As a candidate, President Trump promised he would “end the war” on coal. Since taking office, it’s become clear what he meant: He’d line the pockets of coal companies by putting the health, safety, and paychecks of coal workers at risk.

—Trump’s secretly neogtiating to protect mines that repeadedly put miners lives at risk. In 2013, the Department of Labor implemented the  “Pattern of Violations Rule,” allowing the Mine Safety and Health Administration (MSHA) to focus enforcement on mine operators that repeatedly put the safety of miners at risk. The impetus for the rule? The Upper Big Branch tragedy, an explosion that killed 29 people in a West Virginia mine with an “egregious” safety record.  According to DOL, outdated regulations prevented them from properly monitoring the mine’s compliance. The “Pattern of Violations Rule” was designed to change that, but instead of protecting mine workers, the Trump Administration used a suit brought by mine operators to justify rolling back the rule as part of ongoing “settlement” discussions with the mining industry.

SIDEBAR: President Trump’s new Assistant Secretary of Labor for Mine Safety and Health, David Zatezalo, is now overseeing the “settlement” in the lawsuit. The problem? Zatezalo previously served as the Chairman of the Ohio Coal Association and the Kentucky Coal Association, industry associations that are among the plaintiffs in that very suit.

—Trump froze efforts to protect miners from being crushed or killed by underground equipment. In 2015, DOL began a rulemaking to require that all major mining machinery be equipped with proximity detection technology to prevent unintended and potentially deadly contact with miners.  According to DOL, the technology was necessary to prevent miners from being pinned or crushed when working near mobile equipment.  Shortly after taking office, President Trump unilaterally froze the rule, placing it on DOL’s long-term agenda to languish.

SIDEBAR: MSHA estimated the new rule would have prevented 42 coal miner deaths and 179 injuries between 1984 and 2014. Looking ahead, the agency projected the rule would prevent an additional 15 fatalities and 70 injuries over the next 10 years, in addition to savings from operational shutdowns associated with injuries and fatalities. But mine operators claimed the cost of keeping miners safe was too high, and the Trump Administration agreed.

—Trump made it harder for unemployed coal miners in Kentucky to get healthcare. Contrary to promises made by President Trump during the campaign, coal jobs in Kentucky have not shown any signs of growth. Indeed, during 2017 the coal mining industry in Kentucky lost 6.8 percent of its jobs year-over-year. Despite these trends, the Trump Administration approved Kentucky’s plan to place work requirements on Medicaid, making it harder for miners to access healthcare if they are unable to secure employment.

SIDEBAR: If the Trump-approved plan is implemented, Kentuckians are projected to have a total of 238,310 fewer months of Medicaid access in the plan’s first year, and 1,140,032 fewer months of access in the plan’s fifth year.  This devastating loss is compounded by the Kentucky labor market. As union membership in the state continues to decline, Medicaid will increasingly become a crucial source of healthcare.

—Trump’s making it easier for coal country insurers to cut coverage for opioid addiction treatment. The opioid epidemic is ravaging coal country. Labor intensive jobs like coal mining lead to high opioid prescription rates, which in turn place miners at an increased risk of opioid addiction. Before the Affordable Care Act, one-third of plans sold on the individual market did not cover addiction. The ACA changed this by specifically mandating insurance plans cover drugs to treat opioid use disorder, alcoholism, and opioid harm reduction. But in October, the Trump Administration proposed a rule that would allow states further leeway in designating what minimum essential health benefits insurers must cover, opening the door for insurers to offer plans that provide little to no coverage for Americans suffering from opioid addiction.

SIDEBAR: An additional consequence of the opioid epidemic? Increased rates of HIV in coal country. In 2017, Northern Kentucky saw a 48 percent in new cases of HIV. The increase is tied to sharing needles and syringes used to inject opioid painkillers.