Policy-makers seeking to limit the impact of coal electricity-generating units (EGUs, also known as power plants) on air quality and climate justify regulations by quantifying the health burden attributable to exposure from these sources. We defined “coal PM 2.5 ” as fine particulate matter associated with coal EGU sulfur dioxide emissions and estimated annual exposure to coal PM 2.5 from 480 EGUs in the US. We estimated the number of deaths attributable to coal PM 2.5 from 1999 to 2020 using individual-level Medicare death records representing 650 million person-years. Exposure to coal PM 2.5 was associated with 2.1 times greater mortality risk than exposure to PM 2.5 from all sources. A total of 460,000 deaths were attributable to coal PM 2.5 , representing 25% of all PM 2.5 -related Medicare deaths before 2009 and 7% after 2012. Here, we quantify and visualize the contribution of individual EGUs to mortality. , Editor’s summary The success of measures to mitigate environmental damage can be hard to assess. The advent of new modeling tools brings us closer to estimates that are reproducible and do not need expensive and time-consuming computing. Henneman et al . found that coal-burning power stations emit fine particulates (PM 2.5 ) containing sulfur dioxide that are associated with higher mortality than other types of PM 2.5 (see the Perspective by Mendelsohn and Min Kim). Using a reduced-form atmospheric model combined with historical Medicare data from the US, the authors identified the coal-burning power plants associated with the greatest mortality and estimated the effect that closure or scrubber installation has had on reducing it. This type of approach can provide a rapid indication of the effectiveness of environmental protection measures to inform ongoing policy decisions. —Caroline Ash , From 1999 to 2020, about 530,000 deaths in the Medicare population were attributable to US emissions by coal burning for electricity generation.