I‘ve spent thirty years underground, breathing in the dust and history of these Appalachian hills. Now, in late 2025, my breath comes short, a rattling reminder of the price we paid for “keeping the lights on.” They call it Black Lung; I call it the sound of a man running out of time. But lately, it ain’t just the miners who are wheezing—it’s the whole state. We’re witnessing what the folks in suits call “demographic decline,” but down here, it just feels like we’re being erased.

It used to be that when a man got sick, he had his community and, eventually, a bit of help. But this new “One Big Beautiful Bill Act” they signed back in July has ripped the floor right out from under us. They’re cutting a trillion dollars from Medicaid over the next ten years. For a fellow like me, those medical cards were the only way to afford the inhalers and the specialists in Charleston. Now, with these new “work requirements” and paperwork checks every six months, half the people I know are losing their coverage. If you can’t breathe well enough to walk to the mailbox, how are you supposed to prove you’re working forty hours a week?

Because of these cuts, the hospitals are dying, too. They capped the federal help for rural clinics, and for a place like ours that treats mostly the poor and the uninsured, that’s a death sentence. Over 700 rural hospitals are on the brink of closing their doors across the country. When the local hospital goes, the town goes with it. It’s the biggest employer we’ve got. Without it, the young people—the few we have left—don’t just leave for better jobs; they leave because they’re scared to raise a family where there ain’t a doctor within a two-hour drive.

Even the folks who moved here to work the fields and the sites are disappearing. We’ve seen over a million people leave or get pushed out since the start of the year because of the new immigration freezes and deportations. You might not think that matters to a coal miner, but when the local grocery store shuts down because they can’t find workers, or the construction on the new bridge stops cold, the whole mountain feels it. We’re losing the very hands that were supposed to help us rebuild.

So, the hills are getting quieter. The schools are emptying out, and the only people left are the old and the sick, folks like me who are too tired or too broke to move. They say the labor force is shrinking for the first time in fifty years, and I believe it. We’re becoming a “care desert,” a place where the map just ends. It’s a hard thing to realize that after a lifetime of giving everything to this country’s dirt, the country decided the dirt wasn’t worth the cost of keeping us alive.