Sweltering summers turn air conditioning into a lifesaving device. Yet millions of Americans cannot afford it.
The heat in swampy New Orleans, Louisiana, is so intense that locals describe the weather as mostly summer with other seasons scattered in. Jeffrey Elder, medical director for emergency management at University Medical Center New Orleans, treats many patients with heatstroke. “We see it every summer in a few ways,” he says. “It could be an elderly person who cannot use air conditioning, has a broken unit, or lives alone. They are later found in a heat-altered state.” Children and the elderly suffer most because they cannot regulate body temperature easily.
Cooling indoor spaces with AC is a proven deterrent against heat-related illness. However, not all Americans can afford this protection.
Emergency rooms fill with heat patients
By the time patients reach the emergency room, they often face true medical emergencies. Many arrive in altered mental states or unconscious, with body temperatures above 103F (39.4C). Elder says the first response involves ice baths and rapid cooling.
Climate change pushes summer temperatures higher, breaking global heat records year after year. Experts warn that Americans’ health faces increased risks as AC becomes increasingly unaffordable. Communities that cannot cool indoor spaces experience higher rates of heat-related illness.
Elder emphasizes staying out of the sun and using AC to remain safe. Detroit, Michigan, serves as an example where air conditioning significantly reduces heat risks. Yet the luxury remains out of reach for many households.
Energy insecurity affects millions
In 2020, nearly 34 million U.S. households faced energy insecurity, meaning they could not afford basic energy needs like air conditioning or heating. That accounted for almost a quarter of U.S. homes at the time. Elder stresses that access to functional, reliable AC is crucial, particularly in hot cities like New Orleans.
Mark Wolfe, energy economist and executive director of the National Energy Assistance Directors Association, says heatwaves now last longer. “A day in an overheated apartment is manageable. A week can be deadly,” he warns. Longer and more intense heatwaves already affect communities worldwide.
In 2020, roughly 25 million households reduced or skipped meals or medicine to pay energy bills. About 12 million households received disconnection notices that year.
Air conditioning and the climate
Air conditioning contributes around 3% of global greenhouse gas emissions. At the same time, it protects people from rising global temperatures. Experts predict AC demand and emissions will increase.
Research shows efficient AC units powered by renewable energy, combined with better building designs and urban planning, can reduce these emissions. Low-income Americans face the greatest energy burden. These households spend roughly 10% of their income on energy, compared with a national average of 6%.
This burden forces families to ration AC or suffer heat exposure. Extreme heat kills more Americans each year than hurricanes, tornadoes, or earthquakes. Experts still struggle to gather comprehensive data on heat-related deaths.
Tracking heat-related illness remains difficult
Few studies track how heat affects U.S. communities. Hospitals classify heat-related illnesses inconsistently, complicating statistics. Elder explains that one patient might receive a diagnosis of rhabdomyolysis caused by heat exposure.
Low-income populations suffer disproportionately. Historic redlining limits shade and greenery in neighborhoods of color. Heat worsens pre-existing conditions such as heart disease and diabetes, prevalent in low-income Black and Latino communities. Outdoor laborers face risks of chronic kidney disease. Homeless individuals experience higher mortality and long-term complications from heatstroke.
Maternal health and extreme heat
Heat affects maternal health, too. A 2023 study in Southern California linked maternal exposure to environmental heat with higher risks during delivery. Green surroundings lowered these risks. Heat exposure also highlighted disparities among mothers with different education levels.
Karen Lusson, senior attorney at the National Consumer Law Center, emphasizes that extreme heat is an ongoing problem. The National Weather Service predicts more heat events, with record-breaking temperatures continuing through 2025.
Families make painful choices
Low-income families often choose between food and AC. Sherita Hamlin, a mother of five in Chicago, juggles feeding her children, providing internet access for summer school, and keeping them safe from temperatures above 100F (37.8C). She uses coupons, food banks, and careful budgeting to pay for air conditioning.
Sociologist Diana Hernández, author of Powerless: The People’s Struggle for Energy, documents families’ struggles without AC. Children with conditions like eczema face flare-ups in uncooled apartments. Hernández calls this a “small but not inconsequential indignity.”
Home cooling costs will rise faster than inflation. In 2025, the average yearly U.S. electric bill will reach $784 (£580), a 6.2% increase from 2024.
Federal energy assistance at risk
No nationwide policy prevents utility shutoffs during extreme heat. Forty states and Washington D.C. have cold weather protections, but only 21 have hot weather safeguards. The Low Income Home Energy Assistance Program (Liheap) provides $4.1bn (£3bn) annually to six million households.
In 2025, the program’s staff faced layoffs, and federal plans threaten its continuation. Advocates warn that losing Liheap could endanger lives. Diana Hernández calls it “energy access is lifesaving.” Without federal support, states would rely on temporary programs with limited resources.
The human cost of heat
Hamlin recalls receiving a Liheap stipend in 2018. She worries what will happen to families if the program ends. “Families will have to sacrifice something. Essentially, the necessities of life,” she says. Heatwaves and rising energy costs force Americans to make impossible choices.
New Orleans has implemented local rules requiring landlords to provide cooling systems that keep bedrooms below 80F (26.7C). Experts warn these measures alone cannot compensate for national gaps in support. Heat remains a growing threat to the most vulnerable communities in the U.S.
