CARLIN, Nevada — As a mining family, the Paweleks worried little about their health care. Mike’s job as a gold miner provided the family with good insurance, and the medical clinic in town run by the mines was affordable. When Mike and Patty needed surgeries for bad knees, the mine paid for travel and lodging in Salt Lake City, 250 miles from their home.
That was before Mike, 64, was diagnosed with cervical dystonia, a rare neurological condition that causes violent tremors, ending his 32-year career with Newmont Mining Corp. in 2019.
The Paweleks lost their primary income. They also lost their health insurance — and the robust health care access it afforded. In other parts of the country, Mike’s disability insurance and Patty’s Obamacare plan could have easily gotten them a primary care doctor. But in mining communities like Elko County in northeastern Nevada, mine insurance is so important to the local health care infrastructure that many without it have to fight for basic care.
“We mostly had Newmont insurance forever and didn’t really know anything else,” said Patty, a 59-year-old retired school bus driver. “And then it just came all crashing down.”
The Paweleks’ struggles are emblematic of the problems that beset mining communities where health systems have been disrupted and distorted by the industry’s booms and busts, creating ripple effects that make it harder for people to access care, deepening inequities and worsening health outcomes in populations often predisposed to poor physical and mental health.
Mining companies offer good jobs with good benefits that can counterintuitively damage health care access. Health systems can grow dependent on those insurance plans to survive, and the benefits are in some cases so good that providers are reluctant to serve others in the community. It’s the consequence of a national health care system that feeds off employer-sponsored health insurance to turn a profit, and, as a result, warps itself to meet the needs of those who have it.
Six months of interviews with more than 90 patients, providers, retired miners, community leaders and health care experts across the U.S., including in three towns characteristic of the mining industry’s past, present and future — Williamson, West Virginia; Elko, Nevada; and White Sulphur Springs, Montana — reveal the breadth of these perils: retired and injured miners, and their families, struggling to get care; communities left with beleaguered or closed health facilities; and pricy hospital bills in towns where mines have driven up median incomes.
A growing number of communities will likely soon face similar predicaments as mines open across the United States amid the Biden administration’s push for more domestic sourcing of resources — such as copper, lithium and cobalt — needed to power electric cars and produce renewable electricity.
Copper, for example, is used in wind turbines, generators and electrical cables, and U.S. demand for the mineral is projected to double between 2021 and 2035. The Biden administration for the first time this year added copper to the U.S. critical materials list and is pushing to increase the domestic production and refinement of critical minerals and materials as it aims to achieve 100 percent carbon pollution-free energy in the next dozen years.
“It’s unclear yet how many new mines we’ll get in the United States. But we’ll get several, at least. Maybe a lot, and every one of those mines is going to be located in a community that’s going to have a pretty similar set of struggles,” said Mark Haggerty, senior fellow on the energy and environment team at the left-leaning Center for American Progress. “The challenge is going to be the same in all of these rural communities. They’re all going to have struggling health care, rural hospitals, potentially.”
Miners are more likely to have private health insurance than many other rural workers, in part, because of the dangers of the job. Nearly three-quarters of non-managers are insured by private health plans compared with roughly 57 percent in construction and 53 percent in agriculture, according to the Rural Policy Research Institute.
But these health plans are often better than the insurance in the rest of the community and create market dynamics that sour health care access.
“Doctors want these big reimbursements from the very rich insurance policies that the gold mine provides. They don’t want the pennies they receive from Medicare,” said Jan Brizee, former ombudsman for the Nevada Office for Consumer Health Assistance representing Elko and other rural counties. “So you have somebody who’s retired after 25 or 30 years, and now they have nothing, having to travel out of town to get even primary care, let alone a specialist.”
Not all mining communities experience these problems, and similar issues exist in towns dependent on other industries with good benefits, like manufacturing. But mining communities face unique obstacles compared with other one-company towns — including remoteness and challenging geography — that make it difficult to attract other businesses that would diversify their health insurance landscape.
Miners also tend to be in worse health than their counterparts with other manual labor jobs, with higher rates of poor sleep and heart disease. And while mine-related injuries have dropped over the last decade, thousands of mine workers are still injured seriously enough each year that they miss work, according to the National Safety Council. Underground mining machine operators rank among the top 10 for deadliest professions, according to the U.S. Bureau of Labor Statistics.
The mining association in Montana said good health benefits reflect the risk and difficulty of the job, and Nevada’s mining association acknowledged that their robust benefit packages can have unintended consequences.
“The Nevada mining industry is proud of the benefit packages that are available to our employees. We also pay the highest wages on average among private employers — nearly twice the state average — and recognize that these robust compensation packages have a ripple effect through a community,” said Dana Bennett, interim president of the Nevada Mining Association, in an email.
The National Mining Association and the American Exploration and Mining Association declined to comment.
Medicaid expansion and extra federal funding to support rural health centers and hospitals have helped in some towns. But providers bemoan stingy state Medicaid reimbursement rates that aren’t enough to pay the bills, paltry federal funding to support primary care and hospital designations that don’t meet the needs of all facilities.
For the most part, these solutions have inadequately addressed the systemic failures of employer-based health systems in these communities.
“It’s a huge, hidden sector of the American economy. It’s out in the hinterlands. No one in America knows,” said Michael Topchik, national leader at the Chartis Center for Rural Health. “These are communities that are meeting vital needs. But guess what? They have vital needs. Health care is one of those vital needs, and it’s failing.”
Before the floods, before coal crashed, before the opioid epidemic — and before it lost its hospital — Williamson flourished.
Known as the “heart of the billion-dollar coalfields,” downtown Williamson was perennially packed. People traveled 80 miles — from Charleston and Huntington, West Virginia’s two biggest cities — to shop, paying for everything with the wads of bills in their pockets.
And they came from all over the region to go to Williamson Memorial Hospital.
Most everyone in town has a story about the hospital on the hill. They were born there, or their kids or parents were. It saved them from pneumonia or complications from chickenpox or liver disease. People went to the cafeteria just for the chicken tenders.
That was before coal collapsed, taking Williamson Memorial along with it. By the 1970s, increasing mechanization and more surface mining requiring fewer workers had diminished the coal workforce. And the industry tumbled into a death spiral after the Great Recession, the result of lower natural gas prices and a shift toward renewable energy. It hurt related sectors, like rail, too.
For decades, the hospital thrived on the industry’s good-paying health insurance, but it became so dependent on those plans it couldn’t survive without them.
“Once those health benefit plans went away, so did the access to health care,” said Nathan Brown, a lawyer, former coal miner and president of the Mingo County Commission.
‘A rippling effect’
Williamson is one of many rural Appalachian towns where the decline of the coal industry upended the health care system. The town is a shadow of its former self, and the closure of its lone hospital is a cautionary tale for communities anticipating the bounty new mines will bring.
“That hospital … offered stability to the community, and when those doors closed for the last time, it was another dent in the armor of our community,” said John Mark Hubbard, a former Mingo County commissioner whose father and grandfather were coal miners.
When coal was booming, companies paid 100 percent of health care premiums. Health plans were — and in other mining communities still are — an attractive benefit for workers.
“The amount of dollars company-wide that were appropriated to those health benefits 20 years ago was astronomical,” said Leasha Johnson, a former coal company employee and now executive director of the Mingo County Redevelopment Authority. “I had 100 percent coverage. The health care coverage was just phenomenal back in the heyday.”
The hospital had so much demand that it added a fourth floor and tripled the size of its emergency room in the mid-1990s. The facility boasted in the local newspaper of its robust suite of services, including two delivery rooms, three operating rooms, a seven-bed intensive care unit, a 16-bed telemetry unit, an endoscopic lab and a cardiopulmonary rehabilitation program.
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