First, the only way U.S. workers get black lung disease is working in a coal mine.

Second, respiratory diseases caused by exposure to coal mine dust are 100 percent preventable.

Third, coal mine operators can prevent their employees from developing pneumoconioses by following their written dust control plan.

Fourth, employers who fail to do so—and the industry that allows it to happen—should pay the cost of the disease.

But, many are not bearing the cost of black lung disease.  Taxpayers are picking up the tab.

According to new research from CDC/NIOSH, nearly 40 percent of lung transplants received by patients with coal workers’ pneumoconiosis (CWP) were paid by Medicare. They weren’t paid through workers’ compensation insurance or another source that reflects the employer’s liability for the disease. And the cost is not insignificant. The average cost of double lung transplant is $1.19 million. That’s a hefty amount of cost-shifting to taxpayers for a work-related disease that is 100 percent preventable.

NIOSH researchers used data from the United Network for Organ Sharing (UNOS) to examine trends in lung transplantation related to patients with CWP.  Their analysis covered the period October 1987 through June 2017.  The payment source was just one component of their investigation.

In the most recent 10 years, 49 individuals with severe CWP received a lung transplant.  The total number of coal miners receiving lung transplants is 62 when the researchers looked back to 1994. The patients’ ages at time of their transplant surgery ranged from 41 to 69 years.  The mean age was 57 years. Seventy percent of the recipients lived in Kentucky, Virginia and West Virginia.

Lung transplants are a rare treatment for patients with CWP.  The eligibility criteria is tough to meet. It includes an assessment of projected survival benefit, medical necessity, and distance from a donor hospital.  Candidates for transplants are also encouraged to raise funds to cover the cost of their care.  At the University of Kentucky’s program, for example, transplant coordinators expect patients to develop a fundraising plan.  They recommend an organ transplant candidate have $5,000 to $10,000 in savings to cover medicine and local housing expenses.

Of the 2,327 lung transplant surgeries conducted in the U.S. in 2016, only six involved patients with CWP.  The NIOSH researchers note however, that the portion of all lung transplants going to patients with CWP (and dust disease unspecified) has increased substantially.  For the period 1996 to 2006, the rate was less than 1 per 1,000 lung transplant recipients, compared to a rate of 2.68 per 1,000 for the period 2007 to 2017.

The payer information for the 62 cases is largely as follow:

• 24 paid by Medicare (39%)
• 21 paid by private insurance (34%) which I presume could include workers’ compensation insurance, and
• 15 paid by “other government” (24%) which would include the Black Lung Disability Trust Fund (funded by an excise tax on coal)

The NIOSH researchers who conducted this analysis published a similar one in 2016.  I commented on it at the time and noted the cost-shifting to Medicare.  Healthcare expenses for occupational diseases, in particular those as well recognized as coal workers’ pneumoconiosis, should be the responsibility of employers. In fact under Medicare rules, the Department of Labor’s Federal Black Lung Benefits Program is supposed to be the first payer for any healthcare related to a miner’s black lung disease. That’s obviously not happening in many instances.

I filed a FOIA request in January 2016 to learn how many lung transplants were paid for by Labor Department program. I learned that the program authorized payments for seven lung transplants performed in the years 2008 through 2014. Twenty-four lung transplants were conducted in that time period.

In this new paper, the NIOSH researchers express specific interest in the payer information puzzle:

“Although the Organ Procurement and Transplantation Network includes some information on payer type, the relatively high proportion of CWP transplants paid for by public insurance programs—and notably “other government insurance,” which likely includes the Black Lung Disability Trust Fund (which pays for CWP claims when no responsible mine operator can be identified)—merits additional attention. We confirmed with UNOS that more specific payer information were not available in the registry data.”

For my part, I filed a FOIA request earlier this week with the Labor Department. I’ve asked for their most recent data on payments for lung transplants received by coal miners.

If the “other government” payer is not the Labor Department’s Black Lung Disability Trust Fund, who is it?