A new federal rule aims to close a loophole allowing coal companies to walk away from their obligations to pay disability benefits and health insurance to miners who worked for them and contracted black lung disease.

The so-called "self-insurance loophole" lets companies dump hundreds of millions of dollars in health liabilities onto the Black Lung Disability Trust Fund, a safety net program riddled with debt and backed up by taxpayer dollars.

Brendan Muckian-Bates, policy and advocacy associate for the Appalachian Citizens Law Center, said the recent merger of coal giants Arch Resources and Consol Energy, both of which have relied heavily on self-insurance, has advocates concerned about how future black lung liabilities will be covered.

"The trust fund that exists currently was not necessarily set up in a way to accommodate this corporate shedding of health care liabilities," Muckian-Bates explained.

The Labor Department rule now requires companies to put down 100% of their liabilities as collateral, and requires a yearly review process of their self-insurance polices to help ensure adequate resources for benefits are available. A recommendation to create a publicly accessible data portal to make compliance with the new regulation more transparent was not included in the final rule.

Muckian-Bates pointed out black lung can take years to develop and early symptoms typically do not qualify folks for benefits. The condition is full-blown years down the line, in retirement or after a career switch or mine closure. At that point, individuals then have to rely on benefits from their previous employer.

"This new rule ensures that those coal companies who would be responsible for that disability have the collateral necessary to cover their health care needs, as well as their benefit stipends," Muckian-Bates outlined.

Black lung disability payments to miners have been shrinking. In 2024, the monthly payment for an individual was around $772 a month, or up to around $1,500 a month for households with three or more dependents.A new federal rule aims to close a loophole allowing coal companies to walk away from their obligations to pay disability benefits and health insurance to miners who worked for them and contracted black lung disease.

The so-called "self-insurance loophole" lets companies dump hundreds of millions of dollars in health liabilities onto the Black Lung Disability Trust Fund, a safety net program riddled with debt and backed up by taxpayer dollars.

Brendan Muckian-Bates, policy and advocacy associate for the Appalachian Citizens Law Center, said the recent merger of coal giants Arch Resources and Consol Energy, both of which have relied heavily on self-insurance, has advocates concerned about how future black lung liabilities will be covered.

"The trust fund that exists currently was not necessarily set up in a way to accommodate this corporate shedding of health care liabilities," Muckian-Bates explained.

The Labor Department rule now requires companies to put down 100% of their liabilities as collateral, and requires a yearly review process of their self-insurance polices to help ensure adequate resources for benefits are available. A recommendation to create a publicly accessible data portal to make compliance with the new regulation more transparent was not included in the final rule.

Muckian-Bates pointed out black lung can take years to develop and early symptoms typically do not qualify folks for benefits. The condition is full-blown years down the line, in retirement or after a career switch or mine closure. At that point, individuals then have to rely on benefits from their previous employer.

"This new rule ensures that those coal companies who would be responsible for that disability have the collateral necessary to cover their health care needs, as well as their benefit stipends," Muckian-Bates outlined.

Black lung disability payments to miners have been shrinking. In 2024, the monthly payment for an individual was around $772 a month, or up to around $1,500 a month for households with three or more dependents.

Community Health Centers are stepping up to meet a critical need for dental care across Tennessee.

Dental visits at these clinics have increased by 19% and patient numbers have risen by nearly 16%, underscoring the importance of these services.

Libby Thurman, CEO of the Tennessee Primary Care Association, said the demand has grown, especially as more people have gained dental coverage through TennCare, the state's Medicaid program. Thurman explains TennCare did not cover dental services for adults until recently, although it did cover children.

"In 2023, the state expanded access to dental services under TennCare for adults," Thurman noted. "We have had some challenges keeping up with that demand, and that really stems from just making sure we have enough dentists to serve all of those patients."

In 2023, Community Health Centers in the state provided more than 79,000 dental visits to more than 35,000 patients. Across the state, 24 of the 30 health centers now offer dental health services.

Thurman stressed the importance of having access to dental care, since it is so closely tied to a person's overall health. She added the clinics integrate dental services into their broader mission of providing whole-person care.

"Dental care, aside from just oral health, actually has a lot of links to systemic health," Thurman explained. "It's linked to a lot of chronic disease management - so, if your oral health care is unmanaged, likely your chronic disease could be worsened."

Thurman emphasized Community Health Centers provide care to all, regardless of a person's insurance or income status. They also have a sliding-fee scale, so patients are often able to get dental care at a lower cost than they might find elsewhere.

Groups across the state are working to reduce overdose deaths among minority populations.

According to state data, overdose deaths are on the decline but among Black residents, there were around 68 deaths per 100,000 people last year; more than 51% greater than the overall rate of deaths.

Matt Johnson, board member of the nonprofit CARES Coalition in Franklin County, said the county is struggling with a lack of emergency shelter and medical services for undocumented individuals. The coalition's Community Connectors Project aims to go door-to-door in neighborhoods to help residents access the services they need.

"People who don't necessarily have a visa or a green card, or even health insurance," Johnson outlined. "We need them to be able to go and receive services; for kids to be able to see dentists, especially within our minority population has been a challenge."

The coalition is one of 10 organizations awarded $50,000 grants from the Foundation for a Healthy Kentucky's Funding for Recovery Equity and Expansion program, a partnership with the Cabinet for Health and Family Services' Kentucky Overdose Response Effort.

In Western Kentucky, the Four Rivers Foundation has expanded mental health and health care services in underserved schools.

Dr. Alex Wright, CEO of Wright Medical who works with the foundation, said gaps in access often result in students either not receiving or experiencing long delays in care. He noted so far, more than 3,000 students have been served in the classroom.

"In some of our districts, we estimated up to 50% of children were lacking any continuity of health care," Wright reported. "Many of these children haven't had a pediatrician or primary care provider, usually since they were an infant or a toddler."

Research points to increased stigma surrounding substance use disorder and mental health in communities of color. According to the Yale School of Medicine, treatment inequities persist. Nationwide in 2018, the majority of Black and Hispanic people diagnosed with the substance use disorder did not receive treatment.


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By Cat Sandoval for WISH-TV.
Broadcast version by Joe Ulery for Indiana News Service reporting for the WISH-TV-Free Press Indiana-Public News Service Collaboration

Respiratory syncytial virus (RSV) is on the rise in Indiana, according to the Centers for Disease Control and Prevention, and it's forcing some hospitals to implement visitor restrictions.

Dr. Christopher Doehring, of Franciscan Health in Indianapolis, spoke with News 8 about why this respiratory virus increases during winter months and what hospitals are doing to prevent its spread.

"Like most of the respiratory viruses, as the weather turns cooler and people spend more time inside and around each other, its a just a highly contagious respiratory virus," Doehring said. "Like all respiratory viruses, we tend to see an increase in cases this time of year."

Holiday get-togethers can help spread the virus.

"You start to see around Thanksgiving time, you start having families coming together," Doehring said. "They're spending times in doors and it's multiple generations together. It's a natural epidemiologic phenomenon."

According to medical experts, RSV causes infections in the lungs. In healthy adults and older children, symptoms are mild, similar to the common cold.

RSV can be prevented by using good hygiene, such as washing hands and avoiding touching one's face.

Doehring said babies, premature babies, and immunocompromised elderly adults can experience severe cough, shortness of breath, and pneumonia, or even death. Doehring recommends getting vaccinated.

"Once you have the symptoms or are under the weather, take the time to recover, heal, and minimize exposing others as best as you can," Doehring said.

At Franciscan Health Hospital, masks and hand sanitizers stations are readily available to prevent the spread. Those under the age of 18 because younger visitors are more likely to spread respiratory viruses. Other hospitals in Marion County are doing the same.

Doehring says he has seen an increase of RSV cases, which is typical this time of year, but it's not alarming.

"Certainly in our hospitals and around other hospitals in central Indiana, we're not at a point where we're overrun or overcrowded in our ICUs or emergency department," Doehring said.


Cat Sandoval wrote this article for WISH-TV.


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