Oil company stock buybacks exemplify economic trends that a majority of Americans believe help the wealthy while hurting the working class and the poor. With rising consumer prices and decades of stagnant wages cutting into workers’ household budgets, Americans have consistently expressed concerns about governmental leadership on economic issues and low economic confidence over the last year.

Smith signaled that USW’s future bargaining and campaigns in the oil sector will mobilize workers to confront these corporate practices: “Rather than focus solely on shareholders, it’s essential for companies to commit to resources like safer technologies and decarbonization that will provide longevity and stability for the energy industry and its workforce. We intend to continue pushing for these types of investments.”

USW is not alone in this push. To fill a void of adequate governmental regulation or reform that would address corporate greed as a driving force of economic inflation, labor unions representing workers in a variety of employment sectors are organizing campaigns that expose the underlying causes of economic inequality and address Wall Street stock buybacks, dividends, and ownership in companies.


Workers Confront Wall Street Corporate Ownership

A handful of Wall Street asset management firms known as the Big Three — BlackRock, Vanguard, and State Street — together comprise the largest shareholder in approximately 90 percent of S&P 500 firms and 96 percent of Fortune 250 companies. This concentration of ownership alarms both sides of the political spectrum for different reasons. But legislative regulation has yet to rein in Wall Street firms that arguably violate antitrust laws.

A recent Duke Law Journal article, “Agents of Inequality: Common Ownership and the Decline of the American Worker” by Zohar Goshen and Doron Levit, examines how the rise of powerful institutional investors like the Big Three impacts workers. The study finds that common owners — defined as “a few powerful institutional investors controlling large stakes in most U.S. corporations” — have contributed to a trend where “workers are bringing greater returns to their employers [and] shareholders are taking a larger and larger cut of each corporate dollar, suggesting that common owners have the market power to reduce hiring and keep wages down.”

Perhaps nowhere in the US labor movement is this battle for workers against Wall Street capital more visible than in Brookwood, Alabama, where the United Mine Workers of America (UMWA) are engaged in a nineteenth-month strike with Warrior Met Coal.

Warrior Met, a company organized by Wall Street private equity funds during the US bankruptcy process, demanded significant cuts in pay and benefits from its workforce, then pocketed hundreds of millions of dollars as it took the company public. Now owned primarily by Wall Street management funds, Warrior Met spent $7.1 million during the third quarter of 2022 in expenses related to the interruption of business partially attributed to the labor dispute. It continued to post a net income of $98.4 million last quarter and has paid $1.3 billion in dividends to its shareholders over the last six years, according to UMWA.

“Warrior Met has the profitability to reach a fair contract with the union. It is simply choosing not to,” emphasizes Phil Smith, UMWA chief of staff and executive assistant to the president.

The extended labor dispute may be influenced by the fact that the Warrior Met Board has little accountability to its Wall Street shareholders, and company executives are able to cash in on this lack of oversight.

“Warrior Met is currently 96 percent owned by Wall Street investment funds. After the largest shareholders, where Vanguard has recently overtaken BlackRock, many funds own just a few percent. Ownership is very diluted among dozens of funds. No entity holds more than 15 percent of the stock, meaning there is no strong force bringing the company’s Board of Directors in line. The Board is essentially answerable to no one, leaving them free to take any action it wishes,” explains Smith.

The Warrior Met Board’s actions parallel a forty-year trend of an ever-widening gap between CEO and median worker pay that contributes to expanding and accelerating economic inequality in the United States. US Federal Reserve data shows that in the second quarter of 2022, the top 1 percent of earners held more wealth than the entire middle class in the United States combined (40th to 80th percentiles).

“Executive compensation is way out of proportion to worker pay and business operations,” Smith details. “In BlackRock’s report issued when it was Warrior Met’s largest shareholder, they highlighted this and voted against Warrior Met’s proposed Executive Officers’ Compensation Packages.”

Overall, stock ownership in the United States continues to be concentrated in the hands of the wealthiest, whitest, and most educated Americans, with 89 percent of stocks owned by households making over $100,000 a year. This means that both stock buybacks and dividend payments exacerbate racial and ethnic economic disparities, with black or Latino households owning only 1.6 percent of the total stock market value, according to US Federal Reserve data from the second quarter of 2022.

According to Goshen in an interview with Columbia Law School, “employees of public corporations are resigning themselves to depressed hiring and stagnant wages, even as their productivity — and consequently their value to the corporations — surges to record levels. Relatively richer investors get most of the benefit of higher stock prices.”

Moreover, “At present, Congress, to all appearances, does not have the political will to break up institutional common owners, as institutional investors have effectively ‘captured’ Congress through political spending. Since the 2008 financial crisis, institutional investors have drastically ramped up their campaign contributions and lobbying expenditures.”

While Wall Street investment in corporations has accelerated economic inequality and Congress has yet to pass overarching legislation to address this, unions are strategizing how to represent their members in labor disputes with companies that have Wall Street firms as major shareholders, and address the profit flow from workers into the pockets of wealthy investors.


Stock Buybacks as a Tool of Wall Street Greed

US families and workers struggled with financial hardships coming out of the COVID-19 pandemic, including shifts in the job markets and increased costs for food, gas, and other necessities. At the same time, Wall Street lined the pockets of wealthy investors and corporate executives with record-breaking stock buybacks in 2021 worth hundreds of billions of dollars. Consumers still confront this corporate “greedflation,” in which unfettered and under-regulated accumulation of profits is concentrated in the hands of a privileged few able to increase consumer prices, suppress employee wages, and authorize stock buybacks for personal and shareholders’ financial gain.

Stock buybacks occur when a company purchases its own stock shares on the open market. Companies do this for two main reasons. First, stock buybacks are one way that companies distribute profits to shareholders who pay minimal taxes on buybacks versus dividend payments. This means that shareholders amass more personal income instead of paying more taxes that support schools, firefighters, libraries, and other shared public services.

Second, stock buybacks reduce the number of shares on the open market, and the value of the remaining shares typically increases due to reduced supply. Because of this, before 1982, stock buybacks were generally considered a form of market manipulation by the United States Securities and Exchange Commission (SEC) under the Securities and Exchange Act of 1934.

“Stock buybacks were once illegal, and the practice should be outlawed again. After the pandemic slump, corporations across the economy have resumed this greed tool while citing ‘inflation’ and ‘supply chain’ issues for raising prices while racking up record profits,” explains Sara Nelson, president of the Association of Flight Attendants-CWA (AFA-CWA), representing fifty thousand flight attendants at nineteen airlines.

The AFA-CWA is part of an eight-union coalition that launched an aviation industry No Stock Buybacks campaign calling for airlines to “invest in the people on planes and all the workers who make them fly.” The goal of the campaign is to have airlines fix operational issues, provide enough staffing to meet the public’s travel demands, and conclude contract negotiations before any profit is sent to Wall Street through stock buybacks.

In aviation, as in other sectors of the economy, stock buybacks prioritize the short-term distribution of profits to a privileged few over reinvesting the money in the longer-term stability, growth, and operations of the company, particularly in preparation for unforeseen circumstances and market changes. From 2010 to 2019, major US airlines spent 96 percent of free cash flow on stock buybacks. In the five years before the COVID-19 pandemic, United, Southwest, American, and Delta spent more than $39 billion in stock buybacks. Thus, as airlines spent profits enriching wealthy investors for over a decade when hard times hit the airline industry in 2020, travelers and workers immediately felt the impact of the aviation industry’s investment in Wall Street instead of employees, operations, and cash reserves. Sean M. O’Brien, general president of the International Brotherhood of Teamsters, emphasizes that the campaign goals benefit both workers and consumers: “Greedy corporations would rather divert profits to Wall Street through stock buybacks than focus on workers and the flying public. We cannot allow this to happen. Our unions came together early in the pandemic to secure the Payroll Support Program (PSP) relief package which protected workers and also barred airline executives from stock buybacks.”O’Brien refers to how aviation unions successfully paused airline stock buybacks by intensively lobbying for PSP legislation that met the needs of their members while recognizing that travelers also benefit from airlines’ investment in operations and staffing. Money that airlines received through the PSP, initially part of the 2020 CARES Act and extended under subsequent legislation, set financial regulations on airlines receiving program funds, including capping executive compensation and banning stock buybacks for one year beyond the relief period. However, that ban on stock buybacks concluded on September 30, 2022 — directly after a “summer of airline chaos” with increased flight cancelations, delays, and prices.Through union-endorsed PSP legislation that “included strong labor protections,” president of the Air Line Pilots Association, International (ALPA) Captain Joe DePete explains that “U.S. carriers and their crewmembers were well positioned for the increased travel demand we are experiencing today. However, some airlines failed to properly plan, resulting in operational issues and increased cancellations causing significant frustrations for passengers and airline employees alike.”

The No Stock Buybacks coalition channels public frustration over airlines’ recent unpredictable operations and mobilizes union members to pressure the aviation industry at a time when, according to Nelson, “nearly 700,000 aviation workers are at the table bargaining for our next contracts. . . . Our efforts have successfully stopped the return of stock buybacks in aviation for now.”

New legislation has yet to address windfall profits or stock buybacks; the No Stock Buybacks coalition has effectively deterred airlines from re-engaging in this practice. Together with UMWA, USW, and other organized workers that demand their unions engage in creating a more equitable economic system, labor is challenging Wall Street power.

Writer: Erika Wills

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Notice: Medicare Parts A and B Enrollment


Enrollment for Medicare Parts A and B is mandatory for retirees, surviving spouses, and dependents receiving a health service card.

If you or your spouse are eligible to enroll in both Medicare Parts A and B by virtue of age or disability, then you are required to enroll.

Failure to enroll will result in a penalty and potentially a loss of health care benefits.

The initial enrollment period for Medicare Part B begins three months before your 65th birthday including the month you turn 65, and ends three months after that birthday.

In the case of a disability benefit, you are required to enroll 24 months after the date you are determined to be disabled.

If you do not enroll in Medicare Part B during your initial enrollment period, you have another chance each year to sign up during a “general or open enrollment period.”

Your coverage begins the following July.

However, your monthly premium increases by ten percent for each twelve-month period you were eligible for but did not enroll in Medicare Part B.

All individuals who meet the criteria described above are required to enroll.


If you have any questions, please contact the UMWA Health & Retirement Funds at 800-291-1425.

Visit Medicare.gov for more information.


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“Our fight was his fight”; West Virginia’s labor community honors Jim Bowen

Source: MetroNews

CHARLESTON, W.Va. — Jim Bowen was a legend, a friend and a mentor to those who knew him. The former president of the West Virginia AFL-CIO stood up for the state’s working class until he neared his final days.

“His whole entire life was not about himself. It was about other people,” United Mine Workers of America President Cecil Roberts told MetroNews.

Roberts was among West Virginia’s organized labor community to join together Sunday afternoon in a Celebration of Life ceremony to honor Bowen at the Four Points Sheraton in downtown Charleston.

Bowen died Sept. 26 in Florida at the age of 87.

Roberts said Bowen made a difference by turning bad jobs into good jobs while sticking up for West Virginia’s coal miners.

“He turned unsafe jobs into safe jobs, unhealthy jobs into healthy jobs,” he said. “He just loved being with coal miners. Our fight was his fight.”

Bowen served as WV AFL-CIO president from 1997-2004. During those years he was a fixture at the state Capitol and lobbied on behalf of labor issues. His most notable fight during those years involved the 2003 battle to reform the state’s beleaguered Workers Compensation program.

Roberts said Bowen would attend every UMWA convention after he retired.

“I’ve lost somebody that always spoke highly of me, defended me and lifted me up with his words and actions and those kinds of people are difficult to find in your life,” Roberts said.

Bowen was also a longtime leader and member of the United Steelworkers of America. He became best known as part of the negotiating team during the Steelworkers’ labor dispute with Ravenswood Aluminum in the early 1990s. The nearly two-year dispute was a watershed moment of organized labor in the state and Bowen was one of the union’s negotiators who helped forge an agreement which ended the dispute.

State Senator Mike Caputo (D-Marion) serves as the vice president of the West Virginia AFL-CIO and as a longtime UMWA representative. Caputo considered Bowen a close friend.

“He always used to say I have a special interest and that’s people. That was Jim. I learned and grew from him. We became best friends, played cards together and went to dinner together,” Caputo said.

Caputo lead Sunday’s ceremony, at Bowen’s request.

“I was honored when his widow told me that he left in his wishes that I emcee his Celebration of Life. I hope I can get through that okay,” Caputo told MetroNews at the beginning of the event. “I’m just honored to have known him.”

U.S. Senator Joe Manchin (D-W.Va.) also stopped by Sunday to show his support and said Bowen always contacted him to make sure West Virginia’s working class was top of mind on Capitol Hill.

“Jim was for everybody. Jim would call me and say ‘Joe, can you help this person or help that person?’ It was always helping somebody,” Manchin said. “Jim was not only a mentor. Jim was a good man.”

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New MSHA App Provides Additional Resources to Miners


The Mine Safety and Health Administration (MSHA), the agency tasked with enforcing mandatory safety and health standards for all mines in the US, has recently developed an app for iPhone and Android phones that will help get timely information directly to miners and members of the mining community.  The app allows miners to easily use the tool at mine sites and outside of working hours to search for best safety and health practices and find resources on understanding their rights and responsibilities under the Federal Mine Safety and Health Act of 1977. The app also sends users notifications of mining accidents and how to prevent them. 


“Miners nationwide can now access important safety and health and miners’ rights information in the palm of their hands,” said Assistant Secretary of Labor for Mine Safety and Health Chris Williamson. “This new, innovative tool is another technical and educational resource to empower miners and help them play active roles in mine safety and health; even so, the Mine Act is clear that mine operators have the primary responsibility to maintain safe and healthy working conditions and provide regular and thorough training to miners.” 


The app is available free and can be found by clicking Android or iPhone and can also be found at the respective app stores by searching for “Miner Safety & Health.”  


More information is available at www.MSHA.gov/MinerApp 

Senate climate bill has West Virginia written all over it

DATE: 8/12/2022

CHARLESTON, W.Va. (AP) — The sprawling economic package passed by the U.S. Senate this week has a certain West Virginia flavor.

The package, passed with no Republican votes, could be read largely as an effort to help West Virginia look to the future without turning away entirely from its roots.

The bill contains billions in incentives for clean energy — while also offering renewed support for traditional fuel sources such as coal and natural gas — as well as big boosts for national parks and health care for low-income people and coal miners with black lung disease. That’s no accident. Most provisions were included as the price the Democrats had to pay to win the all-important support of Sen. Joe Manchin of West Virginia, who says they will help folks back home.

John Palmer, a 67-year-old retired coal miner from Monongah, says it’s about time.

“We ain’t had too many people care about us,” Palmer said. “We’re always out there fighting for different things. Everybody’s got an agenda, and our agenda was for working-class people. That’s what everybody’s agenda should be, but it’s not.”

Manchin, a conservative Democrat who chairs the Senate Energy and Natural Resources Committee, was a key vote needed to pass the spending package in the 50-50 Senate and send it to the House, where lawmakers are expected to take it up Friday.

The bill invests nearly $375 billion to fight climate change, caps prescription drug costs at $2,000 out-of-pocket for Medicare recipients and helps an estimated 13 million Americans pay for health insurance by extending subsidies provided during the coronavirus pandemic.

If those subsidies are not extended, West Virginia is among the states that will lose the most support for people paying for health insurance, according to the Urban Institute, meaning thousands of people could lose coverage.

Kelly Allen, executive director of the West Virginia Center on Budget and Policy, said the provision in the bill to cap insulin prices at $35 a dose for seniors will make a big impact in the state, which has the greatest number of people living with diabetes per capita in the country.

“There are people who ration insulin, or who have to make decisions between getting groceries and paying for a drug cost, or paying rent and paying for drug costs,” she said.

But Manchin, who has received more campaign contributions this election cycle from natural gas pipeline companies than any other lawmaker, won concessions on the climate front. The bill includes money to encourage alternative energy and to bolster fossil fuels with steps such as subsidies for technology that reduces carbon emissions. It also requires the government to open more federal land and waters to oil drilling.

In a statement, Manchin said he worked with colleagues to craft the “most effective way” to help West Virginia. He declined to be interviewed for this story.

Manchin also has proposed a separate list of legislation to speed up federal permitting and make energy projects harder to block under federal acts. As part of an agreement with Democratic leadership, he specifically asked that federal agencies “take all necessary actions” to streamline completion of the Mountain Valley Pipeline, a project long opposed by environmental activists.

The 303-mile (487-kilometer) pipeline, which is mostly finished, would transport natural gas drilled from the Appalachian Basin through West Virginia and Virginia. Legal battles have delayed completion by nearly four years and doubled the pipeline’s cost, now estimated at $6.6 billion.

Chelsea Barnes, legislative director for Appalachian Voices, an environmental organization that sued to stop the pipeline, said there’s a lot to be excited about in the legislation. But she deemed Manchin’s concessions to the fossil fuel industry “unacceptable.”

“We’d really love to just be celebrating,” Barnes said, “but we know that there’s so much in the bill that is also going to hurt communities.”

Barnes said the bill contains many provisions her organization has wanted for a long time, such as extending and increasing tax credits for clean energy projects, with bonus credits for low-income communities and for communities where a coal mine or power plant has closed.

That means there’s going to be a higher incentive for clean energy developers to set up shop in Appalachia. She said many people she’s worked with on clean energy projects are not excited to see coal jobs disappear but are excited to be part of “the energy economy of the future.”

“They like the idea of retaining that energy-producing heritage, and I think there’s a lot of pride in continuing that role in our society, in our culture,” she said.

Still, she’s concerned about support for carbon sequestration and storage projects in the bill, saying they haven’t been cost-effective compared with clean energy alternatives. She fears that might prolong the life of power plants.

She also said permitting reform in the bill amounts to “permitting destruction” that would damage the environmental review process and silence residents’ voices.

The bill also contains millions of dollars for tourism, long seen in West Virginia as a way to boost the state’s beleaguered economy. West Virginia is home to multiple national parks, including the New River Gorge National Park and Preserve, which opened in 2020.

The National Park System would receive at least $1 billion in the package to hire new employees and carry out projects to conserve and protect wilderness areas.

The bill also permanently extends the excise tax on coal that pays for monthly benefits for coal miners with black lung disease, which is caused by inhaling coal dust.

Since the program’s inception, more retired miners in West Virginia have received black lung benefits than any other state, with 4,423 people receiving benefits last year. But the fund is $6 billion in debt.

For decades, the tax has required annual legislative approval. Twice in recent years, federal lawmakers failed to extend the tax, most recently for this year. That cut the tax by more than half — a windfall to coal companies that put benefits in jeopardy.

The fund is needed more than ever, United Mine Workers of America Chief of Staff Phil Smith said, with miners being diagnosed with black lung at younger ages than before because of higher amounts of silica dust in mines — something that’s not regulated.

Palmer worked underground for 40 years at the Federal No. 2 Mine in Monongalia County, which went bankrupt and shut down shortly after he retired a few years ago. His father, a coal miner, died of a lung disease, and his younger brother also has black lung. He said knowing the money will be there is a “relief” and that miners earn the benefit — an average of just over $700 a month — when they risk doing dangerous work.

“We went down in these holes that kept the lights on for everybody,” he said. “We’re the ones sacrificing our bodies.”