Responding to a Health Emergency’s Long-term Impact – A Brief Survey of Limited Benefit Health Plans

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    At 5:30 a.m. on Nov. 20, 1968, an explosion shook the Consol No. 9 coal mine just north of Farmington, West Virginia. The blast, felt up to 12 miles away, sent a plume of flame and smoke 150 feet in the air. Ninety-nine men were nearing the end of their shift that early morning and were more than 600 feet below ground when the mine exploded. Twenty-one men escaped. The rest were trapped inside.

    The fire continued to burn for a week, complicating rescue and recovery efforts. On Nov. 29, the mine was sealed to extinguish the fire. It was not until September 1969, 10 months later, that the mine was unsealed to search for the miners’ bodies. In a recovery effort that continued for 10 years, 59 bodies were recovered. Nineteen of the miners were never found.

    For most of us, this immediately brings to mind those dark days following the attacks of Sept. 11, 2001 (9/11). We all recall the images of destruction, the frantic attempts at rescue, and the extended recovery effort that followed. This experience had many lasting impacts on the minds and sentiments of Americans. These include a renewed appreciation for people who do difficult and dangerous jobs, including rescue and recovery workers, and who, above all, have a desire to help.

    The Farmington disaster had the same effect. In 1969, West Virginia coal miners staged a wildcat strike to demand better benefits and raise awareness about an ongoing health threat to miners – Black Lung Disease. Riding a wave of public sentiment and concern for the safety of miners, Congress passed the Federal Coal Mine Health and Safety Act of 1969. The law expanded safety inspections, instituted penalties for non-compliance, and initiated benefits for those disabled by Black Lung Disease.

    Congress expanded federal Black Lung benefits under subsequent legislation. Today, Black Lung sufferers and their families can receive monthly payments and enroll in a “limited benefit” health plan that pays for their Black Lung-related medical costs. This is similar to the limited benefit plan that Congress created for the 9/11 first responders and survivors.

    Limited benefit plans are only one of the mechanisms the federal government uses to address the long-term effects of a public health crisis or challenge. Both Black Lung Disease and many 9/11-related health conditions are the result of hazards experienced at work. These lend themselves to solutions similar to Workers’ Compensation, a common limited benefit plan created to address work-related injuries. Other federal responses include research to better understand causal factors and health impacts, creation of grant programs to assist victims, expansion of existing federal health benefits, and the administration of trust funds paid for by those held responsible for the event or disaster. Today, the federal government administers numerous such programs across multiple branches and agencies.

    Many recent and ongoing health emergencies and events will also require a long-term response. For example, in 2014 the Department of Veterans Affairs launched a registry, expanded benefits, and initiated research on veterans’ exposure to open burn pits and other airborne hazards in Iraq and Afghanistan. While the Centers for Disease Control and Prevention is creating a registry of those impacted by the Flint water crisis to facilitate long-term understanding of health impacts. It is also likely that the unfolding COVID-19 crisis will cast a long shadow as lasting impacts of COVID-19 infection are better understood.

    These responses will develop over a predictable pattern. The initial response is usually handled by an expansion or mobilization of existing programs. But after the government’s initial response to an emergency, the longer-term response evolves over time as the causal event and impacts are better understood. Often, significant scientific research and monitoring is required to understand emerging health issues related to the initial event. For this and other reasons, new benefit programs and the legislation to create them may lag by many years. In the meantime, victims shoulder much of the burden. Often the help they need falls into the gaps in our decentralized healthcare system and patchwork of public and private health insurance programs.

    When and if a new benefit program is finally created, there may already be many programs of more limited scope spread over numerous federal and state agencies, along with private and non-profit institutions. There may also be many interest and advocacy groups involved. For this reason, implementation of these program can be a complex and sensitive endeavor. Standard commercial approaches may not work without significant tailoring to meet the unique requirements of citizens and government.

    At Karna, we have a deep interest and commitment to public health. And we, like all Americans, have a strong impulse to help when faced with a public health crisis. We are fortunate to be able to do that by supporting numerous federal response efforts today. Our tailored approaches are informed by an understanding of how health research, health data and analytics, and health insurance operations interact with the structure, capabilities and culture of our federal government. This, we have learned, is a science unto itself.

    Leslie Siddeley, Program Director II

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