"There have been a lot of heart attacks," Lee said. "Many young people died."
When coal is burned, carbon dioxide, sulfur dioxide, nitrogen oxides and mercury compounds are released into the air, according to the EPA. Research has shown those fine particles can be linked to serious health problems, including premature death.
Children, who breathe more often, and senior citizens, who tend to have health problems agitated by pollution, are particularly vulnerable, said Colleen McKaughan, an associate director in the EPA's air division.
In Montana, the Northern Cheyenne live near the state's largest coal-power plant, the Colstrip Steam Plant. The four-unit power plant operated by PPL Montana produces 2,200 megawatts of electricity and is one of the largest employers in eastern Montana with roughly 400 workers. Many in the tribe want it shut down.
In northeastern Utah, the Ute Indian Tribe has threatened to sue Deseret Power over pollution from its 30-year-old plant on the reservation, which generates 500-megawatts of electricity. Ozone readings in the region can reach nearly twice the limit considered safe by the EPA, especially during winter months.
"They are legitimately concerned about the impact the power plant has on the reservation," said Michael Harris, a lawyer representing the tribe.
Harris said some tribal members have complained of asthma attacks and cancer clusters and the plant might be to blame. Deseret Power did not respond to a request for comment.
To be sure, tribes fighting energy companies are the exceptions.
The massive Four Corners Steam Plant sits on Navajo land in Fruitland, N.M., where the Arizona Public Service Company says it generates 2,040 megawatts of electricity and serves New Mexico, Arizona, California and Texas.
Tribal members who work at the power plants earn roughly triple the average Navajo family income of about $20,000 per year. The tribe expects to receive more than $7 million annually from the two power plants on its land under its latest lease proposals.
"A lot of our own people who are critical of coal are not understanding the economic benefits," said Stephen Etsitty, executive director of the Navajo Nation Environmental Protection Agency.
"It's easy to perceive a problem when you see a big power plant smoke stack … but that often causes you not to look at other areas of concern."
In Moapa, Simmons — whose 31-year-old brother passed away after working at Reid Gardner Generating Station — can see the Nevada power plant from her kitchen window. It reminds her of her brother's death.
She also frets for her 24-year-old son, who works at the plant and comes home with ash-covered skin. His wife is pregnant with Simmon's first grandchild.
"The land is poisoned," she said. "I don't even open my window because I don't like to look at it."
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