美国国家公共电台 NPR Obamacare Repeal Threatens A Health Benefit Popular In Coal Country（在线收听）

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The Affordable Care Act includes special provisions that make it easier for coal miners to get black lung benefits. If the ACA goes away, obtaining those benefits could become harder. Kara Lofton of West Virginia Public Broadcasting has more.

KARA LOFTON, BYLINE: At the Pulmonary Rehabilitation Clinic in Scarbro, W.Va., oxygen tubes dangle from the noses of three miners slowly pedaling on stationary bikes. All of these men have black lung, a disease caused by breathing in coal dust. Over time, the dust coats the lungs and causes them to harden. Hard lungs are difficult to expand and contract which makes it hard to breathe.

JAMES BOUNDS: You try to get air in them, and they don't want to cooperate with you like they did before.

LOFTON: That's James Bounds, one of the retired miners at the clinic. Not every coal miner gets black lung in the same way that not every smoker gets cancer, but for those who do, the disease is devastating.

BOUNDS: As your disease grows more in you, there's no cure for it at all. It keeps getting harder and harder until, I guess, one day when you take your last breath, and they just won't expand for you no more.

LOFTON: Bounds is currently one of about 38,000 miners and dependents receiving black lung benefits, compensation for the physical damage he sustained while doing his job. It took him four and a half years to get approved, despite the fact that his lungs are so bad, he has to stop moving to talk.

Debbie Wills is black lung program coordinator for Valley Health primary care system. She says that prior to the Affordable Care Act, it was almost impossible to qualify for the compensation benefits. Coal companies pay the benefits and also pay into a federal trust fund that pays when coal companies can't.

DEBBIE WILLS: Coal company lawyers would doctor shop around the country and find two, three, four, five, seven doctors to say, yes, this miner is disabled, but it's not because of black lung.

LOFTON: Now it's a little bit easier, and the process often goes more quickly. That's because the Affordable Care Act includes something called the Byrd Amendments. One part shifted the burden of proof. Wills explains that instead of miners having to prove that mining caused their black lung, the coal companies have to prove that mining didn't.

WILLS: Once we had the Byrd Amendments, you still have to prove that 100 percent disability which is hard to prove, but if you can prove that and you've worked 15 years or longer in the mines, then you're entitled to a presumption that your disease arose from your coal mine employment.

LOFTON: Another part provides lifetime benefits to certain eligible dependents who survive the death of a miner if the miner had been receiving the benefits before their death. If the ACA is repealed without a replacement, cases that were approved after the ACA went into effect could be reopened, leaving the miner or surviver vulnerable to losing the benefits. And burden of proof may shift again making it difficult for applicants to qualify.

Earlier this month, both the House and the Senate introduced resolutions to preserve the Byrd Amendments from a broader ACA repeal. Republican West Virginia Representative Evan Jenkins, an ACA opponent, introduced the measure in the House.

EVAN JENKINS: I am a firm believer that Obamacare is already in a death spiral and desperately needs to be fixed. So while we are going to work to improve our health care system, I feel strongly about my resolution to make sure that the presumption relating to black lung is contained in whatever is the end product of this year.

LOFTON: But that end product is still a pretty big question at this point. For NPR News, I'm Kara Lofton in Charleston, W.Va.

INSKEEP: This story is part of a reporting partnership with NPR, West Virginia Public Broadcasting and Kaiser Health News.