As Black Lung Cases Rise, Will Clinic Funding Follow?

A rise in incidences of black lung disease among coal miners is prompting some lawmakers to try to send more money to cash-strapped rural health centers that could hold the key to piecing together missing data.

An extra $2.7 million is little in the context of the broader federal budget, but proponents say this amount, that includes funding for the Federal Office of Rural Health Policy, is crucial if health workers are to respond effectively to recent findings by the National Institute of Occupational Safety and Health. House lawmakers successfully inserted the spending into a package of fiscal 2018 spending bills that passed the chamber in September.

Research shows that the incidence of coal workers’ pneumoconiosis, or black lung disease, is rising among coal miners, and that the cluster of cases at three clinics in southwestern Virginia studied by NIOSH researchers is the largest ever reported in scientific literature.

The need to gather more data on the findings could place new demands, the thinking goes, on health centers already struggling to serve sick miners.

Congress must secure the funds “to better assist the influx of miners, and to support the clinics’ work in quantifying the extent of this epidemic,” Rep. Bobby Scott (D-Va.), the ranking member of the House Education and the Workforce Committee, said at a hearing on mine safety Feb. 6. He is seeking more funding, along with Rep. Morgan Griffith (R-Va.) and other House members.

Dated Gear, Little Cash

Federal law set up a system where privately owned black lung clinics seek grants from the Federal Office of Rural Health Policy, part of the Department of Health and Human Services’ Health Resources and Services Administration. But funding for the 28 centers that screen, diagnose, and treat about 13,800 miners in 15 coal-producing states is insufficient, lawmakers say.

The Federal Mine Safety and Health Act of 1977 authorizes up to $10 million for the grants, but typical appropriations are around $6.7 million per year, Scott and Griffith and other lawmakers said in a letter to the White House last year, seeking more funding in the president’s fiscal 2018 budget request.

The funding level means the three clinics Stone Mountain Health Services operates in southwestern Virginia that NIOSH studied must use decades-old medical equipment, Ron Carson, director of the clinic’s black lung program, told Bloomberg Environment. He said area veterinarians have more modern health-care facilities.

Miners suffer through both unnecessary health risks—being exposed to higher radiation levels than necessary through 1970s-era X-ray machines—and needless delays when printed readings must be mailed elsewhere for analysis, Carson said.

Carson and NIOSH researchers attribute the rise in incidences of black lung to multiple factors. More miners, for example, are leaving work and seeking medical screening as coal production declines and those still on the job extract thinner seams of coal that expose them to higher levels of silica, they said.

Regulations finalized in 2014 to control miners’ silica exposure took effect in 2016. In a research letter published Feb. 6 in the Journal of the American Medical Association, NIOSH scientists wrote that “continued surveillance” will be needed to determine if the rules have any effect in reducing black lung.

The effort will tax centers like Stone Mountain, Carson said, and other centers that lack Stone Mountain’s rudimentary electronic records.

Spending Amendment

The spending boost has cleared a few hurdles so far.

Scott and Griffith won adoption of an amendment last year to the fiscal 2018 spending bill that passed the House of Representatives in September 2017. The amendment would have transferred $2.73 million from a HRSA administrative account to fund grants for the community health centers. That would have boosted funding for the centers to $10 million, the maximum authorized level.

Whether the funding will make it to the health clinics is uncertain because the House spending legislation, H.R. 3219 or the “Make America Secure Appropriations Act,” differs from Senate spending priorities.

Lawmakers Feb. 9 passed a federal budget agreement for fiscal 2018, which funds the government at current levels until March 23, giving appropriators time to fill in the details on future spending.

“It would make a big difference,” Carson said.

Because Congress has not yet appropriated the funds, Martin Kramer, a HRSA spokesman, told Bloomberg Environment, “it’s a little premature for us to be able to discuss what the clinics need.”

House Appropriations Committee spokeswoman Jennifer Hing said in an email to Bloomberg Environment that the committee “cannot speculate or comment on provisions that may or may not be included in upcoming legislation.”

It can be hard to explain to former coal miners, Carson said, why more funding isn’t available.

“I just say, ‘Well, we’re going to be OK,’” Carson said. “We just have to work with what we’ve got, and hopefully something in the near future will come around.”

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