Senate several letters from constituents about loved ones' deaths from opioids and urged his colleagues to act to prevent more deaths. Manchin took "an unusual proposal" to President Trump to address the crisis and called for a "war on drugs" that involves not punishment but treatment. He proposed the LifeBOAT Act, which would fund treatment. He also opposes marijuana legalization. In January 2018, Manchin was one of six Democrats who broke with their party to vote to confirm Trump's nominee for Health Secretary, Alex Azar. In his 2018 reelection campaign, Manchin emphasized his support for Obamacare, running an ad where he shot holes in a lawsuit that sought to repeal the Affordable Care Act. In January 2019, Manchin was one of six Democratic senators to introduce the American Miners Act of 2019, a bill that would amend the Surface Mining Control and Reclamation Act of 1977 to swap funds in excess of the amounts needed to meet existing obligations under the Abandoned Mine Land fund to the 1974 Pension Plan as part of an effort to prevent its insolvency as a result of coal company bankruptcies and the 2008 financial crisis. It also increased the Black Lung Disability Trust Fund tax and ensured that miners affected by the 2018 coal company bankruptcies would not lose their health care. In a May 2019 letter to Attorney General William Barr, Manchin and Republican Susan Collins wrote that the Affordable Care Act "is quite simply the law of the land, and it is the Administration's and your Department's duty to defend it" and asserted that Congress could "work together to fix legislatively the parts of the law that aren't working" without letting the position of a federal court "stand and devastate millions of seniors, young adults, women, children and working families." In September 2019, amid discussions to prevent a government shutdown, Manchin was one of six Democratic senators to sign a letter to congressional leadership advocating for the passage of legislation that would permanently fund health care and pension benefits for retired coal miners as "families in Virginia, West Virginia, Wyoming, Alabama, Colorado, North Dakota and New Mexico" would start to receive notifications of health care termination by the end of the following month. In October 2019, Manchin was one of 27 senators to sign a letter to Senate Majority Leader Mitch McConnell and Senate Minority Leader Chuck Schumer advocating the passage of