What Happened?

Thousands of coal miners with black lung disease may not be getting the medical coverage their employers are legally required to provide, and the federal government has no system in place to check.

A report published in May by the Government Accountability Office (GAO), the nonpartisan watchdog that audits federal programs for Congress, found that the Department of Labor (DOL) does not track whether coal companies are actually paying for miners' medical care. About 22,500 people, including miners, survivors, and dependents, received more than $153 million in federal black lung benefits in fiscal year 2025. Yet the government cannot confirm whether the coal companies legally on the hook for medical costs are holding up their end.

Why Does it Matter to Me?

If you or a family member worked in coal mining and developed black lung disease, a serious and irreversible lung condition caused by breathing coal dust, federal law entitles you to both income payments and medical coverage. The medical side is not.

In 2024, there were 7,709 miners receiving federal black lung benefits. Nearly all, 93 percent, were 62 or older. Among miners under 62, close to one in four received only federal benefit payments, averaging $13,400 a year. For that group, any gap in medical coverage from their former employer hits especially hard.

Miners in all six focus groups the GAO conducted reported problems getting black lung-related medical benefits. Two of those groups specifically said they had trouble getting medical coverage from the coal companies responsible for providing it.

Both Sides, Now

The GAO made one recommendation: that DOL start collecting information on, and monitoring, whether coal companies are providing medical benefits as required. DOL agreed with the finding and said it plans to update its customer experience surveys to ask miners about their medical coverage. The agency also said it will use those survey results to decide whether further action is needed.

Four Democratic senators (John Hickenlooper of Colorado, John Fetterman of Pennsylvania, and Tim Kaine and Mark R. Warner of Virginia) requested the GAO study back in March 2023. Kaine, Warner, and Fetterman, along with Reps. Morgan McGarvey and Bobby Scott, have reintroduced the Black Lung Benefits Improvement Act to strengthen miners' access to the program. No Republican response to the GAO report is included in the source material.

What Happens Next?

The GAO's recommendation is currently listed as open, meaning DOL has agreed to act but the watchdog is still monitoring whether it follows through. DOL has not set a public deadline for updating its surveys or launching any follow-up process. Congress could push the issue forward through the Black Lung Benefits Improvement Act, but that bill has not yet passed. Until DOL puts a monitoring system in place, there is no mechanism to confirm whether miners are receiving the medical benefits the law says they are owed.

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