Rates of black lung disease have hit a 25-year high in Appalachian coal mining states and have reached epidemic levels in coal communities across the nation. On January 1st, 2022, the sole source of revenue for the Black Lung Disability Trust Fund was cut by more than half after Congress failed to extend the Black Lung Excise Tax before the end of 2021. Our report shows why the trust fund must be restored at least to its former level.