Photo: President Lyndon B. Johnson shakes the hand of one of the residents of Appalachia as Agent Rufus Youngblood (far left) looks on. (Source: Cecil Stoughton)
Appalachia has long looked to the Federal Government for assistance to “get by”, and the federal government, in its fashion, has responded. Five Appalachian states are among the 10 states most dependent on federal funding.[i] West Virginia gets 26.2 percent of its annual income from federal government programs, Mississippi 24 percent, Kentucky 22.4 percent, and Alabama 21.8 percent.[ii] In some of the most distressed counties, such as Martin County, Kentucky, which LBJ visited in the 1960s to declare his “War on Poverty”, the income from government transfer payments exceeds all the income from wages and salaries – a ratio that far outstrips the national average.[iii]
As part of LBJ’s War on Poverty, billions upon billions of federal dollars poured into Appalachia in the form of welfare, food stamps, unemployment benefits, disability compensation, education funding, black lung payments, housing aid, etc. Martin County, KY alone has received over $2.1 billion in federal aid since 1960s.[iv]
West Virginia: Map of Poverty
|Photo: Map showing the ARC economic designations for the counties of the U.S. state of West Virginia. The ARC gives each county one of five designations: “Distressed” (the most economically endangered), “At-Risk,” “Transitional,” “Competitive,” and “Attainment” (“attainment” meaning the county is at least on par with national averages). The data is based on three-year unemployment, income per capita, and poverty rate. No counties in West Virginia were given the “Attainment” designation, and thus it is not listed on the map. (Source: Wikipedia: Economy of West Virginia)|
Despite the large influx of federal dollars, the war on poverty has clearly failed to lift the people of the region out of poverty. Instead, it maintains people in poverty, dependent on government assistance to get by. In 2011, Martin County’s largest source of personal income was its $143 million in government aid. In Martin County, one-third of the 12,742 people in the county have Medicaid coverage, one-fourth of its families draw at least one disability check, and 35 percent of its people receive food stamps.[v]
Then there are the exploding federal disability payments (SSDI). Coal miners are consistently exposed to dust, hazardous gases, fumes and loud noises, and the low mine tunnels limit a worker’s ability to move freely which can lead to blood clots, musculoskeletal diseases, and bone injuries.[vi]
The Social Security Administration requires applicants to be totally disabled to qualify for disability benefits and coal miners apply for conditions. Broken bones, brain injuries, spinal cord injuries, black lung, arthritis, asthma, cancer, diabetes, headaches, mental illness, and seizure disorders all qualify.[vii] 
A Disabled Miner
|Photo: Jack Smith, 42, a disabled miner from Rhodell, West Virginia near Beckley, with his wife, Della Mae. His legs were crushed by a mine roof cave-in after working one year, but it took 18 years to receive workmen’s compensation. In addition to those benefits, he makes money as the operator of a beer joint a block from his home because of their lengthy fight for compensation, the Smiths had to go on welfare for a time, a memory which makes them bitter, and is a frequent complaint of other miners who are injured. (Source: Jack Corn)|
Following the federal welfare reform legislation which passed in the 1990s welfare benefits were cut back sharply, both in amount and in the number of months the benefits were available. Not coincidentally, the number of people applying for the disability payments (SSDI) increased dramatically both in the region and the nation as welfare benefits were cut off. By 2009, more than 9.6 million people in the United States were counted as disabled with the rates of disability in the rural areas of the United States 80% higher than in the urban areas.[viii] According to the Social Security Agency, in 2013 Social Security disability recipients in the United States accounted for 4.8 percent of the population but 8.2 percent of the population in Kentucky and 8.9 percent in West Virginia.
Disability payments are concentrated in counties where jobs require manual labor, and therefore not surprisingly in coal counties where more than 10 percent of the population have qualified for SSDI.[ix] In Martin County, KY, for example, when the coal industry declined, the claims for disability payments increased dramatically.
Disability checks average $710 per person per month. Statistics showed that workers are more likely to apply for disability when their job disappears,[x] and the largest category of claims is for musculoskeletal system (back pain) and connective tissue damage (31.7 percent).[xi]
|Source: Social Security Administration and Bureau of the Census|
Black Lung Payments
The federal government started to pay black lung benefits in 1969 following the passage of the Coal Mining Health and Safety act after thousands of miners walked off the job and demanded that black lung be recognized as an industrial disease deserving compensation.[xii] Amended in 1973, the Black Lung Benefits Act provided monthly payments and medical benefits to coal miners that were disabled from black lung disease and their dependents if the disease caused the death of the miner. Benefits are paid from the Black Lung Disability Trust Fund which collects a tax from by coal mine operators on each ton of coal sold.[xiii]
Black Lung Test
|Photo: Dr. Donald Rasmussen, physician at the Black Lung Laboratory of the Appalachian Regional Hospital, in Beckley, West Virginia, places a syringe in the arm of a coal miner about to be tested for the disease. (Source: Jack Corn)|
Black lung benefits have become one of the most important income sources for coal communities in Appalachia. Since 2009, miners in Ohio have received over $95 million in federal black lung benefits, Kentucky another $230 million and West Virginia more than $300 million.[xiv] As of FY 2016, there are approximately 700,000 black lung benefits claims in the US. All told, the black lung program has paid out more than $44 billion to disabled miners.
The most black lung claims come from Pennsylvania (140,728), followed by West Virginia (125,367) and Kentucky (109,334).[xv] In the black lung program, beneficiaries receive $651 to $1,302 every month depending on their number of dependents.[xvi] Recent years has witnessed an increase in positive black lung diagnosis,[xvii] while the declining coal production, bankruptcies of coal companies, and expiring temporary tax increase have put the Fund at serious financial risk.[xviii]
Programs such as disability and black lung have largely taken the place of direct welfare payments as the primary fund of government assistance in the region due in substantial part to the reforms to welfare made in the 1990s requiring work as part of welfare and setting time limits on payments under the welfare program. In 1989, of the 188,957 working age adults in poverty in West Virginia, 42,074 received family assistance. In 2011, among 210,000 working age adults in poverty, only 8,000 received family assistance. Meanwhile, there are about 70,000 adults on the Supplemental Security Income program in West Virginia (disability), one of the highest enrollments in the nation.[xix]
The state of West Virginia provides temporary unemployment insurance benefits to workers unemployed through no fault of their own. If eligible, unemployed individuals can receive $24 to $424 every week for a maximum of 26 weeks.[xx] Similarly, unemployed workers in Kentucky can receive $39 to $415 every week for a maximum of 26 weeks if they qualify for benefits.[xxi]
The elderly have benefited the most from the various federal entitlement programs and the poverty rate among the elderly has dropped from about 35% in 1959 to 9% today. Children have replaced the elderly as the most impoverished age group in the region and the nation – 22 percent of children in the nation live below the poverty line. If they meet certain conditions such as intellectual disabilities, children in Appalachia can receive a $698 monthly check from the Supplemental Security Income program until they turn 18. This aid is so important that some parents sometimes pull their children out of literacy programs because the parents are afraid of losing the disability check if their child learns to read. Similarly, some single mothers do not to marry again because their monthly federal check would diminish.[xxii]
As far as access of the poor and the working poor to health care, the Affordable Care Act dramatically decreased the number of uninsured (health) in the Appalachian region. In Kentucky, the uninsured population dropped 8.3 percent between 2013 and 2015.[xxiii] In West Virginia, 416,858 people are now covered by expanded Medicaid.[xxiv] In contrast, Virginia, one of the 20 States that opted out of the Medicaid expansion, left 400,000 Virginians uninsured, many of whom had lost their jobs in the dying coal industry.
The Supplemental Nutrition Assistance Program, formerly known as the Food Stamp Program, is one of the most important social safety net programs in the region and benefits over 44 million (13.5%) individuals who receive an average of $134 per person each month in 2016.[xxv] In 2014 in West Virginia, 362,501 people received food stamp benefits accounting for 19.59% of the entire state’s population.[xxvi] In McDowell County, WV, one of the poorest counties in the state, the percentage approached 40%[xxvii].
|Photo: The SNAP serves 1 in 7 Americans, and food insecurity has severe impact on the physical and mental health of children. Many children in Kentucky depend on school breakfast and lunch programs for food. (Source: Center for Poverty Research at the University of Kentucky)|
In Kentucky, approximately 19% of the state’s citizens are SNAP recipients.[xxviii] In the coal mining counties, however, almost half of the population receives SNAP benefits. For example, in Owsley County, KY, 53 percent of the local population are SNAP recipients.[xxix] In response and in an effort to control costs, the federal government tightened restrictions on eligibility. With the restrictions getting tougher, fewer people qualified for SNAP. In January 2016, the SNAP benefit requirements changed again for adults in West Virginia and now recipients must meet a work requirement of 20 hours a week or be enrolled in a work or education-related training program to continue receiving food assistance despite the fact that many jobs available in West Virginia are part-time jobs offering less than the 20 hour minimum. Also, single mothers find it challenging to meet the work requirement while taking care of children. [xxx]
Those who are able to keep the benefits have seen a huge reduction on the monthly checks – Vada McCoy from Laurel County Kentucky, for example, who barely gets by with disability payments and SNAP benefits, saw her SNAP benefits drop from $200 to $82 a month, and now she cannot afford enough food forcing her to pick up food from the Come-Unity Cooperative Care, a local nonprofit.[xxxi]
 According to the Bureau of Labor, coal miners are more likely to be killed or to incur a non-fatal injury or illness, and their injuries are more likely to be severe than workers in private industry as a whole. Statistics show that as of 2007, the rate of fatal injuries in the coal mining industry was 24.8 per 100,000 fulltime equivalent workers compared to the 4.3 per 100,000 fulltime equivalent workers for all private industry, and in 2008, the rate of nonfatal illnesses and injuries in coal industry was 4.4 percent, 13 percent higher than the private industry. More serious injuries and illnesses require days away from work 2.6 percent in the coal industry compared to 1.1 percent in the private sector.