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Lisa Emery loves to talk about her “boys.” With each word, the respiratory therapist’s face softens and shines with pride. But keep her talking, and it doesn’t take long for that passion to switch to hurt. She knows the names, ages, families and the intimate stories of each one’s scarred lungs. She worries about a whole community of West Virginia coal miners — including a growing number in their 30s and 40s — who come to her for help while getting sicker and sicker from what used to be considered an old-timer’s disease: black lung.

“I love these guys,” she said, wiping tears. “I tell them … ‘Every single one of y’all that sits down in that chair is why I feel like I was put on this earth.’”

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.

The opposition comes months after Trump signed executive orders to allow coal-fired plants to pollute more and to streamline the permitting process and open up new areas for mineral production, including oil and natural gas drilling and mining of “beautiful, clean coal.” He was celebrated at the White House by smiling miners in hard hats, including some with West Virginia stickers, as he promised to put more people to work underground.

“One thing I learned about the coal miners: That’s what they want to do,” Trump said. “You could give them a penthouse on Fifth Avenue in a different kind of a job, and they’d be unhappy. They want to mine coal.”

But since his inauguration in January, a volley of firings, department eliminations and proposed regulation rollbacks have targeted hard-won health and safety protections fought for over decades to safeguard coal miners and other working-class folks.

The silica rule was delayed in April after industry groups suing the government filed an emergency request in court to block it from taking effect, citing costs and difficulties implementing it. Around the same time, the Trump administration told nearly all employees at the National Institute for Occupational Safety and Health that their jobs were being cut.