The latest research indicates that emissions from uneconomically dispatched coal plants — coal plants that run when cheaper resources are available — cost communities $13–$26 billion in health costs each year. These costs are 13 times greater than what consumers are paying for that electricity, which is close to $1–$2 billion per year. Between 2015 and 2023, communities have had to pay $236 billion in overall added health costs.
Power plants near population centers cause the most damage
The health costs are staggering but they are also location specific. The following map shows the distribution of these health costs at the county level and the corresponding bar graph aggregates these impacts at the regional level. The regions with the highest health impacts are in the areas covered by MISO (serving the Midwest) and PJM (serving the Mid-Atlantic), and the Southeast.
Two factors play a role in high health impacts, (1) emissions when it is uneconomic to run the coal plant and (2) the proximity to dense populations. In regions like MISO and PJM, coal plants are located near densely populated cities. Even though the West has high uneconomic dispatch emissions, the population is more spread out, so health costs are lower, though nearby residents still experience significant effects. On the other hand, PJM has historically had less uneconomic dispatch losses than other areas but has the second highest health cost because those coal plants are located near population centers.
The latest RMI analysis takes emissions from uneconomic dispatch months and uses the EPA Co-Benefits Risk Assessment (COBRA) tool to convert these emissions to health costs and health impacts. Emissions from months when coal is dispatched uneconomically result in extensive health impacts that burden both individuals and society at large, as shown in the charts below. The EPA tool COBRA can also convert emissions into specific health impacts such as predicted mortality, emergency room visits, and asthma impacts. Nationwide, between 2015 and 2023 coal emissions during uneconomic months contributed to 19,565 emergency room visits from aggravated respiratory and cardiovascular conditions. Exposure to these pollutants has been estimated to cause 16,661 cases of premature mortality. These emissions have also been estimated to exacerbate new cardiac diseases (5,771 cases) ranging from heart attacks to strokes and neurological disorders (3,644 cases). Furthermore, carcinogenic substances emitted from coal plants when they were uneconomic could be associated with 447 cases of lung cancer.
The health impacts of uneconomically dispatched coal emissions significantly worsen a range of asthma symptoms, including 3.4 million instances of increased albuterol use and more than 1.8 million cases of persistent cough. Most alarmingly, coal plants running when there were cheaper resources available created over 50,000 cases of asthma in people who did not have asthma at all. These emissions have also been estimated to cause over 900,000 lost workdays and over 3 billion lost school days nationwide, because adults and children suffering from these symptoms needed time to recover.
Communities face immense challenges from these exacerbated symptoms that affect daily life and economic productivity. The health burden translates to increased healthcare costs and reduced quality of life, disproportionately impacting vulnerable populations and stressing healthcare systems. Communities could see improvements in public health and their quality of life, alongside the economic benefits from reduced healthcare costs, if coal plants were turned down when cleaner and cheaper resources were available.
While presenting a series of executive orders conceived to increase electricity generation from coal, President Donald Trump misleadingly suggested that environmental regulations were to blame for the industry’s decline, wrongly said that coal plants are being opened “all over Germany,” and misleadingly, and repeatedly, referred to coal as “clean.”
Experts agree the main culprit for the decrease in coal-fired power in recent decades was the surge of more cost-effective and cleaner kinds of energy, especially natural gas. In Germany, a handful of old plants were fired back up in 2022, but were closed again in 2024. Germany plans to end coal-fired power generation by 2038. Also, coal combustion emits more carbon emissions than any other fossil fuel used to produce power, not to mention other pollutants.
But several experts told us blaming environmental regulations and claiming coal is cleaner, cheaper or more efficient than its alternatives is misleading.
“The coal industry’s decline is due first and foremost to cheaper alternatives, namely natural gas but also renewable energy,” Sanya Carley, faculty director at the University of Pennsylvania’s Kleinman Center for Energy Policy, told us in an email. “It is more economically efficient and less carbon intensive to build gas units or renewable energy such as wind and solar than it is to build a coal plant.”
Just as leasing federal land to coal mines won’t mean more coal production, opening up land to oil drilling won’t increase oil production. That will depend on the price per barrel and the expectation of future prices compared to the price of production. Opening land could lower the cost of producing coal or oil. Firms must determine whether the projected decrease is enough to pursue investments and how those costs will measure against future fuel prices. If opening the land has any effect, it would not start for years to come.
There are too many moving parts in such a system; the government cannot possibly align all of the markets and incentives. This could only work if the government were both the buyer and seller of the entire coal supply chain from mines to purification to power generation to electricity consumption. Price signals matter. Price signals tell you the status of supply and demand without much delay or high costs of communication. Right now, price signals are telling us that coal is not valuable relative to other means of energy production.