The human body can’t withstand extra-hot temperatures for very long. A healthy person can tolerate 95 degrees Fahrenheit of combined heat and humidity for a few hours, but prolonged exposure causes weakness, cramps, confusion, dizziness, and dehydration. After a certain point, vital organs like the brain begin to swell.

Nearly 100 million Americans faced these dangerous conditions over the past few weeks. Yet very few live in places that guarantee any kind of access to cooling. Throughout most of the country, air conditioning is still treated as a luxury to be used for comfort, not as a public health necessity that saves lives.

The US has managed to do better when it comes to helping people get through the winter. The vast majority of states have policies that forbid power shutoffs during a winter freeze. Most states also require heating for multifamily homes. But policy governing cooling in the summers is a patchwork that lets the most vulnerable slip through the cracks. Federal buildings, housing, and prisons have standards for heat, but no guarantee of AC. And only eight states have any kind of requirements that utilities keep the power on during a heat wave, according to data compiled by Energy Justice Lab of Indiana University and shared with Vox.

“We understand the public health implications if a person has an apartment that’s too cold, especially for the elderly,” said energy economist Mark Wolfe, executive director of the National Energy Assistance Directors Association and the Energy Programs Consortium, an organization that assists low-income consumers. “We have rules that require that multifamily building owners must provide adequate heat. There’s no gray area.”

The nation doesn’t have an accurate picture of just what the lack of any coherent cooling strategy costs the public. Some low-income consumers have to choose between turning on the AC or buying food. For some, it means utilities have cut off their power for falling behind on an unpaid bill, even in life-threatening heat.

Reports are just starting to trickle in on how fatal the current heat wave is. Many of these deaths are entirely preventable. That’s especially true when heat-related deaths and illnesses happen inside the home, where we spend most of our time. When Oregon faced a triple-digit heat wave last summer, officials reported many of the people who had died were found indoors without AC or a fan. According to Arizona Department of Health Services numbers, roughly a third of heat-caused deaths happen inside the home.

Cooling policies have not caught up to a hotter planet

One thing we can count on: More heat are waves coming. The world has already warmed by 1.1 degrees Celsius, a seemingly small shift in the climate that results in extreme heat becoming more common and more frequent. There are more extremely hot days, and fewer extremely cold ones, across the globe.

In the US, Climate Central identified 126 locations that now have an extra week of extremely hot days annually compared to 1970 (places like Phoenix and Austin are worst off, now seeing weeks above 100 degrees). And summer nights are warming nearly twice as fast as daytime temperatures, leaving people with no respite from the heat.

The health consequences of that 1-degree shift are showing up in mortality data: Arizona’s Maricopa County has reported a mid-season record of 222 suspected deaths from heat, 29 of them confirmed. At least 25 of these happened in the past week. These numbers are roughly in line with what studies have estimated: More heat waves mean more deaths and illnesses from heat stress. For every additional day of extreme heat per month, one investigation in the Journal of the American Medical Association found, there are 7 additional deaths per 10 million people.

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You don’t have to live in a traditionally hot climate to face risks. Historically cooler states face even greater challenges. Fewer residents have AC, and people are less acclimated to the heat. A 95-degree day in Washington state can be more deadly than the same temperature in Texas. Last summer, more than 500 people died in Oregon, Washington, Idaho, and Canada when temperatures shattered records in the triple digits.

The answer to hot weather is to get people out of the heat. That’s especially true for the most vulnerable populations, which have lower tolerances. This includes older adults, very young children, people with chronic conditions like high blood pressure, and people who are overweight.

But simply going indoors might not be any better. There are all sorts of reasons the home can become a death trap: People live in concrete houses that were built to withstand the cold, but lack AC or ventilation to keep cool. Or people have AC but are afraid to turn it on because they can’t pay the bill. Or the AC unit is broken and the landlord hasn’t fixed it. Or the utility company shut off the power over a missed bill payment. The Census’s Pulse Survey, for example, has found that about one in every five households has been unable to pay a utility bill in the last 12 months.

Cooling tends to be overlooked at every level of government. The designated federal program to help low-income consumers, the Low Income Home Energy Assistance Program (LIHEAP), spends 85 percent of its funds on heating in winter, rather than cooling in summers, Wolfe explained. Biden last week announced $385 million in more funding for LIHEAP, but Wolfe estimated its needs for cooling to be about $3.8 billion, equal to its heating budget.

Even cities with robust climate plans have been slow to change. Chicago, for instance, only recently passed a requirement this summer for assisted living homes to provide AC. Some traditionally hot places have these protections in place, but not all. And the problem is that climate change is blurring the lines between hot and cold climates.

Indoor heat deaths are entirely preventable

There’s one policy the US can pass today that can also save lives: stopping utility shutoffs in the summertime because a customer has missed one or more payments.

Right now, only 18 states have any protections that prevent utilities from shutting off a customer’s power in a heat wave because of missed payments, while 41 states have these protections for the cold. That leaves most of the population vulnerable to utility shutoffs during the deadliest extreme weather window of the year.

Utility disconnections have been getting more attention. During the first year of the Covid-19 pandemic, some states prevented any utility disconnections for nonpayment. A Center for Biological Diversity report found that since the pandemic began in January 2020 through December 2021, households had their power shut off more than 3.6 million times. Florida, Georgia, Indiana, Pennsylvania, and Illinois accounted for the most disconnections.

The size of the population affected by utility cutoffs is hard to pin down. Some utilities voluntarily suspend power shutoffs above certain temperatures, but there is no oversight or even reporting in many states. Indiana University researchers are attempting to collect data for the first nationwide database that gets at the scope of this problem. David Konisky, Indiana University’s co-director of the Energy Justice Lab, estimated the number to be in the tens of thousands every summer.

Arizona is one of the few states with a policy to protect its residents from utility disconnects in the heat. In 2018, 72-year-old Stephanie Pullman died after Arizona Public Service (APS) cut her power amid a 107-degree heat wave. Pullman fell short of her payment by about $50 that month. Her death didn’t become public until Phoenix New Times reporter Elizabeth Whitman published an article in 2019.

Pullman’s case built support for Arizona to finally ban these kinds of utility disconnections in the summer. In 2022, Arizona’s utility regulator made its temporary rules permanent for utilities like APS. The rule prevents some Arizona utilities from shutting off power in summer months or when temperatures pass 95 degrees.

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Stacy Champion, a climate activist who lives in Phoenix in Maricopa County and advocated for the new rule, argues the policy is still riddled with loopholes. First of all, it does not apply to the state’s second-largest utility, Salt River Project, because it’s not regulated by the same body. The state legislature could fix that with a law that governs all utilities. Second, the rule itself sets a relatively high temperature threshold that’s limited to summer months, which means early-season heat waves aren’t covered.

Champion has advocated for even stronger heat protections that are temperature-driven, pointing to her years of submitting records requests from Maricopa County on heat-related deaths. She sees reports on heat-related deaths start to crop up as soon as temperatures rise past 85.

Setting the threshold for utilities at 95 degrees may not even be enough to protect the most vulnerable. Indiana University’s Konisky thinks there’s a more chronic problem even when the temperature is milder. “We tend to focus on [disconnections] during heat waves, or during cold spells, or during natural gas price spikes, but this is happening all the time,” he said. “It’s not just the very poor who get disconnected more frequently, but it’s people of color, people with young children, people with medical disabilities.”

One of the chronic underlying problems is racial discrimination. Just like utility disconnections data, this is difficult to show. In 2017, NAACP released a report on utility disconnection in colder months showing that they happened to African Americans at a higher rate than white people, regardless of income. In New York City, Black residents in New York City account for half of heat-related fatalities despite being 22 percent of the population. Access to air conditioning is a key factor, but so is the green spaces and tree cover that can make a neighborhood cooler.

Filling this policy gap on utility disconnections doesn’t have to be left to the states. “Congress could pass a law tomorrow that says utilities cannot disconnect anyone for nonpayment” at certain times of the year, Wolfe said. Whether it’s states or Congress that fills the gap, there isn’t any more time to waste.

“Twenty years ago, maybe once during the summer you’d have this very bad heat wave,” Wolfe said. “This summer it is just continuous. Our society is not ready for this. Our programs aren’t ready for it. People aren’t ready for it.”