Global warming will lead to more older adults visiting emergency rooms, but fewer of them will die and overall emergency room spending should drop, according to new research by the Congressional Budget Office.
All told, CBO says, some 2.5 million temperature-related deaths among the Medicare population will be avoided over the next 45 years if the Earth warms as projected.
Warm climates, where deaths usually spike during cold snaps, will experience fewer of those days, CBO said.
Meanwhile, colder climates will adapt to persistently higher temperatures by expanding the use of air conditioning, blunting the worst effects.
“In total, [emergency department] visits would increase by 18 million, ED spending would decrease by $55 billion, and mortality would be reduced by 2.5 million through 2075,” CBO said in its analysis.
CBO, which serves as the government’s official scorekeeper on the cost of legislation, said the findings shed light on expected changes in Medicare spending.
The researchers looked specifically at Medicare, the government’s health program for those 65 and older.
They used emergency department visit data from 2015 to 2019 as a baseline, then projected temperature-related health impacts from 2030 to 2075.
CBO said the biggest factor will be more days with temperatures in the middle range.
The climate model CBO used showed Boston in 2075 would be roughly comparable to Philadelphia and Washington today in terms of “cooling degree days” — a measure of the number of days above 65 degrees Fahrenheit and how far above 65 each of those days reaches.
CBO said an 85-degree day in Boston increases emergency visits by 19 per 100,000 Medicare enrollees and deaths by six, while a 25-degree day has a negligible impact.
By contrast, an 85-degree day in Dallas has little impact, but a 25-degree day increases emergency visits by six per 100,000 Medicare enrollees and deaths by seven.
Underpinning CBO’s work was the assumption that communities would take steps to adapt to warmer days. Those steps include increasing the use of air conditioning and public health education about heat-related illnesses.
Without those adaptations, CBO said, there would still be a drop in deaths, though on a much lower scale — about 360,000 through 2075.
The rise in emergency room visits stems from more hot days in moderate and hot regions, outstripping the drop in visits from colder regions.
Those colder-region visits tend to cost more, so the drop in numbers would amount to overall savings, even with the rise in moderate- and hot-climate visits.
“In a climate like Boston’s or Philadelphia’s, ED visits increase as temperatures rise, but the opposite is true in climates like that of Dallas. In those climates, there is also a noticeable increase in visits on days when the temperature is near freezing.”
The unexpected finding, though, was the drop in deaths. CBO said deaths will increase in moderate-temperature zones but will drop in cold and hot zones, which will have fewer cold snaps.
“The overall change in deaths is largely attributable to changes in hot [regions]. Deaths are projected to decline in hot [regions] as they experience fewer cold days and adapt to the changing climate because adaptation will reduce deaths on warmer days,” the analysts wrote.
Although CBO estimated that Medicare would save $55 billion through 2075, the analysts said that was only in a scenario in which communities embraced adaptations.
Those adaptations would be costly, though CBO did not offer an estimate.
Other research suggests the gains may be specific to older adults, while younger people may not fare as well. A 2025 Yale University study found that older adults, women and widowed or divorced people were more susceptible to cold exposure, and young single people were vulnerable to heat.
That federally funded study said cold leads to more deaths from cardiovascular, respiratory and metabolic diseases, while heat leads to more circulatory issues as well as “external” deaths from injuries and accidents.
CBO said its new estimate did not tally the necessary accommodation costs, nor did it account for other costs of climate change.
Xavier Boatright, deputy legislative director at the Sierra Club, said the price tag will be high.
“We are dealing with the fallout of human-caused climate change in real-time and it’s taxpayers and families who are paying the price in the form of higher energy bills, crazy insurance premiums, and with their health and safety,” he said in a statement to The Washington Times.
He said the Trump administration has hindered some of those adaptation efforts, such as proposing cuts to heating and cooling assistance programs and curtailing the use of tax credits as incentives to buy energy-efficient heat pumps.
“At the same time, the fossil fuel corporations most to blame for the damage are not being held accountable for their role in perpetuating the climate crisis, and instead are walking away with billion-dollar paydays and handouts from the federal government at every turn,” Mr. Boatright said.
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