This story was originally published by AP News.
Lisa Emery loves to talk about her “boys.” With each word, the respiratory therapist’s face softens and shines with pride. But keep her talking, and it doesn’t take long for that passion to switch to hurt. She knows the names, ages, families and the intimate stories of each one’s scarred lungs. She worries about a whole community of West Virginia coal miners — including a growing number in their 30s and 40s — who come to her for help while getting sicker and sicker from what used to be considered an old-timer’s disease: black lung.
“I love these guys,” she said, wiping tears. “I tell them … ‘Every single one of y’all that sits down in that chair is why I feel like I was put on this earth.’”
As director of the New River Health Association Black Lung Clinic, Emery’s seen guys as young as 45 getting double lung transplants as disease rates soar among miners forced to dig through more rock filled with deadly silica to reach the remaining coal — far worse than the dust their grandfathers inhaled. A rule approved last year by the U.S. Mine Safety and Health Administration would cut the federal limit for allowable respirable crystalline silica dust exposure by half to help protect miners of all types nationwide from the current driving force of black lung and other illnesses.
But, now, it’s in jeopardy amid other Trump administration cutbacks and proposals targeting workers’ health and safety guardrails: Stuck in a politically charged environment that promotes industry, with lawmakers arguing to change it and the federal agency that wrote the rule not pushing to enforce it. Some angry retired miners with black lung are fighting back, demanding that President Donald Trump honor promises he made to the people who voted him in.
The opposition comes months after Trump signed executive orders to allow coal-fired plants to pollute more and to streamline the permitting process and open up new areas for mineral production, including oil and natural gas drilling and mining of “beautiful, clean coal.” He was celebrated at the White House by smiling miners in hard hats, including some with West Virginia stickers, as he promised to put more people to work underground.
“One thing I learned about the coal miners: That’s what they want to do,” Trump said. “You could give them a penthouse on Fifth Avenue in a different kind of a job, and they’d be unhappy. They want to mine coal.”
Lisa Emery, director of the New River Health Association Black Lung Clinic, examines a chest X-ray showing progressive massive fibrosis, the most complicated form of black lung, at the center on September 23, 2025, in Oak Hill, West Virginia. (AP Photo/Carolyn Kaster)
Coal miner Ethan Carper leans against his truck outside a convenience store, Wednesday, September 17, 2025, in Oak Hill, West Virginia. (AP Photo/Carolyn Kaster)
Former coal miner and black lung disease patient Roger James pauses to catch his breath after walking across the parking lot at the Maynor Freewill Baptist Church, September 24, 2025, in Beckley, West Virginia. (AP Photo/Carolyn Kaster)
But since his inauguration in January, a volley of firings, department eliminations, and proposed regulation rollbacks have targeted hard-won health and safety protections fought for over decades to safeguard coal miners and other working-class folks.
The silica rule was delayed in April after industry groups suing the government filed an emergency request in court to block it from taking effect, citing costs and difficulties implementing it. Around the same time, the Trump administration told nearly all employees at the National Institute for Occupational Safety and Health that their jobs were being cut. That included those running a congressionally mandated surveillance program that certifies black lung cases.
Loud public uproar and bipartisan criticism followed, and a fraction of the agency’s positions were reinstated. That came only after a West Virginia coal miner diagnosed with black lung sued. A federal judge in that case issued a preliminary injunction ordering the government to bring back respiratory health division workers at NIOSH.
But some jobs, including those focused on mine safety and research, have not been restored. And even employees who have been recalled say a lack of funding and loss of expertise in specialized positions, from chemists to engineers, have made it impossible for them to operate at the same level as before.
In addition, the Labor Department has proposed altering some mining regulations to weaken the authority of district mine health and safety managers that could impact ventilation, roof prevention, and training programs.
The result of all these changes is that many blue-collar workers and first responders nationwide — from commercial fishermen and miners to firefighters and construction workers — will have fewer people working to help keep them safe and healthy while doing some of the country’s most dangerous jobs, many of them deep in Trump country.
In fact, the two reddest states in America — Wyoming and West Virginia — had the highest overall worker death rates in 2023, according to the latest government figures. Together they experienced more than a dozen fatalities in the mining, quarrying, and oil and gas sector that year.
As a United Steelworkers union leader representing about 700 trona miners in Wyoming, Marshal Cummings worries the little-known white powdery rock he digs — used in everything from glass and detergents to paper — could be making workers sick. He helped push for the silica rule to cover miners like him, offering them the same free health screenings as coal miners, and was forced to wait for researchers from NIOSH to investigate air quality at his site after a request he filed was initially killed by the layoffs.
“We got promised that we were going to make America great again, make America healthy again,” Cummings said at the time.
“You should be making these cuts with the scalpel,” he added. “You shouldn’t be using a chainsaw and chunking out all these things because you’re impacting workers.”
On the other side of the country, Emery sits in her office off a busy highway nestled amid West Virginia’s breathtaking mountains and whitewater rivers that attract tourists from across the world. Data collected from her clinic along with more than two dozen others nationwide, spell out what she sees in real time every day: Of the 11,500 coal miners from central Appalachia with X-rays analyzed by NIOSH-certified readers from mid-2020 through mid-2025, 55% had some form of black lung with the highest annual rate — 62% — recorded among miners seen in the past year, according to researcher Kirsten Almberg at the University of Illinois Chicago. That compares to 41% elsewhere in the U.S. over the same five-year period.
Experts say that’s because much of the easy-to-reach coal has already been extracted in West Virginia and neighboring Virginia and Kentucky, forcing miners to use massive equipment to eat through walls of quartz-filled sandstone to reach the remaining thin coal seams. This creates excess dust laced with shards of silica, which also cause lung cancer and kidney disease. It’s 20 times more toxic than coal dust, the major culprit of the past that often sickened older workers. The silica crystals embed in miners’ lungs, causing chronic inflammation and eventually irreversible scarring that peppers X-rays with chalky spots. It leaves proud, once-strong men skinny and weak. They choke on their food and gasp after just a few steps, cradling shiny cylinders that provide a lifeline of oxygen through tubes snaking into their nostrils.
Mark F. Powell, a fourth-generation coal miner in southern West Virginia, stands for a portrait at attorney Sam Petsonk’s office Thursday, September 18, 2025, in Oak Hill, West Virginia. (AP Photo/Carolyn Kaster)
“If you’ve ever about drowned — or anybody’s about drowned — they know what I’m talking about because I go through that every morning,” said Mark F. Powell, a fourth-generation miner from southern West Virginia who’s upset with Trump’s policies. “By the end of the day, I’m so tired. Sometimes I don’t even eat supper. I’ll come home and sometimes I’m not even able to take a shower. I’m not ashamed to tell it. I’ll lay on the floor and go to sleep.”
He said he wore his protective respirator throughout his nearly 30-year career, but was still diagnosed with a progressive form of complicated black lung and silicosis when he was 45. NIOSH certified his X-ray, allowing him to move to a job on the surface with no pay cut. Now, just four years later, he said he doesn’t have the wind to mow his lawn.
A banner with an image of President Donald Trump hangs outside the U.S. Department of Labor, October 14, 2025, in Washington. (AP Photo/Carolyn Kaster)
He said he worries about younger miners. Some, no longer protected by unions, were afraid to speak to The Associated Press or question bosses who may be skirting health and safety regulations.
From 1970 to 2016, more than 75,000 miners’ deaths were connected to black lung, according to NIOSH. Disease rates dropped after Congress put the agency’s Coal Workers’ Health Surveillance Program in place, but have surged since the late 1990s. NIOSH and unions have highlighted the need for the silica rule for decades, which cuts permissible silica dust levels inside mines from 100 to 50 micrograms per cubic meter of air averaged over an eight-hour shift — the same levels already enforced by the Occupational Safety and Health Administration in other industries such as construction. In 2018, NIOSH published a report showing around one in five coal miners with at least 25 years’ experience in central Appalachia had black lung. Those findings were based largely off of working miners who may not have been sick when X-rayed. Researchers say the newer numbers collected from black lung clinics like Emery’s show a bleaker picture because they capture miners who are disabled or retired, many of whom were never screened by NIOSH.
In July, seven House Republicans, led by Representative Tim Walberg of Michigan, who chairs the House Education and Workforce committee, wrote a letter to the Mine Safety and Health Administration opposing parts of the silica rule, saying it ignored commonsense controls such as job rotation and personal protective equipment. The letter did not mention black lung or other diseases caused by silica dust, but said the rule was an example of Biden administration red tape and “imposed hundreds of millions of dollars in costs” on the mining industry.
Walberg did not respond to questions from AP, but a committee spokesperson said in a statement that while the Republicans support ensuring miner safety, the current silica rule does not provide mine operators enough flexibility to apply the standards in an economically feasible way.
The White House and the Labor Department insisted the administration can maintain miners’ health and safety while rolling back regulations.
“President Trump cares about our miners more than any other president in modern history – which is why he has implemented his energy dominance agenda to protect their jobs and revive the mining industry,” said White House spokeswoman Taylor Rogers.
But sick miners say the cost, for them, is their lives. Even after removing all exposure to silica and coal dust, symptoms continue to worsen, typically resulting in only two options: A risky, expensive lung transplant or death.
“I feel like in our part of the country … we’re kinda forgotten about,” said John Robinson, a former miner from Nickelsville, Virginia, who uses a walking stick and oxygen after being diagnosed with the disease 12 years ago at age 47. “I don’t think it’s right.”
Emery said her youngest patient with the most complicated form of black lung, called progressive massive fibrosis, was just 31 when he was diagnosed after only 10 years underground. And he’s not alone: Rates in the region have jumped in recent years — hitting an all-time high for long-tenured miners in the mid-2000s, according to NIOSH data.
“What we’re seeing at the black lung clinics is just really alarming,” she said. “So truly, if the rule got put in place today, cutting the silica exposure level in half, you already have sick miners. It’s going to take a solid 15 to 20 years for us to start to see this taper off.”
Fierce History of Fight, Fueled by Tragedy
Crosses and grave markers are seen at the Hawks Nest Workers Memorial and Grave Site, September 24, 2025, in Mount Lookout, West Virginia. Silica created one of the worst occupational disasters in U.S. history when more than 750 miners — most of them Black — died from breathing the toxic dust while drilling the Hawks Nest tunnel in the early 1930s to divert water to power a metal plant. (AP Photo/Carolyn Kaster)
The history of disease and sacrifice is everywhere in these mountains. Just a few miles from Emery’s office, silica created one of the worst occupational disasters in U.S. history when more than 750 miners — most of them Black — died from breathing the toxic dust while drilling the Hawks Nest tunnel in the early 1930s to divert water to power a metal plant. A small cemetery with rows of sunken, unmarked graves memorializes the tragedy in an area where rumbling coal trains and steep mining tipples remain the backdrop in tired rural towns blighted by unemployment and decaying houses.
But the region also has a proud legacy of using disasters to galvanize workers to fight for greater rights. And West Virginia coal miners have been at the center of it.
Joe Megna was just a teenager when his dad left for the No. 9 mine in Farmington on the day he was set to retire in November 1968.
“I said, ‘This is your last shift, don’t go to work, we’ll go trout fishing,’” Megna said, recalling his dad’s dutiful response to the company. “He said: ‘I owe them that much.’”
Megna said his father then told him he loved him — for the first time — and drove off.
“This was the last time we talked,” he said.
Early the next morning, the ground shook so hard, it was felt miles away. Roaring plumes of smoke billowed more than 100 feet into the sky from a raging fire. Megna’s dad was among 78 miners who did not escape the explosion. His body remains entombed there along with 18 other men who were sealed inside.
FILE – Dense smoke pours from the Mod’s Run air vent of the No. 9 mine, where 78 miners were killed as a result of the mine explosion near Farmington, West Virginia., November 21, 1968. (AP Photo/File)
FILE – The second of two seven-man search teams exit a mine shaft, near Farmington, West Virginia. The No. 9 mine explosion killed 78 miners, November 24, 1968. (AP Photo/File)
It was the first mining disaster broadcast on national television, shocking the public and enraging workers. A few months later, roughly 40,000 West Virginia coal miners walked off the job in an unauthorized wildcat strike, demanding better black lung protections and benefits when the state was a Democratic stronghold. Congress responded by passing the Federal Coal Mine Health and Safety Act of 1969, which required government oversight and enforcement at coal mines and established breathable dust standards — the same ones the 2024 silica rule would cut in half — and compensation for miners disabled by black lung.
The federal black lung surveillance program was created as part of that act, which also helped lay the framework for broader workplace safety legislation a year later that formed OSHA and NIOSH as agencies. While OSHA is charged with enforcing worker health and safety standards under the Department of Labor, including citing employers for violations, NIOSH is the quiet research and development arm. It focuses on making recommendations to avoid work-related illness and injury and is overseen by the U.S. Centers for Disease Control and Prevention.
NIOSH investigates and studies firefighter deaths, including cancers. It certifies N95 masks and reviews and verifies illnesses involving 9/11 first responders who could be eligible for benefits under the federal World Trade Center Health Program. Scientists in its Spokane, Washington, laboratory — which remains gutted — work to keep wildland firefighters, oil and gas workers, and commercial fishermen safe. Some were also helping to develop real-time monitors to alert miners of silica dust overexposure.
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