As director of the New River Health Association Black Lung Clinic, Emery’s seen guys as young as 45 getting double lung transplants as disease rates soar among miners forced to dig through more rock filled with deadly silica to reach the remaining coal — far worse than the dust their grandfathers inhaled. A rule approved last year by the U.S. Mine Safety and Health Administration would cut the federal limit for allowable respirable crystalline silica dust exposure by half to help protect miners of all types nationwide from the current driving force of black lung and other illnesses.

But, now, it’s in jeopardy amid other Trump administration cutbacks and proposals targeting workers’ health and safety guardrails: Stuck in a politically charged environment that promotes industry, with lawmakers arguing to change it and the federal agency that wrote the rule not pushing to enforce it. Some angry retired miners with black lung are fighting back, demanding that President Donald Trump honor promises he made to the people who voted him in.