In early April, President Donald Trump gathered dozens of hard-hat-clad coal miners around him in the White House East Room. He joked about arm-wrestling them and announced he was signing executive orders to boost coal production, "bringing back an industry that was abandoned," and to "put the miners back to work." Trump said he calls it "beautiful, clean" coal. "I tell my people never use the word 'coal' unless you put 'beautiful, clean' before it." That same day, the Trump administration paused implementation of a rule that would help protect coal miners from an aggressive form of black lung disease. Enforcement of the new protections is officially halted until at least mid-August,according to a federal announcementthat came a few days after a federal court agreed to put enforcement on hold to hear an industry challenge. But even if the rule takes full force after the delay, the federal agency tasked with enforcing it in Appalachia and elsewhere may not be up to the task after sweeping layoffs and office closures. Deaths from black lung — a chronic condition caused by inhaling coal dust —had been in declinesince the introduction offederal regulationsover a half-century ago. But in recent decades,cases have risen precipitously. By 2018, the Centers for Disease Control and Prevention estimated that the lungs of about 1 in 5 coal miners in central Appalachia showed evidence of black lung. It is being diagnosed in younger miners. And the deadliest form, progressive massive fibrosis, has increased tenfold among long-term miners. Silica is the primary culprit. Exposure to it has increased since mining operations began cutting through more sandstone to reach deeper coal deposits. The stone breaks into sharp particles that, when airborne, can become trapped in lung tissue and cause a debilitating, sometimes fatal condition. The new rule was set to take effect in April, cutting the allowable level of silica dust in the air inside mines by half — to the limit already in place for other industries — and set stricter guidelines for enforcement. Years in the making, advocates for miners heralded the new standards as a breakthrough. "It is unconscionable that our nation's miners have worked without adequate protection from silica dust despite it being a known health hazard for decades,"acting Labor Secretary Julie Susaid when the rule was announced last spring under the Biden administration. The rule pause came on top of another blow to mine safety oversight. In March, the Department of Government Efficiency, created by a Trump executive order, announced it would end leases for as many as three dozen field offices of the Department of Labor's Mine Safety and Health Administration, with the future of those employees undetermined. That agency is responsible for enforcing mining safety laws. Then in April, two-thirds — nearly 900 — of the workers at the National Institute of Occupational Safety and Health, an agency within the Department of Health and Human Services, were fired. As a result, NIOSH's Coal Workers' Health Surveillance Program, which offered miners free screenings from a mobile clinic, ceased operations. An announcement by MSHA of the silica rule delay cited the "unforeseen NIOSH restructuring and other technical reasons" as catalysts for the pause but didn't mention the federal court decision in the case seeking to rescind the rule. Separately, on May 7, attorneySam Petsonkfiled a class-action lawsuit against Health and Human Services and its head, Robert F. Kennedy Jr., to reinstate the program. His client in the case, Harry Wiley, a West Virginia coal miner, was diagnosed with an early stage of black lung and applied to NIOSH for a transfer to an environment with less dust exposure but never received a response. He continues to work underground. On May 13, U.S. District Judge Irene Berger issued a preliminary injunction to reinstate the surveillance program employees. The next day, Kennedy said the administration wouldreverse the firings of 328 NIOSH employees. That day, they were back at work. "Remaining in a dusty job may reduce the years in which Mr. Wiley can walk and breathe unassisted, in addition to hastening his death," Berger wrote. "It is difficult to imagine a clearer case of irreparable harm." MSHA officials declined to respond to specific questions about the silica rule or plans to implement and enforce it, citing the ongoing litigation. In an emailed statement, Labor Department spokesperson Courtney Parella said, "The Mine Safety and Health Administration is confident it can enforce all regulations under its purview. MSHA inspectors continue to conduct legally required inspections and remain focused on MSHA's core mission to prevent death, illness, and injury from mining and promote safe and healthful workplaces for U.S. miners." Wes Addington is quick to say a career in the mines isn't necessarily a death sentence. He comes from generations of miners. One of his great-grandfathers worked 48 years underground and died at 88. But Addington also said protecting the safety and health of miners requires diligence. He's executive director of theAppalachian Citizens' Law Center, a Whitesburg, Kentucky, nonprofit that represents and advocates for miners and their families. A study the center conducted found that staffers at the MSHA offices scheduled to close performed almost17,000 health and safety inspectionsfrom January 2024 through February 2025. Addington said NIOSH provided the data to document worsening conditions over the past few decades. Addington's organization has advocated for the new silica rule for 17 years. "We didn't think it was perfect," he said. He would have preferred lower exposure limits and more stringent monitoring requirements. "But, as it was, it was going to save lives." The cuts to the agency, Addington said, could affect every American worker who might be exposed to harmful elements in the workplace. NIOSH approves respirators prescribed by Occupational Safety and Health Administration regulations. With fewer inspectors, miners are "more likely to get hurt on the job and those injuries could be fatal," he said. "And if you're a miner that's lucky enough to navigate that gantlet and make it through a 20-, 25-year career," Addington said, "the likelihood that you develop disabling lung disease that ultimately kills you at an early age is much increased." The black lung clinic atStone Mountain Health Servicesin southwestern Virginia has diagnosed 75 new cases of progressive massive fibrosis in the past year, according to its medical director, Drew Harris. "People are dying from a dust-related disease that's 100% preventable, and we're not using all the things we could use to help prevent their disease and save their lives," Harris said. "It's just all very disheartening." He believes it would be a mistake for Kennedy to reorganize NIOSHas he has proposed, shifting the surveillance program team's responsibilities to other employees. "It's a very unique expertise," Harris said. The agency would be "losing the people that know how to do this well and that have been doing this for decades." Rex Fields first went to work in the mines in 1967, a year before anexplosion killed 78 minersnear the small town of Farmington, West Virginia. His wife, Tilda Fields, was aware of the hazards her husband would encounter — the safety issues, the long-term health concerns. Her dad died of black lung when she was 7. But it meant a well-paying job in a region that has forever offered precious few. Rex, 77, now lives with an advanced stage of black lung disease. He's still able to mow his lawn but is easily winded when walking uphill. It took him several weeks and two rounds of antibiotics to recover from a bout with bronchitis in March. Throughout his career, Rex advocated for his fellow miners: He stepped in when he saw someone mistreated; he once tried, unsuccessfully, to help a unionization effort. For these efforts, he said, "I got transferred from the day shift to the third shift a time or two." Today, the Fieldses lobby on behalf of miners and share information about occupational dangers. Tilda organized a support group for families and widows. She worries about the next generation. Two of the Fieldses' sons also went into mining. "People in the mountains here, we learn to make do," Tilda said. "But you want better. You want better for your kids than what we had, and you surely want their safety." KFF Health Newsis a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs atKFF— the independent source for health policy research, polling, and journalism. For more CNN news and newsletters create an account atCNN.com
