By Samantha Young for KFF Health News.
Broadcast version by Eric Tegethoff for Oregon News Service reporting for the KFF Health News-Public News Service Collaboration

Oregon is shipping air conditioners, air purifiers, and power banks to some of its most vulnerable residents, a first-in-the-nation experiment to use Medicaid money to prevent the potentially deadly health effects of extreme heat, wildfire smoke, and other climate-related disasters.

The equipment, which started going out in March, expands a Biden administration strategy to move Medicaid beyond traditional medical care and into the realm of social services.

At least 20 states, including California, Massachusetts, and Washington, already direct billions of Medicaid dollars into programs such as helping homeless people get housing and preparing healthy meals for people with diabetes, according to KFF. Oregon is the first to use Medicaid money explicitly for climate-related costs, part of its five-year, $1.1 billion effort to address social needs, which also includes housing and nutrition benefits.

State and federal health officials hope to show that taxpayer money and lives can be saved when investments are made before disaster strikes.

"Climate change is a health care issue," so helping Oregon's poorest and sickest residents prepare for potentially dangerous heat, drought, and other extreme weather makes sense, said Health and Human Services Secretary Xavier Becerra on a visit to Sacramento, California, in early April.

Becerra said the Biden administration wants states to experiment with how best to improve patient health, whether by keeping someone housed instead of homeless, or reducing their exposure to heat with an air conditioner.

But Medicaid's expansion into social services may duplicate existing housing and nutrition programs offered by other federal agencies, while some needy Americans can't get essential medical care, said Gary Alexander, director of the Medicaid and Health Safety Net Reform Initiative at the Paragon Health Institute.

"There are 600,000 or 700,000 intellectually disabled people in the United States waiting for Medicaid services. They're on a waitlist," said Alexander, who oversaw state health agencies in Pennsylvania and Rhode Island. "Meanwhile Medicaid has money for housing and food and air conditioners for recipients. Seems to me that we should serve the intellectually disabled first before we get into all of these new areas."

Scientists and public health officials say climate change poses a growing health risk. More frequent and intense floods, droughts, wildfires, extreme temperatures, and storms cause more deaths, cardiovascular disease from poor air quality, and other problems, according to the federal government's Fifth National Climate Assessment.

The mounting health effects disproportionately hit low-income Americans and people of color, who are often covered by Medicaid, the state-federal health insurance program for low-income people.

Most of the 102 Oregonians who died during the deadly heat dome that settled over the Pacific Northwest in 2021 "were elderly, isolated and living with low incomes," according to a report by the Oregon Health Authority, which administers the state's Medicaid program, with about 1.4 million enrollees. The OHA's analysis of urgent care and emergency room use from May through September of 2021 and 2022 found that 60% of heat-related illness visits were from residents of areas with a median household income below $50,000.

"In the last 10-plus years, the amount of fires and smoke events and excessive heat events that we've had has shown the disproportionate impact of those events on those with lower incomes," said Dave Baden, the OHA's deputy director for programs and policy.

And, because dangerously high temperatures aren't common in Oregon, many residents don't have air conditioning in their homes.

Traditionally, states hit by natural disasters and public health emergencies have asked the federal government for permission to spend Medicaid dollars on back-up power, air filters, and other equipment to help victims recover. But those requests came after the fact, following federal emergency declarations.

Oregon wants to be proactive and pay for equipment that will help an estimated 200,000 residents manage their health at home before extreme weather or climate-related disaster hits, Baden said. In addition to air conditioning units, the program will pay for mini fridges to keep medications cold, portable power supplies to run ventilators and other medical devices during outages, space heaters for winter, and air filters to improve air quality during wildfire season.

In March, the Oregon Health Plan, the state's Medicaid program, began asking health insurers to find patients who might need help coping with extreme weather. Recipients must meet federal guidelines that categorize them as "facing certain life transitions," a stringent set of requirements that disqualify most enrollees. For example, a person with an underlying medical condition that could worsen during a heat wave, and who is also at risk for homelessness or has been released from prison in the past year, could receive an air conditioner. But someone with stable housing might not qualify.

"You could be in a housing complex, and your neighbor qualified for an air conditioner and you didn't," Baden said.

At the offices of insurer AllCare Health in Grants Pass, Oregon, air conditioners, air filters, and mini fridges were piled in three rooms in mid-April, ready to be handed over to Medicaid patients. The health plan provided equipment to 19 households in March. The idea is to get the supplies into people's homes before the summer fire season engulfs the valley in smoke.

Health plans don't want to find themselves "fighting the masses" at Home Depot when the skies are already smoky or the heat is unbearable, said Josh Balloch, AllCare's vice president of health policy.

"We're competing against everybody else, and you can't find a fan on a hot day," he said.

Oregon and some other states have already used Medicaid money to buy air conditioners, air purifiers, and other goods for enrollees, but not under the category of climate change. For example, California offers air purifiers to help asthma patients and New York just won federal approval to provide air conditioners to asthma patients.

Baden said Oregon health officials will evaluate whether sending air conditioners and other equipment to patients saves money by looking at their claim records in the coming years.

If Oregon can help enrollees avoid a costly trip to the doctor or the ER after extreme weather, other state Medicaid programs may ask the federal government if they can adopt the benefit. Many states haven't yet used Medicaid money for climate change because it affects people and regions differently, said Paul Shattuck, a senior fellow at Mathematica, a research organization that has surveyed state Medicaid directors on the issue.

"The health risks of climate change are everywhere, but the nature of risk exposure is completely different in every state," Shattuck said. "It's been challenging for Medicaid to get momentum because each state is left to their own devices to figure out what to do."

A California state lawmaker last year introduced legislation that would have required Medi-Cal, the state's Medicaid program, to add a climate benefit under its existing social services expansion. The program would have been similar to Oregon's, but AB 586, by Assembly member Lisa Calderon, died in the Assembly Appropriations Committee, which questioned in a staff analysis whether "climate change remediation supports can be defined as cost-effective."

The cost savings are clear to Kaiser Permanente. After the 2021 heat wave, it sent air conditioners to 81 patients in Oregon and southwest Washington whose health conditions might get worse in extreme heat, said Catherine Potter, community health consultant at the health system. The following year, Kaiser Permanente estimated it had prevented $42,000 in heat-related ER visits and $400,000 in hospital admissions, she said.

"We didn't used to have extreme heat like this, and we do now," said Potter, who has lived in the temperate Portland area for 30 years. "If we can prevent these adverse impacts, we should be preventing them especially for people that are going to be most affected."


Samantha Young wrote this story for KFF Health News.


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By María Ramos Pacheco for The Dallas Morning News.
Broadcast version by Freda Ross for Texas News Service reporting for the Solutions Journalism Network-Public News Service Collaboration

Anamelia Jaramillo has lived in Jubilee Park for almost 20 years and is concerned about the heat getting worse every summer.

She fears her air conditioning system failing because her husband has diabetes and can be vulnerable to extreme heat.

“I wish we didn’t have to have the A/C running all day long, but it is impossible to survive in the summer without it,” said Jaramillo, 54, after attending a Zumba class at Jubilee Park on Nov. 11.

In 2023, more than 20 people died in Dallas and Tarrant counties from heat-related illnesses as Texas saw record heat waves and triple-digit temperatures, according to the counties’ medical examiners. The lack of trees and green spaces, such as community gardens and parks, in an urban area contributes significantly to the “urban heat island effect,” as buildings, roads and other hard surfaces absorb and retain more heat.

Dallas’ District 7, where most of the neighborhoods participating in the South Dallas Greening Initiative are located, was ranked the third-highest priority for tree canopy, according to the Dallas Tree Equity Mapping Report published in 2022 by the Texas Trees Foundation.

Districts 4 and 6 ranked as the first and second highest priority for tree canopy, and the organization has been deploying some of their programs to plant more trees in these areas. Early this year, the Texas Trees Foundation released its plan to tackle the lack of trees in the Southwestern Medical District as part of its initiatives to combat the urban heat island effect.

Texas Trees, through the South Dallas Greening Initiative, also is working in the Jubilee neighborhood to address the area’s lack of trees to combat the extreme heat affecting residents’ health and quality of life. The nonprofit is providing thousands of trees to the almost 50,000 residents of Fair Park, Mill City, Queen City, Wheatley Place and adjacent neighborhoods over five years. Jubilee Park is just below Interstate 30 and north of Fair Park.

Chandler Stephens’ father, Calvin Stephens, has owned two vacant lots in South Dallas since the 1980s. The younger Stephens has been talking with Texas Trees about working together on his vision to create a community garden.

Stephens dreams of having a green space in every corner of South Dallas to improve residents’ quality of life.

“I can see [the initiative] as something that will prolong the community’s livelihood. Not only with addressing the urban heat island issue but just by providing greenery,” Stephens said. “Plants and our health is so linked to the health of the earth and the planet.”

The Dallas Comprehensive Environmental and Climate Action Plan established protocols for adapting to climate change challenges in 2020. It states that Dallas needs approximately 735,000 trees to reach a goal of 37% tree canopy cover and, specifically, mitigate the urban heat island effect.

Since its founding in 1982, Texas Trees has planted an estimated 1.5 million trees across the Dallas-Fort Worth region. In 2023, the Dallas-based nonprofit secured a $15 million grant from the Reduction Act through the U.S. Forest Service’s Urban and Community Forestry program for the South Dallas Greening Initiative.

The project, however, is part of a long-term solution to extreme heat, and many of Jubilee’s residents want to see more.

“I am in favor of the initiative and for them to plant more trees in the area, but we also need help with how to pay the electricity bills,” Jaramillo said.

In any community, including South Dallas, trees may not be at the top of each resident’s list of the needs they see for their community, said Elissa Izmailyan, chief strategy and operations officer with Texas Trees.

“We are showing up with a commitment to help and the ability to offer trees and urban forestry education but realize that we’re entering a landscape where there are a lot of other needs and priorities,” Izmailyan said.

“So first, we need to be sensitive to that broad range of priorities and capacities. Second, we need to think about how our offering intersects with other needs in a way that’s additive.”

The project will have several components beyond planting trees in the community, Izmailyan said.

The first phase has been to reach out to the community and work with nonprofits and organizations in South Dallas to establish a trusting relationship and understand the community’s needs and wants.

That’s where partnerships with local organizations come into play, as well as involvement with community leaders.

The Jubilee Park and Community Center is a nonprofit that works to restore equity and resources for the 3,000 residents of the Jubilee neighborhood. The community center has been around for almost 30 years and offers education, health, food access and after-school programs.

Emily Plauche, Texas Trees’ community greening manager, said the initiative includes an educational component that teaches residents about trees, their benefits, how to care for them, green jobs and other measures that can be taken to combat extreme heat.

“So there’s always going to be other needs or things that arise, too, and we can’t necessarily, with our money, purchase that. But we can help advocate and get the city involved and bring other people to the table who have some of these potential solutions,” Plauche said. “We are deeply committed to the well-being of the community.”

Texas Trees will work with some of the area’s schools to boost green spaces and tree planting on the campuses. The organization already runs a program across the city focusing on schools needing more canopy.

Marissa Castro Mikoy, president and chief executive officer at Jubilee Park, said that over the years Texas Trees has helped plant over 150 trees on their campus, and they can see the benefits to the community, from providing shade to beautifying the park.

Benefits of trees

In April, Dallas shared findings from a study that identified at least 10 neighborhoods as urban heat island spots. Some of these spots have less green space, and the temperature is 10 degrees hotter than in other parts of the city.

Trees can help reduce the urban heat island effect and improve people’s and the environment’s health in several ways.

They provide shade and block incoming solar radiation, lowering temperatures by several degrees. They also release water vapor, which can help cool temperatures. According to the Environmental Protection Agency, trees sequester carbon from the atmosphere in their wood and roots, absorb gases and provide a place for harmful air particles to land.

At the same time, according to the U.S. Forest Service, trees provide mental health benefits such as stress reduction, improved mood and a sense of well-being due to increased exposure to nature.

Cities across the country and the world have documented the long-term effects of planting trees strategically in urban areas.

In Chicago, according to studies, neighborhoods with higher tree canopy cover have experienced temperature reductions of up to 4.6 F to 6.8 F compared to areas with little or no tree canopy.

Similarly, in Medellin, Colombia, temperatures fell by 3.6 F in the first three years of their program installing green corridors, and officials expect a further decrease of 7.2 F to 9 F over the next few decades, even taking into account climate change, the Secretary of Environment of Medellin reported.

Limitations

Trees are one solution that can help residents in South Dallas combat extreme heat, but Castro Mikoy said the initiative needs to be combined with solutions to the area’s other problems.

Displacement, making ends meet and food insecurity are some issues facing South Dallas residents that make heat waves even more damaging for them.

Silvia Herrera, 48, a Jubilee resident, avoids turning on lights and household appliances during the day in the summer to keep her home cooler and reduce her electricity bills. She said her bill is around $500 in the peak summer months.

“You have to make decisions such as when you turn on the A/C and what things to avoid to spend less energy so the bill [electricity] is not too high because then I can’t pay for it,” Herrera said.

Planting trees and having the ecosystem to purchase, transport and maintain them can also be expensive. The South Dallas Greening Initiative was able to come to life because of the grant Texas Trees secured. Not all cities or organizations can afford this type of solution, which is a limitation to replicating this program everywhere.

Community First

Through the five-year plan, Brittani Hite, strategic director of Ethos Equity Consulting, which is working with Texas Trees on the initiative, said there should be no surprises for the residents.

The project is for the community and by the community, said Hite.

“We understand that the solutions are already within the community,” Hite said. “South Dallas residents know what they want. They know what they need, but because of environmental and ultimately systemic racism, unfortunately, we lack green spaces, trees and other basic necessities in our city’s Black and brown neighborhoods.”

From Hite’s perspective, the conversations among the Jubilee moms after Zumba classes to Stephen’s dream of having community gardens that work with the wants and needs of the South Dallas community, will have an impact on finding the right solution.


María Ramos Pacheco wrote this article for The Dallas Morning News.


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New Jersey Gov. Phil Murphy is maintaining the state's clean-energy progress. In his final State of the State Address, Murphy thanked lawmakers for advancing the state's climate and clean-energy goals during his time in office. But he also called on them to codify the state's clean-energy standards into law this year.

Ed Potosnak, executive director of the New Jersey League of Conservation Voters, said this furthers the state's ability to meet its climate goals.

"The laws that exist on the books require New Jersey to get roughly 88% of its energy from clean sources: solar, wind, and nuclear. We're on track to meet those goals. What this call to action and the legislation will need to achieve is the last five years to get the remaining 12%," he explained.

The state has made these strides despite setbacks. In 2023, offshore wind developer Orsted canceled the Ocean Wind project, citing costs. Other offshore wind farms have been met with backlash over perceived impacts on wildlife and complaints of how they could ruin the state's coastline. However, offshore wind is projected to create more than 10,000 jobs by 2030.

The state has seen many severe climate-change impacts grow since 2012's Superstorm Sandy. These have caused an estimated $50 billion to $100 billion in damage between 1980 and 2024.

While moving to clean energy helps the state brace for these storms, Potosnak said fossil fuel companies are fighting to maintain the status quo.

"It doesn't take long for you to remember the TV ads that you've seen where some nice woman walks across the screen and says, 'Natural gas is clean energy,' when in fact natural gas causes pollution, asthma, cancer and heart disease," he continued.

However, the incoming administration of President-elect Donald Trump is promising to bolster the fossil fuel industry. Along with this, he's proposing to cut many climate-funding initiatives, including the Inflation Reduction Act.

By Ethan Brown for The Sweaty Penguin.
Broadcast version by Shanteya Hudson for Alabama News Service reporting for the Solutions Journalism Network-Public News Service Collaboration

A 2023 Pew Research survey found only 27% of U.S. adults feel individual actions can help "a lot" to reduce the effects of climate change. But according to panelists at a Tuesday webinar from ClimateVoice and WorkforClimate, there's a solution - advocacy in the workplace.

"A lot of people understand that if they can get a hold of their employer's resources, they can have an outsize impact on climate change in a way that you will never be able to do as an individual voter or consumer," said Drew Wilkinson, Founder of Climate Leadership Collective.

Prior to founding his own company, Wilkinson was a paralegal at Microsoft. In 2018, two years into his tenure, he emailed The Ocean Cleanup to propose a collaboration at Microsoft's Global Hackathon to find solutions for ocean plastic pollution. At that point, The Ocean Cleanup had built technology to remove plastics from rivers and deployed it in Indonesia and Malaysia, but could not yet identify whether collected waste was actually plastic, or other debris such as sticks and leaves. Through Wilkinson's Hackathon project, participants developed a machine learning model to perform this task, successfully identifying over 30,000 ocean photos.

That same year, Wilkinson and a coworker launched the first employee sustainability community at Microsoft. The group grew rapidly, reaching 10,000 members and 37 local chapters in 2023, and playing a central role in Microsoft's strategy to become carbon negative, water positive, and zero waste by 2030.

"This is fundamentally about changing the paradigm of who gets to work on sustainability in a company," said Wilkinson. "It's not just for the people who have it in their job titles. It's about democratizing sustainability so that everybody can work on it in whatever way they want to."

In fact, a majority of employers want their subordinates' help with sustainability. In Willis Towers Watson's 2021 HR and Climate Strategy Survey, 84% of North American executives reported that employees play a major role in the successful delivery of their company's climate strategies.

It wasn't just large corporations where panelists made their mark. According to Arielle Terry, now Manager of Lending Solutions at ATMOS Financial, even a brand new employee working remotely can create positive change.

"Climate matters so much to me," said Terry. I'm so passionate about it, and I know my friends are probably like 'stop talking about it all the time.' But I just can't."

Before her current job, Terry worked as an Implementation Expert at Perceptyx, an employee experience transformation company with around 400 employees. A month into her job, Terry was shocked to learn that her 401(k) was invested into fossil fuels, deforestation, and other companies whose values did not align with her own.

"As employees, we should not have to invest in things we don't agree with," said Terry.

Before a company town hall, Terry posted a question about climate friendly 401(k) alternatives in the company Slack channel. To her surprise, her question received the most responses and was the first one asked at the town hall. After recruiting ten colleagues to a climate employee resource group, Terry eventually succeeded in convincing the company to add a climate friendly fund. She now works to improve solar lending practices at ATMOS.

While Wilkinson and Terry notched exciting wins in their respective roles, they did not come without challenge.

"A big thing is just, kind of, being ignored," explained Terry. "We were told 'we're gonna reevaluate benefits in 2023' and just being pushed off a lot."

In initial conversations with human resources, Terry learned Perceptyx did not have sustainability goals going into 2023. But by organizing coworkers and staying persistent, she still made a difference from the ground up.

Wilkinson echoed a similar sentiment.

"What it really takes to drive change for employees is a small but very tenacious and very persistent group who refuse to go away. If you can get more colleagues to join your cause, obviously it's harder to say no to ten than one, or ten thousand than a thousand."

To help individuals start their workplace advocacy, ClimateVoice developed an Employee Action Guide. The guide details four steps for all employees, regardless of title, to inspire progress: get the facts, find your influence, engage your coworkers, and advocate for action.

"No matter where you work, you have inside access. You have the relationships with your coworkers, with your leadership," said Deborah McNamara, Co-Executive Director of ClimateVoice. "Start thinking systemically about who's making the decisions and how you can have these important conversations about creating change."

ClimateVoice encourages employees to not just inspire action within the company, but also push employers to use their company's power to influence government policy.

"Right now we have this very lopsided situation where fossil fuel companies are unfortunately dominating the discourse," explained McNamara. "We want employees and companies to be doing more to advocate for the climate solutions that we need through policy."

ClimateVoice acknowledges that political engagement on climate may be daunting for some executives. That's why their guide includes a list of common objections - such as a preference for focusing on internal sustainability, a fear of wasting lobbying firepower, and a worry for pushing away partners like the U.S. Chamber of Commerce - and ideas for how employees can respond.

"It does require changing systems that are very entrenched," said McNamara. "We believe that employees are an important lever for change."

While corporate sustainability - particularly the concept of environmental, social, and governance (ESG) goals - has become controversial in recent years, companies who engage in the practice report several benefits beyond helping address climate change. Strong ESG practices increase sales, cut costs, attract investors, build customer loyalty, reduce legal liabilities, and improve recruitment with younger employees.

Panelists shared that their workplace advocacy didn't just help their companies' carbon footprints; it also helped their personal climate anxiety. A 2021 Pew Research poll found 59% of millennial and 69% of Gen-Z social media users said they felt anxious about the future after viewing climate content. While studies show excessive fear and anxiety often leads to lower engagement in the climate cause, Wilkinson's sustainability work at Microsoft allowed him to flip that script.

"For me, the antidote to anxiety is action," shared Wilkinson. "Believe that you can get power and influence. [We] are here to tell you that you surely can."


Ethan Brown wrote this article for The Sweaty Penguin.