During the first heat wave of 2025, 55-year-old Shauna Thomas was found dead in her suburban St. Louis apartment after spending at least three days without air conditioning or running water. Police said she had “several medical issues” that may have played a role.
Clinicians, community leaders, and public health workers often advise people with chronic conditions, such as diabetes, to use air conditioning or go to air-conditioned buildings. But that advice assumes that air conditioning is actually affordable and available.
Thomas’ tragic death highlights why cooling should be added to major government programs that provide heating.
Extreme heat isn’t just uncomfortable. A medical stress test. An early season heatwave has already hit the western part of the country. The eastern United States is likely to follow suit later this month. Forty million Americans live with diabetes, and heat can quickly dehydrate them, disrupt their daily routines, and cause their blood sugar levels to become unstable, sometimes requiring emergency treatment. Reliable cooling can prevent many of these emergencies. When cooling equipment breaks down, energy costs make it impossible to purchase cooling equipment, or cooling equipment simply becomes unavailable, people lose the ability to manage their chronic diseases.
Energy insecurity is concentrated in low-income households, rental housing, and Black and Latino communities. In cities, housing quality, tree cover, and infrastructure shape neighborhood heat exposure, with some communities consistently hotter than others. These patterns reflect decades of disinvestment and housing policy decisions, rather than individual choices.
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In areas where central air conditioning has historically been less common, rising temperatures are hitting homes that were previously not designed to withstand intense heat. Outside urban centers, aging housing stock and thin safety nets create similar risks. This is a challenge to environmental justice that is rooted in policy, infrastructure, and who bears the costs of inaction.
For diabetics, heat degrades temperature-sensitive medications and makes it difficult to control blood sugar levels. A recent meeting of the National Academy of Medicine emphasized that effective heat policy must address inequalities in exposure, resources, and infrastructure. As heat waves become longer and more intense, heat-related deaths will continue to increase, especially among people managing chronic conditions without reliable access to air conditioning. Energy policy has become health policy.
The Low-Income Home Energy Assistance Program (LIHEAP) is a federal program designed to help households maintain safe indoor temperatures when energy costs skyrocket. However, the fiscal year 2026 budget cycle revealed that support remains weak. With extreme heat predicted to pose a public health threat, the administration has proposed eliminating LIHEAP entirely. Congress ultimately rejected that approach and enacted year-round appropriations in February that provided $4.045 billion in funding for LIHEAP. Still, programs that face extinction in one budget cycle cannot provide the stability that people depend on.
Uncertainty from the federal government has forced states to triage. Pennsylvania delayed the opening of LIHEAP, citing an inability to backfill costs because federal allocations did not arrive on time. Connecticut took the opposite approach, creating a state sanctuary to keep essential services (including LIHEAP) running. These different responses highlight that the system relies more on state capacity than on state coherence.
That patchwork has consequences. In Pennsylvania, winter funding shortfalls led the state to discontinue its LIHEAP cooling program in 2025. Federal regulations allow cooling assistance but do not require it, so whether it exists depends largely on where you live.
Florida has proposed a different model, treating extreme heat as a core issue in LIHEAP, operating a defined heating and cooling season, and providing year-round crisis assistance. These days, Florida serves more households through cooling than heating assistance.
Congress needs to take four steps to resolve this issue.
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First, it increases the reliability of LIHEAP by ensuring predictable funding and treating cooling as essential. When federal guidance treats cooling as an option, protections remain uneven and hit hardest on households with the highest energy burdens and the least control over their housing conditions.
Second, modernize LIHEAP for the climate we currently face. The Heating and Cooling Relief Act, which would update the program to address both heating and cooling needs, has not yet made it out of committee. Federal policy must reflect current exposure patterns, not outdated assumptions.
Third, secure LIHEAP functionality. The bipartisan LIHEAP Staffing Assistance Act would establish minimum levels of HHS staffing to ensure the program is available when households need it most. That too remains stagnant.
Finally, it establishes basic federal protections against utility shutoffs for medically vulnerable populations. Power outages disproportionately impact households that already face high energy burdens and lack of housing protection. Most states restrict winter heating shutdowns, albeit inconsistently. Far fewer companies have summer closure restrictions.
Congress should build on this state-level precedent to ensure that medically vulnerable households are protected from power outages during heat waves, regardless of where they live.
Prevention is key because the next crisis is predictable. Congress could continue to treat air conditioning as an option and then act by surprise if heat creates an avoidable emergency. Alternatively, energy policy could be aligned with medical realities. Advice is not a plan. Access.
Charles E. Leonard, Pharm.D., MPH, is a senior fellow at the Leonard Davis Institute for Health Economics at the University of Pennsylvania and an epidemiologist focused on drug safety for people living with chronic health conditions. Anthony Nicomb, MHS, MPH, is an advisor to the National Academy of Medicine Climate Community Network, a former program manager for the White House Environmental Justice Advisory Council, and a public health strategist specializing in the health impacts of climate change.
