Lincoln County, Montana

The clinic that screened 8,900 patients

For twenty-five years, a clinic in Libby, Montana screened residents for the disease that was killing them. The Center for Asbestos Related Disease tested 8,900 people for the lung scarring, the pleural thickening, the mesothelioma that has taken at least 400 lives in Lincoln County since the vermiculite mine closed in 1990. It was funded by a $3 million annual federal grant. The only facility in the country that specialized in what W.R. Grace left behind.

In May 2025, the Lincoln County sheriff padlocked the door. BNSF Railway had sued under the False Claims Act. A jury found 337 false claims. The sheriff served a $3.1 million writ of execution and seized nearly all clinic property. The U.S. Attorney is contesting the seizure, arguing the building was purchased with federal funds. The administration has placed the grant itself on a list of potential cuts.

Gayla Benefield is 81. Her father died of asbestosis. Her mother died of asbestosis. Her husband died of asbestosis. She told KFF Health News: "Eventually, that scarring will fully surround your lungs... and slowly strangle you." The clinic that understood what was strangling her neighbors is dark.

A century of producing for somewhere else

Lincoln County has been producing things for people who live somewhere else for over a century.

The W.R. Grace vermiculite mine, seven miles northeast of Libby, supplied as much as 80% of the world's vermiculite from 1963 to 1990. The ore was contaminated with tremolite asbestos. An estimated 35 million homes still contain it as attic insulation. A 2017 peer-reviewed study documented 694 asbestos-related deaths in the county between 1979 and 2011, a mortality rate 40 to 60 times the national average.

In June 2009, the EPA declared a Public Health Emergency, the only one in the agency's history, calling it "the worst case of industrial poisoning of a whole community in American history." The cleanup has cost federal taxpayers approximately $600 million, making it the most expensive Superfund site in the nation. Seven of eight operable units are remediated. The mine itself, 10,000 acres of contaminated ground, still has no proposed cleanup plan. EPA anticipates releasing one in 2027. A 2023 settlement required W.R. Grace to pay $18.5 million over ten years. For a disaster that killed hundreds of people and contaminated 35 million homes.

Stimson Lumber operated for nearly a century, peaking at 400 employees with a $15 million payroll. It closed in 2002. Unemployment went from 6.7% to 15.8% in six months. And Libby Dam, 422 feet tall, five turbines, 600 megawatts, flooded the Kootenai River Valley in 1975 to generate $127 million worth of electricity per year for eight states. The Army Corps relocated the town of Rexford. The Great Northern Railway, formerly the county's largest taxpayer, rerouted south. Lincoln County has never been compensated.

The concept that organizes all of this is the residual. What remains after extraction. The ore shipped out. The timber shipped out. The electricity flows out. What stayed is the tremolite in the lung tissue, the disability rate in the 95th percentile nationally, the unemployment rate in the 97th. The county produced extraordinary value. The county did not keep it.

The fifty-five point gap

The CDI's dominant domain for Lincoln County is Structural Poverty, at 82.73 out of 100. One in four residents, 24.3%, has a disability. The 95th percentile nationally. The national median is 15.9%. Montana's is essentially the same. Lincoln County is 53% above both. Unemployment runs in the 97th percentile. Transfer income, the share of household income coming from Social Security, SSI, and disability payments, lands in the 88th.

Decades in the mine and the mill show up in the body. And when bodies break, they need care in a county where 14.2% of residents have no health insurance, the 86th percentile, nearly double Montana's 7.5% median. Cabinet Peaks Medical Center in Libby has 25 beds. The nearest trauma center is Logan Health in Kalispell, 65 miles south over mountain roads. Veterans make up 12.4% of the population, double the national average. SNAP participation runs 13.1%.

Here's where Lincoln County breaks from the pattern. Consumer Credit Distress scores 27.55. Fifty-five points below Structural Poverty, and the weight of the domain that decides the composite. Credit card delinquency is 3.15%, the 13th percentile. Auto loan delinquency, 2.38%, the 7th. Bankruptcy filings: 14 in all of 2025, a rate of 63.9 per 100,000, half the national median.

People aren't falling behind on payments. They aren't borrowing. The fifty-five point gap between Structural Poverty (82.73) and Consumer Credit Distress (27.55) measures the distance between a place that participates in the consumer credit economy and a place that has exited it. You don't default on a credit card you never opened. And because Consumer Credit Distress carries almost half the weight of the CDI formula, Lincoln County's exit from the credit system drags the whole score down to 42.81. Normal zone. Fifteenth of fifty-six in Montana. That number is not a measure of stability. It's a measure of absence.

Growth on top of the contamination

The number that complicates the residual is the population growth. Lincoln County added 2,824 people between 2020 and 2025, a 14% increase, more than triple Montana's rate. Home values nearly doubled in four years, from $177,000 in 2020 to $324,000 in 2024. Every cost metric — owner burden, rent-to-income, uninsured rates — runs in the 85th-to-89th percentile range.

This is a county with 79% homeownership where the owners are burdened. Not because a $324,000 house is expensive by national standards. Because a $324,000 house on a $51,941 income is a different equation. Weekly wages run $915, below both the state and national medians.

The school district is shrinking even as the population grows. Libby is the fourth-smallest Class A school in Montana, with about 1,146 students and projected enrollment declines. The newcomers are older. The median age is 52.8. The people arriving have equity from somewhere else. The people who stayed have a disability rate of one in four.

The counterforce and the flood

The counterforce sits on top of the contamination. Nomad GCS, a manufacturer of mobile command centers for the military, opened a 100,000-square-foot facility in 2023 on the same 400-acre industrial park where Stimson Lumber once employed 400 people and the EPA removed a million cubic yards of asbestos-contaminated waste. The park was partially delisted from the Superfund in August 2024. Nomad plans to hire up to 200 employees. A Comfort Inn broke ground in March 2025. Business applications hit 376 in 2024, up 79% from 210 in 2019 and 165% from the 2015 trough of 142.

Former commissioner Jerry Bennett told the Flathead Beacon: "When the mill left, it employed 400 people but if we can develop numerous businesses that employ 10 to 20 people with that diversity, it's far better for Libby than having one industry." Diversify, so no single closure sends unemployment to 15.8% again. That logic is being tested now.

Then, in December 2025, an atmospheric river dropped 12 inches of rain on the Cabinet Mountains. At least seven bridges were damaged or destroyed. Tens of millions in damage. But the detail that connected it to everything before: the floodwater overlapped with the Superfund boundary. Officials worried about buried vermiculite resurfacing, asbestos-contaminated waste that, once dry, becomes airborne. EPA said it was "not aware of any impacts."

A line, not a gradient

Lincoln County scores 42.81 on the County Distress Index. Normal zone. Fifteenth most distressed in Montana out of fifty-six counties. Nationally, rank 2025 of 3,144. The composite says ordinary. Every indicator underneath it says anything but.

The neighbors are a split screen. Flathead County, one mountain range south, sits at 38.30. Four points healthier, and still Normal. Bonner and Boundary counties across the Idaho panhandle score 33.66 and 25.73, both Healthy. Sanders County, to the east, scores 50.15. Elevated. The regional pattern is not a gradient. It's a line Lincoln sits on the wrong side of, near its western neighbors who look cleaner by every composite measure, and the wrong side of a structural inheritance that Sanders shares.

The indicators to watch are the gap between Structural Poverty and Consumer Credit Distress. If the business park jobs, the population influx, and the flood recovery investment translate into insured residents and accessible care, that 82.73 domain starts to move. If the growth flows around the people who were here before, the way the electricity flows around the dam, Lincoln County keeps producing value for people who live somewhere else. The composite will keep reading Normal. The clinic stays dark. The scarring continues.