Why it Matters

Tens of thousands of coal miners with black lung disease are legally owed medical benefits from the companies that employed them. But the federal government has no system to check whether those companies are actually paying up, according to a report published in May by the Government Accountability Office (GAO), Congress's independent watchdog.

What happened?

The independent watchdog reviewed the Department of Labor's Black Lung Benefits Program, which pays income and medical benefits to coal miners who are totally disabled by black lung disease. In fiscal year 2025, about 22,500 people, including miners, survivors, and dependents, received more than $153 million in benefits.

The program works like this: the federal government pays income benefits, but coal companies, called "responsible operators," are required by law to cover miners' medical costs. The GAO found the Department of Labor (DOL) has no process to track whether those companies are actually doing that.

Miners described the gap in concrete terms. In all six focus groups the investigative watchdog conducted, with 64 miners across Kentucky, Pennsylvania, Virginia, and West Virginia, participants reported problems getting black lung-related medical care. Two of the six groups specifically said they had trouble getting coverage from the coal companies responsible for providing it.

Why Does it Matter to Me?

In calendar year 2024, roughly 7,700 miners were receiving federal black lung benefits. The GAO found 93 percent of miner beneficiaries in 2024 were 62 or older. About 87 percent relied solely on federal black lung benefits for their disability income.

For younger miners, those under 62, nearly one in four received only federal benefit payments, averaging $13,400 a year in 2024. Medical costs for black lung disease can be substantial.

If a coal company fails to provide required medical coverage and no one is checking, a miner may have no straightforward way to get help.

What happens next?

There was one recommendation: The Labor Department should start collecting information on, and monitoring, whether responsible operators are providing medical benefits. The agency agreed and said it plans to update its customer experience surveys to include questions about medical coverage from coal companies. It also said it will allow claimants to provide contact information for follow-up. The GAO's recommendation remains open, meaning it has accepted DOL's plan but will continue to watch whether the agency follows through.

The Labor Department has agreed to update its surveys but has not announced a timeline for when the changes will take effect. The GAO will monitor the agency's progress and the recommendation will remain open until the Labor Department demonstrates it has acted.

Separately, the Black Lung Benefits Improvement Act would need to pass both the House and Senate and be signed into law before any of its changes take effect. No vote on that bill is currently scheduled.

Both sides, now

Four Democratic senators—John Hickenlooper (D-Colo.), Tim Kaine (D-Va.), Mark R. Warner (D-Va.), and John Fetterman (D-Pa.)—requested the study in March 2023. They, along with Rep. Morgan McGarvey (D-Ky.) and Rep. Bobby Scott (D-Va.), have reintroduced the Black Lung Benefits Improvement Act to expand miners' access to the program. The source material does not identify any Republican co-sponsors.

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