Staff Reports
The Congressional Budget Office quietly dropped a new slide deck this week that will make people scratch their heads. The CBO projects that changing temperatures — if people and communities adapt — would mean fewer deaths among Medicare enrollees through 2075, more emergency-room visits, and lower cumulative emergency-department spending. The headline numbers sound good until you read the fine print.
What the CBO actually found
The CBO presentation, prepared by David Adler, Noelia Duchovny, Evan Herrnstadt and Jared Jageler and issued under Director Phillip L. Swagel, lays out the central projection: through 2075 the Medicare population would see about 2.5 million fewer temperature‑related deaths, roughly 18 million more ED visits, and about $55 billion less in ED spending (in 2019 dollars). Per 100,000 Medicare enrollees, that works out to roughly 120 fewer deaths and about 700 more ED visits by 2075, plus a decline in ED spending of about $2.6 million per 100,000.
The fine print that changes the story
Here’s the kicker: those results assume adaptation happens — mainly more air conditioning and other local responses — and the CBO does not count the cost of that adaptation. The analysis covers only temperature effects on the Medicare population. It leaves out big climate risks like wildfire smoke, floods, vector‑borne disease, and power outages. In a version of the model with no adaptation, the spending picture flips and ED costs rise instead of falling. So the headline savings depend on an optimistic assumption that adaptation will occur and be affordable.
Who pays, and what about heat waves and blackouts?
The slide deck models changes in average daily temperatures, not the tail risks that matter in real life. Averages can hide deadly heat waves, grid failures, and unequal access to cooling. The CBO assumes seniors will be sheltered from heat by more AC, but it doesn’t say who pays for units, higher electric bills, or grid upgrades. If air conditioning fails during a major heat event, the neat gains the CBO reports could evaporate fast. Hospitals and emergency systems also would face higher visit counts even if average spending falls, and that strains staffing and local budgets.
Why conservatives should care and what to demand
This is a policy debate dressed up as good news. Conservatives should welcome sober, transparent numbers — but demand full accounting. If government models assume adaptation, they must also estimate adaptation costs and who bears them. Ask the CBO for plain language on what adaptation steps were modeled. Ask CMS, hospital associations, and state officials how they would handle more ED visits, seasonal stress, and grid risk. We should not let optimistic averages excuse leaving seniors on the hook for rising utility and infrastructure bills.
Bottom line: the CBO slide deck is worth reading, but don’t treat its topline as a free pass. The report shows that temperature shifts could reduce some risks for older Americans if communities and policymakers invest in adaptation. It does not show that climate change is suddenly cheap or harmless. Policymakers need to stop celebrating neat headline numbers and start answering practical questions about costs, equity, and resilience.
