- CBO projects modest global warming will prevent about 2.5 million temperature-related deaths among Medicare recipients through 2075
- Fewer cold snaps in hot regions drive most of the decline as residents adapt with wider air conditioning use
- Emergency department visits are expected to rise by 18 million, but total ED spending will still fall by $55 billion
- An 85-degree day in Boston raises deaths by six per 100,000 enrollees, while a 25-degree day in Dallas raises deaths by seven
- Researchers note cold already kills far more people worldwide than heat, reinforcing the report's findings
The Congressional Budget Office has released a forecast that challenges the dominant narrative around climate change and public health: modest global warming over the coming decades will prevent an estimated 2.5 million temperature-related deaths among Medicare beneficiaries through 2075.
The finding, published in a September report, arrives as policymakers debate the costs and consequences of a shifting climate. CBO used emergency department visit data from 2015 to 2019 as a baseline and projected health outcomes from 2030 through 2075, concluding that the benefits of fewer cold days will far outweigh the harms from additional heat. The report's authors credited adaptation and technology — including expanded air conditioning access — with reducing overall mortality, even as emergency room visits rise in some regions.
Fewer cold days drive the drop in deaths
CBO's central finding hinges on geography. In the hottest parts of the country, cold snaps currently drive spikes in hospitalizations and deaths among the elderly. As the climate warms, those cold days will become rarer, and CBO projects that deaths in those regions will drop significantly. Residents in hot climates are also expected to adapt to rising temperatures, further reducing heat-related mortality. Without any adaptation measures, the report notes, the number of avoided deaths would shrink to roughly 360,000 through 2075 — a much smaller, though still positive, figure.
The model used intermediate warming scenarios, such as SSP2-4.5, and a higher-emissions scenario, SSP3-7.0, rather than the more extreme RCP8.5 pathway that some researchers have criticized as unrealistic. Under these assumptions, CBO found that an 85-degree day in Boston would increase emergency visits by 19 per 100,000 Medicare enrollees and deaths by six, while a 25-degree day there would barely register. In Dallas, the pattern flips: a hot day changes little, but a 25-degree day would push up emergency visits by six per 100,000 enrollees and deaths by seven.
Emergency room spending falls even as visits increase
The report projects that emergency department visits will increase by 18 million over the study period, but total spending will fall by $55 billion. The reason is cost, not volume: cold-weather visits tend to be the most expensive, so fewer of them saves more money than the added cost of more, cheaper visits in moderate and hot regions. CBO estimates that Medicare spending on temperature-related emergency care will drop overall, even as more elderly patients seek treatment on hot days.
The analysis acknowledges that adaptation measures such as public health campaigns and greater air conditioning adoption will carry costs of their own, though CBO did not estimate those expenses. In addition, the report does not account for other effects of climate change beyond temperature.
Cold, not heat, remains the bigger killer
CBO's findings align with a broader body of research that has received far less attention than studies focused on heat deaths. Separate research has found that heat causes roughly 600,000 deaths globally each year, compared with 4.5 million from cold. A 2025 Yale University study similarly found that older adults, women, and widowed or divorced people are especially vulnerable to cold exposure, while young, single people are more susceptible to heat. Cold contributes to deaths from cardiovascular, respiratory, and metabolic disease, while heat drives circulatory problems and deaths from injuries. CBO's analysis focused specifically on the Medicare population, which skews older and stands to benefit disproportionately from milder winters.
A quiet admission that adaptation beats alarm
The CBO report is a rare admission from a government agency that undercuts years of alarmist messaging from federal agencies and major outlets alike. What stands out isn't just the math; it's the acknowledgment that ordinary Americans adjusting on their own, through air conditioning and simple behavioral change, do more to save lives than any sweeping federal climate mandate has promised to. CBO's own numbers make the case that people adapt and technology improves without Washington needing to force the outcome.
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