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the help of West Virginia’s two Senators (Byrd and Randolph, both Democrats), the UMW managed to attach language creating a national Black Lung program to the bill. It received bipartisan support, particularly from legislators in key coal-producing states like Alabama, Kentucky, Ohio, and Pennsylvania, several of whom occupied key leadership positions in Congress.

This peculiar sequence of events meant that one of the stakeholders in state-level control, organized labor, now had a clear interest in national action. The medical community by and large stayed on the sidelines. The government was not proposing to usurp doctors’ role in diagnosing or treating black lung disease; it was proposing to help infected miners, who in turn might be better able to pay for medical care. Private insurers did not feel threatened, for occupational diseases were one of the more troublesome parts of their business. The costs were less predictable because the state of scientific knowledge linking specific job hazards to specific diseases kept changing. And the costs were potentially large if afflicted workers lived for many years with the disease.

Administrators of state programs were the main stakeholder to testify in Congress against the measure. They made dire predictions about “the abandonment of our 55 year- old workmen’s compensation system.” They intimated that the national government was ill-equipped for the task because “workmen’s compensation administration is a professional specialty demanding experience and dedication and an intimate knowledge of local problems. This proposed legislation would replace local control with a centralized administration impairing development in the various regions of the country” (both quotes from Barth 1987: 22). To counter these attacks, supporters included language that made parts of the program temporary.27 They made a number of statements indicating that Black Lung would not set a precedent, that it was emergency aid to a tiny but deserving segment of the population. Although these tactics did not prompt state bureaucrats to change their position, they did make opposition to Black Lung benefits less potent in Congress.

Business opposition was blunted after legislators found a way to minimize the fiscal impact on employers. Part B of the Black Lung program extended benefits to miners who filed claims before the end of 1972, and was financed entirely out of general revenues. It was expected to account for most of the spending. Legislators never seriously considered a payroll tax, the traditional means of financing a social insurance program, because they worried that the regulatory measures contained elsewhere in the Act would already impose a significant burden on an industry that had struggled in recent years. Part C of the program extended benefits to affected miners and their dependents who qualified starting in 1973. It was financed by coal companies operating the responsible mines or by employers more generally if states expanded their workers’ compensation programs to include black lung disease. Coal companies were not obligated to pay for Part C, however, after 1976. Policy makers expected state compensation laws to have changed by then, and all subsequent cases to be handled at the state level. Given the adoption of stronger health and safety regulations, it was widely expected that the number of future cases of black lung


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