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COAL CITY, W.Va. — The sandwich bag was stuffed with pill bottles. 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, 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.

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“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. “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 throughout coal country. With them comes a flood of resentment. As coal companies have filed for bankruptcy protection, 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, is particularly angry at the judges who made these rulings: “Sits on a bench, never been underground crawling in mud, water, slop.”

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

Miners’ advocates say it would have passed this year — but the Republican Senate majority leader, Mitch McConnell of Kentucky, blocked the vote, asking why it didn’t include nonunion miners.

Instead, just before Congress broke on Dec. 9, 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 spokesman for McConnell told STAT by e-mail.

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“Would I have preferred that provision to be more generous? Of course. . . . 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.

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

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

Like many others 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 puts 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.”

Coalson started in 1975, on a team led by his father, and soon began working as a roof-bolter, pinning steel and shooting glue up into the rock ceiling to prevent cave-ins.

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He couldn’t recognize the faces of the men he worked with — they were covered in coal dust. But he knew them by their voices and the idiosyncratic way each cocked his hat. Underground, they went by different names: Rooster, Super Chicken, Hound Dog, Big John, Big Chew, Ears, Bull Dog.

In the 1990s, though, that community started to get used to bankruptcies.

“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,” Tucker said. “Everything we’d worked for and accumulated they just took it away, changed names, and opened up again.”

The miners had to start again at zero, as though they were new employees. Slowly they started to accumulate benefits again, accepting lower pay to get health coverage. So they were devastated when they got letters from the union informing them that those benefits would be ending.

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 pulled 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.

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.

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Already, those benefits are hard to get, and the process may become harder still: Many miners were able to qualify only because of a provision in the Affordable Care Act.

Even so, more are clamoring for those benefits so that at least one part of their health might be taken care of.

“We see an increase in people . . . pursuing those benefits out of desperation, because they have had another benefit taken,” said Laura Creager, a benefits counselor at the Coal Miners’ Respiratory Clinic in Greenville, Ky.

These clinics have sliding payment scales, so low-income patients are able 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’s coordinator.

Some hope that as president Donald Trump will take care of coal miners, as he promised. In the meantime, they can march and meet with senators, and look into other insurance options — but besides that, there is little that miners like Tucker and Coalson can do but pray.

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

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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 be,” Tucker said.

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


Eric Boodman can be reached at eric.boodman@statnews.com. Follow Eric on Twitter @ericboodman.