Patty, a retired school bus driver at age 59, shared that they have been using Newmont insurance for a long time without much knowledge about other options. However, everything suddenly changed and it was a huge disappointment.

The challenges faced by the Pawelek family represent the issues commonly seen in mining towns, where the healthcare systems have been affected and altered by the fluctuations in the industry. This has resulted in ripple effects that hinder people’s ability to receive medical treatment, exacerbating inequalities and negatively impacting the health of populations that are already vulnerable to physical and mental health issues.

Mining companies provide lucrative employment opportunities with attractive perks, but paradoxically, they can hinder access to healthcare. Healthcare systems may rely heavily on these insurance plans for survival, and the alluring benefits may dissuade providers from serving the wider community. This is a direct result of a healthcare system that relies on employer-provided insurance for financial gain, causing it to prioritize the needs of those who possess it.

Over the course of six months, I conducted interviews with over 90 individuals, including patients, healthcare providers, retired miners, community leaders, and health care experts from various locations in the U.S. These locations included Williamson, West Virginia; Elko, Nevada; and White Sulphur Springs, Montana, which represent different stages of the mining industry’s history. The interviews uncovered the many challenges faced by retired and injured miners and their families in accessing healthcare. Additionally, it revealed the struggles of communities left with inadequate or shuttered health facilities, as well as the high cost of hospital bills in towns where mining has boosted median incomes.

As the Biden administration encourages domestic sourcing of resources like copper, lithium, and cobalt for electric cars and renewable energy production, more and more communities in the United States may encounter similar challenges with the opening of mines.

Copper is a valuable resource that has many uses, such as in wind turbines, generators, and electrical cables. The demand for copper in the United States is expected to double from 2021 to 2035. This year, the Biden administration included copper on the critical materials list for the first time. They are also advocating for an increase in domestic production and refining of critical minerals and materials, with the goal of achieving 100% carbon pollution-free energy within the next twelve years.

Mark Haggerty, a senior fellow at the Center for American Progress, stated that the number of new mines in the United States is still uncertain. However, it is expected that there will be several mines, possibly even a significant amount. These mines will all be situated in rural communities that are likely to face similar challenges. The common struggle in these areas will include issues with healthcare and rural hospitals.

The likelihood of miners having private health insurance is higher compared to other rural workers due to the high risks associated with their job. According to the Rural Policy Research Institute, approximately 75% of non-managers have private health plans, whereas only about 57% in construction and 53% in agriculture do.

However, these health plans can often provide better coverage than the insurance options available to the rest of the community, which can negatively impact access to healthcare services.

According to Jan Brizee, a former representative for Elko and other rural counties, doctors prefer the large payments provided by high-end insurance policies from the gold mine. They do not want the small amounts they receive from Medicare. This means that retired individuals after 25 or 30 years may have no access to primary care or specialized treatment options, forcing them to travel out of town.

Key Takeaways

The health plans provided to mine employees usually pay hospitals and doctors at higher rates compared to Medicare and Medicaid.

The insurance offered by 2Miners could disrupt the healthcare system in rural areas as it provides significantly better benefits compared to the rest of the community’s coverage.

This situation can result in retired and injured miners, as well as other residents, facing difficulties in receiving proper care and potentially threatening the stability of hospitals.

Some measures, such as the expansion of Medicaid and increased federal funding for health centers and critical access hospitals, have provided some assistance to rural communities, but they are often insufficient.

As the Biden administration increases efforts to produce and use more essential minerals and materials within the country to facilitate the shift towards renewable energy, there will likely be a rise in the number of communities dealing with these difficulties.

According to the U.S. Bureau of Labor Statistics, underground mining machine operators are ranked among the top 10 deadliest professions by the National Safety Council.

The mining industry in Montana stated that the generous health benefits are a reflection of the dangers and challenges associated with the job. The mining association in Nevada also recognized that their comprehensive benefit packages may have unintended effects.

Dana Bennett, interim president of the Nevada Mining Association, stated in an email that the mining industry in Nevada takes pride in the comprehensive benefits offered to its employees. The industry also boasts of paying the highest average wages, almost twice the state average, among private employers. It is acknowledged that these generous compensation packages have a positive impact on the community as a whole.

The National Mining Association and the American Exploration and Mining Association both chose not to provide a statement.

The expansion of Medicaid and additional federal funding for rural healthcare facilities have been beneficial in certain towns. However, healthcare providers criticize the low reimbursement rates from the state Medicaid program, which are insufficient to cover expenses. Additionally, there is inadequate federal support for primary care and hospital designations that do not adequately address the needs of all facilities.

These solutions have not adequately addressed the systemic issues with employer-provided healthcare in these communities.

“It’s a significant, undisclosed part of the economy in America that is located in rural areas. According to Michael Topchik from the Chartis Center for Rural Health, these communities play a critical role in fulfilling essential needs. However, it is important to note that they also have significant needs themselves, including access to quality healthcare, which is currently lacking.”

PART 1

WILLIAMSON

In 2018, the hospital was sold to a nearby group due to its financial insolvency.

In the autumn that followed, the hospital declared bankruptcy. By the time spring arrived, Williamson Memorial had become one of around 200 rural hospitals that have shut down in the past 20 years.

A probe conducted by the Energy and Commerce Committee of the House.

When strolling along Second Avenue, one can observe numerous empty storefronts in the downtown area. Incidents of building fires, often caused by individuals occupying abandoned properties, are frequently reported. In addition, Goodwill closed its Williamson location in 2017.

Dr. Steve Wilson, an optometrist, described the feeling as similar to nails being driven into a coffin. He noted that seeing the identity of one’s city change can be difficult.

The closure of Williamson Memorial resulted in Mingo County being without a hospital for the first time in 100 years. Some individuals travel across the river to a hospital in Pike County, Kentucky, but this is not in-network for others, such as those under the state employee health plan. This may require them to drive over 80 miles for in-network care. Covering these transportation expenses can be difficult, especially with rising gas prices, inflation, and a median household income of $35,000 in the town.

According to Chris Dotson, president of the Tug Valley Chamber of Commerce, it may not be practical for hourly employees to constantly take time off work and commute for two hours to complete tasks. This can be especially difficult for those with family obligations.

Despite a 33% decrease in population over the past 30 years, there remains a considerable number of approximately 23,000 individuals residing in Mingo County. Among them are numerous retired coal miners who face challenges in obtaining adequate healthcare. These individuals are also dealing with various significant health problems, including black lung disease, a chronic illness caused by the inhalation of coal dust.

Karen Bowling, the former secretary for the West Virginia Department of Health and Human Services and CEO of a hospital in Princeton, West Virginia, stated that there are still coal miners in our community who suffer from various health issues as a result of years spent working in the mines. These health problems include pneumoconiosis, black lung, COPD, heart disease, and even arthritis. Bowling emphasized the importance of finding ways to provide support for these individuals who have dedicated their lives to coal production and have contributed to the country.

A study discovered that miners, including coal miners, have a greater likelihood of experiencing numerous health risk factors compared to other types of manual laborers. These risk factors include heavy alcohol consumption, use of chewing tobacco, and inadequate sleep of less than seven hours.

Following its closure, Williamson Memorial was acquired by Williamson Health and Wellness Center, which is a federally designated healthcare facility. In the past 10 years, the center has expanded to include multiple structures in the downtown area, providing services such as primary care, pediatric care, dental care, and behavioral health services. Additionally, the center hosts an indoor farmer’s market and has intentions to reopen the town’s cherished hospital.

However, the hospital’s renovations have been hindered by delays. Additionally, the hospital will not be eligible for extra federal funding due to its proximity to a Kentucky hospital.

Beckett, the CEO of FQHC and Williamson Memorial, is optimistic that the clinic will bring in patients who can financially support the hospital. The hospital aims to offer lab and radiology services by December and inpatient hospital care after the new year. Emergency room care, which is costly, will be available at a later date.

Williamson is currently waiting.

Larry New, a pharmacist at Hurley Drug, stated that the entire town is relying on this hospital. He expressed concern that if the hospital fails, it may also lead to the downfall of the town.

PART 2

ELKO

County Health Rankings.

Dr. Bridget Martinez, who completed a portion of her medical residency in Elko, believes that with the current benefits and income levels of the population in Elko, we have the opportunity to create an excellent healthcare system. She also mentions the significant gap that exists, which is illogical.

“That is the unfortunate aspect.”

The healthcare system in Elko is divided and disjointed.

The mining industry in northeastern Nevada employs over 11,000 individuals. The majority of these workers are either directly employed or work as contractors for Nevada Gold Mines, which is a partnership between former rivals Barrick and Newmont. This venture runs the largest gold-producing complex globally.

Although there are miners who have doubts about the Nevada Gold Mines clinic because it reminds them of previous company doctors who prioritized the employer’s interests over the employees’, it serves as a facility for workers who have been injured on the job and require treatment and approval to resume work.

Typically, miners can anticipate receiving reasonably priced basic medical services near their residence and financial support for accommodations and transportation when seeking care outside of their hometown. On the other hand, their retired coworker may face challenges in finding affordable and satisfactory healthcare options in the local vicinity.

According to Gerald Ackerman, an assistant dean of rural health at the University of Nevada, Reno School of Medicine, the benefits of this program for mine workers may come at the expense of accessible primary care for others. This creates a divide in the healthcare system.

Requests for comment from Nevada Gold Mines went unanswered.

Certain individuals who do not have employment at the mines utilize the nearby federally qualified health center. This center receives financial support from the federal government, allowing it to accommodate more patients with Medicare and Medicaid compared to a private doctor’s office. Some people turn to urgent care clinics that provide primary care services. Unfortunately, there are also those who have to travel long distances to states like Idaho or Utah for primary care. This can lead to frustration and some may even give up seeking medical assistance.

Many individuals have grown frustrated and have given up, as stated by Sonia Ruiz, the assistant director of the Medicare Assistance Program at Access to Healthcare Network, a nonprofit organization operating statewide.

I wrote a letter to the parent company of the hospital expressing my concerns about the facility’s “anticompetitive pricing.”

According to Brizee, while working as a state ombudsman reviewing patient bills, she noticed that the hospital often charged significantly higher prices for services compared to those in Las Vegas. She believes this is due to the higher wages in the mining industry and the hospital charging based on what they perceived the community could afford. The median household income in Elko, where the hospital is located, is approximately $82,000, which is almost 30 percent higher than in Las Vegas.

The hospital administrators reject any claims that their fees are related to miners’ wages and assert that it is challenging to compare their expenses to those of facilities in Las Vegas due to variations in labor, supplies, and equipment costs, among other factors. They also highlight their collaboration with local government officials and industries, including mining, to ensure that the hospital meets the needs of Elko. Additionally, they mention various ways in which the hospital contributes to the community, including a complimentary drive-through flu shot clinic and over $20 million in charitable and uncompensated care rendered in the previous year.

The hospital released a statement stating that they are the only hospital within a 125-mile radius that provides acute care. They strongly believe that receiving healthcare close to home is the most effective. The hospital constantly reviews their rates and services, and is dedicated to working together with payers, mining companies, local healthcare providers, and community partners to ensure that all members of the community have access to necessary healthcare.

“I am experiencing an issue.”

The difficulties faced by primary care and hospitals also have consequences that spread outward.

In order to save money, the mines and other major employers have partnered with a surgery management company that facilitates out-of-town medical care, typically in Salt Lake. Those who are able to do so, travel independently.

Physicians are claiming that this worsens the shortage of specialized healthcare workers in the community. Since a large number of well-insured patients are seeking treatment outside of the area, it becomes more challenging to attract doctors who could potentially encourage those with good insurance to remain in the community.

Dr. David Hogle, a primary care doctor in Elko, explained that this prevents new gastroenterologists from establishing their own practice. He added, “If the payments for procedures are being sent to Salt Lake, then Medicare becomes the only source of payment.”

A company from another state recently launched an outpatient surgery center in our town. This could potentially increase accessibility to certain specialized healthcare services. According to Angela Browning, the business office manager, the center currently accepts insurance and surgery management plans from mines, Medicare, and veterans and Indian Health Services. The center plans to eventually accept all plans, including Medicaid.

Cobalt has initiated – attempting to establish comparable contracts, which have historically been prevalent in Canada, Europe, and Australia.

According to Cassie Coburn, the executive director of the stewardship council, it is essential for housing, health care, and education to be aligned to ensure that we are organized and ready when these individuals arrive.

The mine is working with the stewardship council and the community, and has hired several Meagher County locals for important roles. The leaders of the mine are optimistic that an increase in new employees will contribute to the growth of the hospital’s patient population.

Nancy Schlepp, Vice President of Communications and Government Relations for Sandfire Resources America, stated that they are focusing on future planning, taking into account the environment, economy, and sustainability. They are mindful that their presence is temporary and are committed to utilizing their time effectively and responsibly.

Matt Vincent, the head of the Montana Mining Association, suggested that having mining company representatives on local health boards and foundations could help prevent any negative effects that may arise from providing good benefits to the health infrastructure.

Vincent stated in an email that these connections enable them to gain direct knowledge of any obstacles. He emphasized that each community, healthcare provider, mining company, and benefits package is unique, and therefore there is no universal solution.

This article was created as a part of the 2023 National Fellowship for the USC Annenberg Center for Health Journalism.