UNIONTOWN, Pa. — Donald J. Trump made coal miners a central metaphor of his presidential campaign, promising to “put our miners back to work” and look after their interests in a way that the Obama administration did not.
Now, three months into his presidency, comes a test of that promise.
Unless Congress intervenes by late April, government-funded health benefits will abruptly lapse for more than 20,000 retired miners, concentrated in Trump states that include Pennsylvania, Ohio and West Virginia. Many of the miners have serious health problems arising from their years in the mines.
In mining areas like Uniontown, Pa., and surrounding Fayette and Greene Counties, which Mr. Trump carried 2 to 1, it is an upsetting and potentially costly prospect. “It’s just a terrible, terrible feeling,” said one of the retirees, David VanSickle, who spent four decades at work in the mines. “I think about that 25 times a day.”
The president has offered no public comment on the issue, even as he has rolled back regulations on mine operators, an omission that has not escaped the notice of Mr. VanSickle and other retired miners.

“To me, that was kind of a promise he did make to us,” Mr. VanSickle said about Mr. Trump, whom he supported last fall. “He promised to help miners, not just mining companies.”
Responsibility for the retirees’ health plans has increasingly shifted to the federal government in recent years, as struggling coal companies have shed their liabilities in bankruptcy court. Congress voted last fall to finance benefits for a large group of retirees for several months, but House and Senate Republican leaders have yet to agree on a longer-term solution.

The benefits can easily mean the difference between a middle-class retirement and economic hardship, since many retired miners are too young to qualify for Medicare. Others have chronic or debilitating health problems that would require expensive supplemental coverage — currently provided by the retiree plan — even with the Medicare benefit.
Norm Skinner worked for more than 20 years as a miner in eastern Ohio and had triple bypass surgery in 2010. Without the retiree health plan, he said, the surgery “would have broke me,” even with Medicare picking up much of the bill.
Uniontown, which lies about 30 miles east of two large mines that once employed well over 1,000 miners but are down to roughly 600 after one ceased production in 2015, hints at both middle-class affluence and postindustrial angst.
Around the corner from Ptak’s, a formidable-looking formal wear store on Main Street, are a handful of dilapidated storefronts and a vast, empty commercial space that advertises “mental health counseling” and “motivational speaking” for veterans. The space has the appearance of a renovation that was never completed and, to the naked eye, could pass for a sign of either revival or decline, like much of Uniontown itself.
Mr. VanSickle, who lost parts of two fingers on the job, said his doctor advised him to retire two years ago, at 59, because he suffers from black lung, a condition associated with long-term exposure to coal dust.

He manages the illness by attaching himself to a breathing machine that essentially props open the airway to his lungs while he sleeps. “My oxygen content would drop so low without it,” he said, fitting tubes into his nose from the bedroom of his comfortable home in Uniontown.
Last fall, Mr. VanSickle priced out a private insurance plan that would provide roughly comparable benefits for him and his wife, who takes about a dozen separate medications to treat lupus and rheumatoid arthritis. The estimates came in at $1,500 to $1,800 per month.

“I don’t know if you’ve ever gone through a serious test at the doctor’s office,” Ms. Leach said by phone. “You wait and wait and don’t hear anything and the pressure starts building up: Am I going to live or am I going to die? That’s exactly what this is like: living and dying.”
Many retired miners who supported Mr. Trump understood that his promise to revive employment in their industry was a long shot in the face of cheap natural gas — “a couple of jobs” might come of it, Mr. VanSickle said.

According to Mr. Manchin, Mr. Trump has told him privately that he supports his efforts, and Kellyanne Conway, counselor to the president, even reshared on Twitter one of Mr. Manchin’s social media pronouncements to that effect.
A White House spokeswoman declined to comment.
In the last few days, the House Republican leadership has suggested that it, too, might support a permanent fix, according to Phil Smith, the chief lobbyist for the miners union, but only if it can settle on a revenue source to offset the full cost. “It leaves the door wide open to ‘Well, we couldn’t find one,’” Mr. Smith said.
Many miners in their early 60s are postponing retirement, unsure if their savings will suffice absent the health insurance they have long expected.
Tony Brnusak, 62, who has worked for nearly 40 years in the Cumberland mine, said he would probably be retiring, if not for the uncertainty around his benefits.
“My wife works and she’ll be retiring next year, but she won’t have the medical when she retires, she won’t have a pension,” he said. “We’re counting on mine.”