By Dr. Cheryl L. Holder, Florida Clinicians for Climate Action
Anna Mae faced an impossible choice: either pay her electric bill or pay for her medication. An elderly woman with chronic obstructive pulmonary disease (COPD) and asthma, she came to me because she couldn’t afford to refill her inhaler.
Miami was in the grip of a miserable heat wave, and Anna Mae (whose name has been changed to protect her privacy) had been running her air conditioning unit night and day. Now the electric bill was due, and she was in my office looking for help.
For many clinicians, Anna Mae’s story is sadly familiar. Many people with fixed or low incomes are still feeling the impacts of post-pandemic inflation and cannot afford to cover their expenses, including energy costs.
As temperatures rise, this budget gap is becoming a matter of life and death. Losing electricity during an extreme weather event, including extreme heat, exacerbates the threat to life. We need to consider a more overarching solution to protect patients.
Extreme heat is the deadliest effect of climate change, killing more Americans than hurricanes, floods and tornadoes combined. Worldwide, heat is responsible for nearly a half million fatalities each year. In addition to causing heat exhaustion and heatstroke, extreme heat can worsen health risks from cardiovascular, mental health, respiratory and diabetes-related conditions.
And it’s getting worse. The summer of 2024 was the hottest in recorded history, in the hottest year yet. Last July saw eight of the 10 hottest days on record; the other two were in 2023.
In Miami, heat season now runs from May 1 through Oct. 31. The city sees 51 more days where temperatures top 90 degrees than it did 50 years ago. I fear for my patients, like Anna Mae, who simply cannot afford the air conditioning they need to stay alive in a hotter world.
But there is hope. Last year, a bill passed in Virginia (with bipartisan support) that prevents utility companies from shutting off electricity when temperatures are at or above 92 degrees Fahrenheit and at or below 32 degrees Fahrenheit – protecting community members during the hottest and coldest days of the year. Temperature-based shutoff protections exist throughout the South, with states like Texas, Louisiana and Mississippi implementing such policies in the past decade.
Here in Florida, a statewide group called Clean Energy for All (CEFA) has been working to promote similar legislation. The Residential Utility Disconnections bill has been filed in the Florida Senate by Sen. Lori Berman and is soon to be filed in the House of Representatives by Rep. Debra Tendrich. If passed, the shutoff protections would go into effect when the “feels like” temperature (heat index) is forecast to be 90 degrees Fahrenheit or higher, when the temperature is forecast to be below 32 degrees Fahrenheit or during a governor-issued state of emergency.
Floridians are especially at risk of deadly shutoffs. Before the state government stopped requiring utilities to disclose disconnection data in 2021, we knew that Floridians faced the highest number of shutoffs in the nation. These disconnections leave community members – like the elderly, children, pregnant people, people with preexisting health conditions and those who depend on medical devices – vulnerable to dangerous weather conditions. This bill could offer the Sunshine State life-saving access to energy during the most dangerous days of the year.
This legislation is urgently needed because existing protections aren’t working. The federal Low Income Home Energy Assistance Program provides assistance with energy costs; however, its funding is limited and often runs out in the early part of heat season.
Patients who are very ill, or who depend on medical equipment (like ventilators), can ask their doctor to complete a Serious Medical Condition Certification Form to prevent utility shutoffs, but here too, protection is inadequate. A nationwide doctor shortage means that even eligible patients would struggle to see a doctor within the limited window before an extreme weather event hits.
Moreover, a medical condition is deemed “serious” only if the patient is not stable. That wouldn’t have helped Anna Mae, who was stable while using her inhaler but risked becoming destabilized – and possibly hospitalized – if she lost access to her medicine. Given the enormous personal, social and financial costs of hospitalization, it’s clearly good preventative medicine to make sure that no one has their utilities cut off during a heat wave or other disaster.
How can you help?
Clinicians can try to protect our patients by identifying those in need, using tools like the Centers for Disease Control and Prevention’s CHILL’D OUT vulnerability questionnaire. We can help patients develop their own heat action plans, and deploy existing protections at the state and federal level on their behalf.
We can also launch or get involved with existing local outreach efforts. My organization, Florida Clinicians for Climate Action, works with our county’s heat task force to inform, prepare and protect residents from heat-related illness. To that end, we educate health care practitioners and reach out to vulnerable populations. As a result of this team effort, Miami-Dade County had a relatively low rate of heat-related emergency department visits in 2023 – despite being in the hottest part of the state.
And finally, we can all advocate for comprehensive solutions, like the Residential Utility Disconnections measure. In this way, we can keep Anna Mae – and our own family and neighbors – safe in a dangerously hot world.
Cheryl L. Holder, MD, is an internist and retired associate professor and associate dean of Florida International University’s Herbert Wertheim College of Medicine. Holder co-founded Florida Clinicians for Climate Action in 2018 and now serves as its executive director. She is co-chair of the Miami-Dade Heat Health Task Force and a member of the National Academy of Medicine’s Climate Collaborative.
This op-ed is adapted from one originally published Nov. 25 on MedPage Today. Banner photo: A woman adjusts her thermostat due to the heat (iStock image).
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