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New research from Climate Central estimates the rise in heat-related emergency room visits due to climate change.

2027 is very likely to be the hottest year ever recorded. Though heat was the climate story of the summer — the ocean heat that dictates the severity of El Niño; the back-to-back heat domes in Europe that killed an estimated 35,000 people; the U.S. experiencing its hottest month in 130 years, breaking the Dust Bowl record — what lies ahead will be, in all likelihood, nothing our species has ever experienced before.
We need to get better at understanding and adapting to extreme heat because lives are on the line. But there is also a lot of bad stuff that happens to people before they actually die from the heat. While excess mortality rates are an important (albeit tricky) way of measuring how bad a heat wave is, climate change-related heat is also fueling an increase in emergency room visits, new peer-reviewed research by Climate Central found.
In a study released Wednesday looking at warm months in the years 2018 to 2025, Climate Central found that the observed rate of heat-related ER visits averaged 130 per 100,000 total visits, compared to a modeled rate of just 95 visits under counterfactual temperature conditions — that is, what temperatures would be without the influence of human-caused climate change. That means human-caused planetary warming directly accounts for about 35 visits per 100,000, or 27% of heat-related emergencies.
While the Sun Belt had the highest overall rates of heat-related ER visits, as expected, the largest relative climate fingerprint appeared in the Northeast (41%) and New England (37%), likely because these regions are far less acclimated to (or built for) extreme heat. Likewise, while July had the highest overall number of ER visits, being the hottest month of the year in the U.S., September showed the highest percentage attributable to climate change (33%) as heat impacts have begun to extend later into the fall.
Measuring emergency room visits might seem superfluous compared to measuring deaths, the latter being the more traditional headline number after an extreme weather-related tragedy. But Kristina Dahl, the vice president for science at Climate Central, told me that her group’s research is part of an emerging branch of attribution science called impact attribution.
“We’re trying to go beyond attributing the physical climate variables like high temperature and see how climate influence percolates into the whole chain of events,” Dahl said. “There’s a lot of literature that shows that heat-related illness increases when temperature increases, and there are a lot of studies that translate high temperatures into deaths and heat-related mortality. But we haven’t seen anything that looks at the lower-level health impacts related to heat exposure.”
Lower-level health impacts are crucial to understand, though. For one thing, more ER visits strain health systems in potentially lethal ways as wait times, premature discharges, and occupancy climb, resources dwindle, and care is rationed, earlier research has found.
Take the 2021 Pacific Northwest heat dome, the most extreme three days in the entire Climate Central record, with an observed rate of 6,763 heat-related ER visits per 100,000. About 1,834 of those visits, or 27%, are attributable to climate change, the researchers found. The Pacific Northwest “probably still would have seen a big spike in ER visits for heat-related illness during that event, even without climate change, because it was so extreme,” Dahl told me. But even a handful more heat patients than usual can gum up an ER, since treating conditions such as heat exhaustion and heat stroke requires lowering a person’s core body temperature slowly back to its normal range. Separate research has found that hospitals are more likely to discharge patients early to free up beds during heat waves, also raising mortality rates.
A visit to the ER isn’t just scary and disruptive; it can also be extremely expensive for whoever’s in the bed. “Our healthcare system is a really challenging system to navigate. It’s strained in a lot of ways, and people’s wallets are also strained because of it,” Dahl pointed out. Understanding how ER visits strain the health care system at large can also help administrators better stage ambulances and personnel ahead of extreme heat events — and invest in workforce expansion and infrastructure upgrades to prepare for the eventuality. Ideally, interventions can prevent people from end up in the hospital at all. Workplace heat protection policies, community cooling centers, and nature- and infrastructure-based cooling solutions are all vital.
There is a critical caveat to the Climate Central analysis, however: The data it uses to calculate heat-related ER visits comes from a Centers for Disease Control and Prevention initiative called the National Syndromic Surveillance Program. More than 85% of U.S. emergency departments report to the NSSP within 24 hours of a patient coming through the doors, conveying the chief complaint that a patient arrives with. “That could be someone saying, ‘I think I have heat exhaustion,’ or ‘I’m super dehydrated,’” Dahl said.
But because of that human element — and because a person having a heart attack isn’t likely to come in saying, “Hey guys, I think I’m having a cardiac event exacerbated by extreme heat” — Climate Central’s analysis faces the same limitations as other excess mortality reports that rely on reporting systems not designed to measure heat impacts. (This is also why NPR recently calculated that the number of people who die from extreme heat in the U.S. each year is likely five times greater than the official CDC numbers.)
When I pressed Dahl on the question, she agreed that Climate Central’s research offers “a conservative look” that could lead to an undercount. “We also know that in parts of the country where physicians don’t typically see heat illness, they tend to be a little less likely to code a visit as heat-related,” she added.
This isn’t a knock on Climate Central’s analysis — rather, it’s frightening to think that the real rates of heat-related hospital visits, much less all visits directly attributable to climate change, are probably much higher. Researchers, of course, need to be careful not to sensationalize, especially since sloppy data and poor science communication can lead to misconceptions and underestimations about the dangers of heat among the population. But it pays to understand what is happening; a surge in ER visits is another piece of the public health puzzle. Hopefully someone is paying attention, because the planet’s hottest summer — if prevailing trends bear out — is now only 41 weeks away.
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If Democrats plan to restore the solar and wind tax credits, then passing BAAJA now suddenly looks like the savvy move.
This is Heatmap Daily, a weekday digest written by our executive editor. Subscribe here.
So here we are. The bipartisan permitting reform bill has cleared its first and most important procedural hurdle in the Senate. On Monday evening, 73 senators voted to end debate on the Bipartisan American Affordability and Jobs Act, or BAAJA, which would broadly make it faster and easier to build federal infrastructure projects of all sorts, especially power lines.
The bill will still undergo what its backers call a “healthy amendment process,” and it will face procedural and substantive votes for the next week or two. But its path to passage, at least in the Senate, is getting clearer.
That’s more than a little surprising. Going into the midterm elections, the conventional wisdom in Washington was that the bigger the Democratic wave, the harder it would be to pass BAAJA. Supporters feared that Democrats, newly flush with confidence, would drop the compromise and choose to restart negotiations anew in the next Congress. That’s certainly what Representative Jared Huffman, the likely incoming chair of the House Natural Resources Committee, has pushed for on X over the past week. And soon after the scale of the electoral deluge for Republicans became clear, Heatmap reported that the bill’s odds of passage had gotten a little steeper.
And yet the bill has actually gotten closer to becoming law, not further, since last Tuesday. And as I pondered the situation over the weekend, I realized the original conventional wisdom was misguided. The midterm elections have strengthened the politics of permitting reform. Tuesday’s results can help explain why the Democratic Senate caucus is now speeding toward passage.
The first dynamic is obvious: This is an affordability bill — it’s right there in the name — and Democrats just won an affordability election. The bill’s projected energy affordability benefits are small but real, and proponents argue (plausibly) that the bill’s most important changes are impossible to quantify in an energy model. The bill will make federally funded public transit much faster to build, for instance, which will have big affordability and emissions implications but is essentially impossible to model.
What’s more, much of the incoming Democratic Senate class ran on a policy platform that looks a lot like BAAJA. James Talarico of Texas, Adam Hamilton of Kansas, Annie Andrews of South Carolina, and — if they win — Scott Colom of Mississippoi and Mary Peltola of Alaska all promised an all-of-the-above energy policy that would expand the supply of fossil fuels and clean energy. That is what BAAJA does, according to its supporters and detractors.
South Carolina’s Andrews even went one step further and explicitly committed to finding a permitting reform compromise with Republicans. “Nobody has the political will to get to work and pass this bipartisan plan. It’s embarrassing,” she wrote. “In the Senate, I'll work to bring members of both parties together to finally get this done.” Now Democrats can get it done before she even gets to the Hill.
BAAJA mirrors Democratic policy commitments in more specific ways, too. Seven of the incoming 11 Democratic senators campaigned on forcing data centers to pay the full cost of their electricity use; it was even one of Abdul El-Sayed’s mandatory “terms of engagement” for the facilities. The rest of the winning Senate class made more vague pledges that data centers should not make Americans’ power bills go up.
The permitting bill would accomplish this goal, too. BAAJA would force data centers and crypto miners to pay the full costs of their connection to the grid, and it would let states go even further in transferring additional system costs from other ratepayers onto data centers.
Last week’s elections could help ease specific data center worries around the bill, as well. Some of BAAJA’s critics have feared that the bill could accelerate the nationwide data center buildout. And in a world where data centers are growing fastest in Republican states, activists might be loath to surrender any federal tool — no matter how feckless — that would be useful to fighting them. But many of the states where data centers and behind-the-meter gas plants are growing most quickly — such as Texas, Ohio, New Mexico, and Pennsylvania — will now have new Democratic governors or outright trifectas next year. The most effective tool for slowing the data center buildout remains state, county, and municipal land use laws. BAAJA would not touch those ordinances. And its data center electricity provisions would actually expand the ways that incoming Democratic governors could make data centers pay for the rest of the grid or even build new infrastructure.
Likewise, BAAJA’s new utility oversight tools look far more powerful in a world where state politicians have promised to fight utilities. Democrats likely also find it easier to write those powers into law in a world where public utility commissions are trending Democratic.
And there is one more reason Democrats might feel more comfortable passing this bill now: Tuesday has made their odds of gaining even more power in the future look better, and this bill will improve as Democrats pass other clean energy or climate policies to augment it.
If Congress soon restores the wind and solar tax credits, for instance — as most every incoming congressional Democrats have vowed to do — then BAAJA’s transmission provisions will go from being merely somewhat good for the climate to being very good. When the Inflation Reduction Act fell short, it was because the United States could not build new power lines fast enough to hook new solar and wind farms to electricity demand. But marrying the IRA’s clean energy tax credits to BAAJA’s transmission mandates would supercharge them both. And if a future Democratic Congress chooses to fund and build a national macrogrid, then passing BAAJA now would make it much easier, because some of the hardest political aspects of such a task — such as creating a federal backstop siting mechanism for new power lines — will already be done. There’s a reasonable political argument that Democrats should eagerly welcome Republican co-ownership of BAAJA’s transmission provisions, so that the party does not have to own the political consequences of such a buildout alone in the future.
Likewise, BAAJA will disproportionately benefit the party that wins the next presidential election, because the bill’s greatest affordability benefits will start accruing to the president who follows Donald Trump. Like all big energy bills, BAAJA will take time to work its way through the energy system. Americans won’t immediately experience cheaper bills or faster projects; after BAAJA’s passage, independent agencies such as the Federal Energy Regulatory Commission will need to write rules governing the law’s new programs and communicate them to states, utilities, and grid managers.
Many of those effects will start to be felt right around the time the next president takes office in January 2029 — or even in the early 2030s. If Democrats feel better about their chances of taking the White House today than they did a week ago, then they may very well feel better about passing this bill now, too.
BAAJA survived its first test, but Trump says the bill “hasn’t been fully negotiated.”
The Senate on Monday night moved to open debate on the Bipartisan American Affordability and Jobs Act — just after the president bizarrely threw cold water on the deal he struck for the bill.
Senators agreed to invoke cloture on a motion to proceed to the bill by a vote of 73–25, a forceful bipartisan tally that could bolster momentum behind the bill. Up next comes what Senator Sheldon Whitehouse, the Democrat from Rhode Island and one of the key sponsors of the bill, called a “healthy amendment process” at a press conference Monday morning. This will constitute the last remaining opening for senators and outside constituencies to try and change provisions they disagree with. How many amendments will make it to a vote, however, is not publicly known. Nor is how fast debate on the bill will move along, so best be patient.
I’m aware of pushes for at least two amendments to be considered — one ostensibly to remove the bill’s changes to the National Historic Preservation Act and another related to future administrations potentially revoking Trump-era permits. Some of the lawmakers who voted to proceed on the bill may become “nays” depending on how the amendment process goes.
In a normal world, this would be the clarifying moment for BAAJA, when the clouds would part and a pathway to passage and enactment would appear obvious. There are certainly rays of hope for the pro-BAAJA squad because a large bipartisan vote would help the legislation move briskly in the House.
But we still live in the Trump era, so instead, just as senators were preparing to vote, and after the White House released a formal statement endorsing the bill, the president told the world that actually, the deal wasn’t done.
Politico reported in September that the president told his aides he would direct the Pentagon to clear its queue of onshore wind projects to strike a deal on permitting. The White House has for weeks been telling reporters it’s been advancing wind projects through the Pentagon airspace clearance process in good faith. As we reported in late October, these claims have not always lined up with what the administration and renewable energy trade groups have been stating in federal court, where a judge months ago required the government to resume these once-routine height approvals.
For some reason, asked about this at a White House media briefing Monday evening, Trump told reporters from the press room podium that actually he won’t approve wind turbines even if the bill becomes law. Then he said, “The bill hasn’t been fully negotiated.” You can watch the full clip of the comments here.
It’s unclear whether these comments affected the bill’s odds at final passage, but they did lead to a very long all-caps post on X from Representative Jared Huffman, who’s in line to lead the House Committee on Natural Resources in the coming Congress. The White House has tried to clarify the president’s remarks, and Senator Whitehouse blamed the comments on Trump’s age. So just because we’re seeing legislative progress doesn’t mean the future will make sense.
Researchers, advocates, and funders gathered to discuss intervening in the global climate on purpose.
For decades, deliberately intervening in the Earth’s climate system was something most scientists and policymakers didn’t dare talk about. But last month, more than 250 people from six continents gathered in Reykjavik, Iceland for a three-day summit devoted entirely to willfully tinkering with the climate to make it more resilient.
The gathering served as a purposeful, if hesitant, coming out party for a field so controversial that just a few years ago, hundreds of researchers signed the Solar Geoengineering Non-Use Agreement, which called for an end to public funding for scientific research into the field. But this summit revealed that the sector — while still deeply divided over questions of money, governance, and deployment — is beginning to emerge from the shadows.
Why now? The consensus among climate scientists about our ability to mitigate warming is growing more dire by the day. The United Nations now acknowledges that limiting temperature to 1.5 degrees Celsius above pre-industrial levels is out of reach, putting more drastic adaptation solutions in play.
“It is increasingly clear to anyone who’s paying any attention that we are screwed, right? That we have blown past every possible reasonable threshold at which our existing theory of change can possibly lead to a safe and equitable climate future,” Joshua Elliott, chief scientist at Renaissance Philanthropy, told me. He directs the two-year-old nonprofit’s Advanced Research for Climate Emergencies initiative, which organized the event. “I feel like the second election of Trump was such a nail in the coffin.”
The three-day Global Risk and Stabilization Summit brought together scientists, engineers, funders, insurers, and at least one venture-backed startup to talk about everything from thickening Arctic sea ice to shielding Antarctic glaciers with underwater curtains to spraying reflective particles into the stratosphere to bounce a portion of incoming sunlight back into space. That last approach, a method of solar geoengineering known as stratospheric aerosol injection, tends to dominate geoengineering discussions, as it could theoretically cool the planet quickly and relatively cheaply.
That doesn’t mean it’s generally accepted, however. Far from it. The sessions at the ARC summit ran under Chatham House Rules, i.e. no reporting who said what — or even whether they were there at all — without explicit permission. ARC plans to release a synthesis report on the state of field next year, but in the meantime the conference website made clear: “Attending the summit does not imply that you endorse the report, any particular intervention, or the stabilization framing. Attending means you are taking part in the conversation and nothing more.”
This type of careful distancing is par for the course in geoengineering circles. Just as many mainstream climate advocates once viewed adaptation — and later carbon removal — as distractions from the need to cut emissions, geoengineering has suffered under the same criticisms. Its oftentimes sci-fi sounding interventions are already ripe conspiracy fodder. Add to that its underresearched environmental impacts and side effects, and some of these strategies could prove truly disastrous in the wrong hands.
But at least people are finally talking about it. In the weeks since the summit, attendees have published dozens of Substack and Linkedin posts about what they saw, heard, and took away from the conference. I talked to many of them about this first attempt to intentionally gather and grow the sector.
Naturally, they don’t all agree on the best path forward. Seemingly everyone acknowledges that conducting more research and designing better Earth monitoring systems is a no-lose situation. But big questions remain unresolved: what role private capital should play; how openly to discuss the possibility of near-term deployment; the somewhat uncomfortable overlap between climate engineering, defense, and national security; and how to educate policymakers and the general public about interventions that sound to some like nefarious overlords trying to control the weather.
The field doesn’t even yet agree on what to call itself. The conference organizers prefer “Earth systems stabilization” to “geoengineering,” arguing that a sector like this should be defined by its goal rather than how it gets there. The terminology remains unsettled, however, with one critic, University of Waterloo economist and former geoengineering researcher Juan Moreno-Cruz telling me in an email that the renaming “feels like a campaign” with the “objective of moving more towards action.”
At this nascent stage, any one individual can have an outsized voice. Based on the published speaker list, as well as various recaps posted during and after the event, the guest list featured some of the field’s biggest names. That included David Keith, founder of the direct air capture company Carbon Engineering and a pioneer of solar geoengineering, which involves releasing aerosols like sulfates into the atmosphere to reflect a small portion of sunlight back into space. Also in attendance were Columbia University climate economist Gernot Wagner, Paris Agreement architect Sue Biniaz, and J.P. Morgan climate advisor Sarah Kapnick, alongside delegates from some of the big environmental NGOs, including the Environmental Defense Fund and Natural Resources Defense Council.
More potentially polarizing attendees included Yanai Yedvab, the CEO of solar geoengineering startup Stardust Solutions — one of the first for-profit entities to enter the space — and Lowercarbon Capital, the climate tech venture firm that led its Series A round.
The function that private sector funding and venture-style startups could or should play in this field remains one of the biggest points of tension. Many strongly believe that the only appropriate customer for a globally consequential intervention like stratospheric aerosol injection is a coalition of national governments. But there seems to be a preemptive acknowledgement among those I spoke with that getting the United Nations itself to align on research and potential terms of deployment is unlikely.
Paul Gambill, an ARC fellow and co-founder of Nori, an early carbon removal marketplace, told me that one session at the summit was titled “The Future is Minilateral,” a nod to the growing interest in a small bloc of countries — “maybe six or so” — working together on the issue. Several people I spoke with described a model in which governments would buy technology from a company like Stardust, but retain control over if, when, and how to deploy it.
But even within the ARC set, that framing seems to have skeptics. Noah Deich, another ARC fellow and carbon removal veteran who co-founded the nonprofit Carbon180, sees the profit motive as inherently dangerous. There’s no guarantee that the science will ever advance to the point where governments are comfortable becoming customers, but investors always want to see returns. That disconnect, he argues, creates the incentive to commercialize the technology before either the research or the public is ready.
“That to me is very, very concerning, and shows a lack of judgment at a first order for the people who have invested in this, and for the people who have accepted that private sector money,” Deich told me. “That makes me very, very wary about what they’re going to do when faced with the choice of, hey no government wants to do this. Or these governments have said it is illegal, and this one says it’s fine. Like, will they actually respect the ones that say it’s illegal?”
Others see private capital as all but inevitable. Susan Su, a climate tech investor and analyst, thinks the sector would do best to engage with the private sector strategically rather than fearfully. “Money in general comes with ideas, and in my view, that’s okay,” she told me. If a venture backer has their own notions about how and where to deploy stratospheric aerosol injection, for instance, that need not dictate the agenda. “It’s the entrepreneur’s or the initiative’s job to push back against those ideas and to shape them.”
Su also thinks the field ought to be more open to discussing deployment as a possible outcome from both the research and conditions on the ground, rather than treating it as the third rail. “There’s a sentiment of caution that I think is rooted in a previous era, where it’s been a long road to reach whatever limited consensus there is today that we should even research this,” she explained to me in an email. “With that much caveating, it’s hard to imagine why a funder would get excited to back something that everyone’s saying shouldn't exist.”
Still, it’s not hard to imagine a near-term future in which climate change presents an increasingly urgent national security concern, and the instant governments start treating geoengineering as a defense priority, the money could be practically limitless. Private geoengineering companies could function essentially as defense contractors, with militaries as their primary customers.
The comparison makes some understandably uneasy, as it risks framing climate interventions as weapons to be wielded by states with the resources to develop and deploy them. But however you look at it, “people are starting to realize, there’s no scenario where this stuff doesn’t become geopolitical very very fast,” Gambill told me. And that makes an already controversial field considerably messier.
One way to sidestep some of the thorniest questions around global governance could be to start with a focus on more localized interventions. In the Arctic, for example, companies such as Real Ice and Arctic Reflections are testing ways to thicken sea-ice by pumping seawater onto its surface during the winter. In Antarctica, researchers are studying the feasibility of underwater “seafloor curtains” in front of the Florida-sized Thwaites Glacier to keep warm ocean water from melting it from below. If that glacier were to fully collapse, it could raise global sea levels by up to two feet. There are also some truly low-tech options on the table, too: One calls for reintroducing bison to the Alaskan tundra, where their heavy footsteps would compact the snow and help keep the underlying permafrost frozen.
There’s even a more localized version of solar geoengineering. Called marine cloud brightening, it involves spraying a fine mist of seawater into low-lying clouds over the ocean. The salt particles encourage the formation of smaller cloud droplets, making the clouds brighter and more reflective, cooling the ocean and surface below. Unlike stratospheric aerosol injection, the impacts of which could persist for a year or more, a single deployment of marine cloud brightening lasts mere days, making it readily reversible and easier to test. Australian researchers have piloted this tech over the Great Barrier Reef.
"It feels like people read Kim Stanley Robinson’s novels and are trying to actually figure out if any of that stuff makes sense,” Deich told me. In Robinson’s acclaimed 2020 novel The Ministry for the Future, he imagines efforts at stratospheric aerosol injection, glacier stabilization, and large-scale rewilding in response to a fictional — but readily imaginable — catastrophic heat wave.
Deich worries, however, that he didn’t hear enough emphasis at the summit on the ongoing role carbon removal — not just emissions cuts — would have to play in a world even temporarily reliant on an intervention like stratospheric aerosol injection. That’s because of the risk of “termination shock”: If scientists suddenly halted solar geoengineering, the warming it had been masking would likely return within just a few years unless carbon removal efforts could draw down significant CO2 in the interim.
“The [carbon dioxide removal] community from the very early days tried very hard to say, first priority is obviously stopping emissions, but we also need to do removal, and we can’t wait for one to do the other,” Deich told me. “And I don’t see that same type of drumbeat being articulated by the SRM crowd.”
He and others are well aware of the moral hazard argument that has long dogged carbon removal: that this tech will give fossil fuel companies cover to keep emitting, and politicians an excuse to avoid the harder work of decarbonization. With carbon removal, however, that concern is generally simple to rebut. All recent IPCC reports have concluded that removals will be necessary to keep warming anywhere near safe levels. And in many cases, cutting emissions is still far cheaper than removing carbon after the fact.
But it’s a different calculus for an intervention like stratospheric aerosol injection, which is cheap by comparison and could lower global temperatures without doing anything to address the underlying emissions buildup. It’s easy to see how policymakers and the public could say, “Let’s let future generations deal with this building up of greenhouse gasses. We don’t really have to care about that now, we can just keep the temperatures a bit lower and buy ourselves time,” Robert Höglund, a carbon removal advisor and co-founder of the market tracker CDR.fyi, told me. “I think that’s fair. It’s a real risk.”
For its part, ARC plans to publish a report early next year bringing together the work of roughly 40 authors to lay out the state of the field’s science, governance, and social legitimacy. This will come alongside an open map of the interventions being studied and tested as well as funding and research gaps that remain. Rather than immediately holding another global summit, the organization plans to convene regional meetings next year primarily in low- and middle-income countries to explore possibilities for local research efforts in climate vulnerable nations. The next global gathering might then be scheduled for 2028.
In the meantime, many hope ARC and others will help shepherd along myriad research and communications efforts. Because if any message dominated the inaugural summit, it was: Geoengineering isn’t yet ready for prime time. There’s much more research to do, and significant stakeholder groundwork to lay, especially as the field considers how to best invite policymakers into the conversation.
“You cannot create a field. Nobody can declare it into existence,” ARC director Joshua Elliott told me of the effort to bring together the disparate experts working on climate stabilization. What organizations like ARC can do is build the infrastructure for it to emerge. That looks like convening researchers, advocates, and even skeptics; synthesizing siloed knowledge; opening the arguments to debate; establishing academic journals; and creating funding streams within governments and other institutions. But from there, the big decisions belong to others.
“That’s where our theory of change stops,” Elliott told me. ARC won’t decide whether the aerosols are injected into the atmosphere or Arctic ice is thickened. “It is the governments and the multilateral institutions that we have charged with making these decisions, despite however functional you think those institutions might be.”