Last year was a tough one for farmers. Amid such as corn and soybeans, for supplies like , as well as the Trump tariffs and the , many farms weren’t profitable last year.

And now, the enhanced Affordable Care Act subsidies that many Americans, including farmers, relied on to purchase health insurance are gone, having .

James Davis, 55, who grows cotton, soybeans, and corn in northern Louisiana, said he didn’t know how he and his wife would afford coverage. Their share of their insurance premium quadrupled for 2026, jumping to about $2,700 a month.

“You can’t afford it,” Davis said. “Bottom line. There’s nothing to discuss. You can’t afford it without the subsidies.”

More than a quarter of the agricultural workforce purchases health insurance through the individual marketplace, according to , a health information nonprofit that includes Â鶹ŮÓÅ Health News.

That 27% rate is much higher than the overall population’s — only .

Farmers are used to facing challenges such as unpredictable weather and fluctuating commodity prices. But the loss of the enhanced subsidies, coupled with challenging economic conditions, will make coverage unaffordable for many.

Without major intervention from Washington, farmers say they’ll have to choose between being uninsured or leaving the farm work behind for a job that offers health insurance.

A Gamble for Farmers

Farming is dangerous work. Agricultural workers spend much of their time outside and exposed to the elements. Many of their duties can lead to injury or illness. They drive and operate heavy machinery, work with toxic chemicals, and handle large animals.

The rate of work-related deaths for farmers is .

The financial toll of non-fatal farm injuries is also significant. from the University of Nebraska Medical Center found that the average cost of a farming injury was $10,878 in medical care and $4,735 in lost work.

It’s essential that farmers can purchase comprehensive insurance, said , a rural sociologist and associate professor of agricultural health and safety at Pennsylvania State University, where she studies the social and economic needs of farm households.

In a , Becot found that more than 20% of U.S. farm households had medical debt exceeding $1,000 and that more than half were not confident they could cover the costs of a major illness or injury.

“That shows you the level of vulnerability and concerns that farmers are facing,” she said.

Mental health is also a concern. as likely to die by suicide compared with the general population. Mental health hotlines that serve rural communities have an in calls.

These concerns around farmers’ , coupled with a , conjures memories of the farm crisis of the 1980s, said , a vice president at the industry group . During that decade, there was a raft of foreclosures, and .

“We’re really afraid of what’s going to happen,” Klein said.

Farmers can be reluctant to acknowledge that they rely on government-subsidized insurance, said Meghan Palmer, 43, who runs a dairy farm in northeastern Iowa with her husband, John, 45.

“We’re not handout-takers,” Palmer said.

More than 40% of dairy farmers lack health insurance — among all agricultural sectors.

But going uninsured is not an option for the Palmers.

During their first year of marriage, the couple recalled, they were uninsured and had to pay out-of-pocket for two unexpected health crises: Palmer had an appendectomy, and her husband needed stitches after getting kicked in the face by one of his cows.

“It was stupid of us,” Palmer said of the decision to forgo coverage.

But this year, the combined out-of-pocket monthly cost of their plans is increasing by more than 90%, to $368.18. Their total 2026 deductible is $7,200.

Palmer is a registered nurse who picks up shifts on an as-needed basis, allowing her the flexibility to prioritize her work on the farm. She’s now searching for a job with health benefits. But she worries a job that doesn’t allow her to keep up with the farm work will create a greater burden for her husband.

“John is working exhausted most of the time,” she said. “That’s when mistakes get made and you end up in the ER.”

Political Consequences

Even after the enhanced subsidies expired at the end of 2025, the Palmers estimate their income will still be low enough that they’ll qualify for some tax credits to purchase coverage.

However, under the GOP’s One Big Beautiful Bill Act, , so if the Palmers have a surprisingly profitable 2026, they’ll be forced to pay some, or even all, of that subsidy back at tax time.

A farmer’s income can vary drastically year to year, Becot said, partly because commodity prices can fluctuate rapidly.

Some farmers might deliberately choose to not expand their businesses, because too much profit might mean they lose access to health care subsidies.

Farmers who are insured through Medicaid have similar concerns, Becot said. But prioritizing health care affordability by suppressing operational growth can have long-term consequences for a farm’s success.

Palmer, in Iowa, and Davis, in Louisiana, are both upset that lawmakers aren’t more sensitive to the economic demands of farming and how those have coincided with rising health costs.

President Donald Trump recently pledged $12 billion in one-time to row crop farmers, but that’s not going to stop health care costs from ballooning.

Republicans are aware that health care affordability is a problem and have put forth proposals, said , a political scientist at the University of Northern Iowa. But most don’t support extending the enhanced ACA subsidies, because they don’t see them as a good solution to the problem of rising health care costs.

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One of the plaintiffs, the reproductive justice nonprofit , wasted no time in returning to one of its core missions: to provide financial support to traveling patients.

“The decision came at about 5:30. I think we funded an abortion at 5:45 — because that’s how severe the need is, that’s how urgent it is that we get back to the work that we’re doing,” said Jenice Fountain, executive director of Yellowhammer Fund, which advocates for abortion access.

On April 2, the U.S. Supreme Court heard oral arguments on whether South Carolina can from the state’s Medicaid program. This came just days after Planned Parenthood received notice that the Trump administration from the Title X Family Planning Program for nine of the group’s affiliates.

“We’re just seeing kind of a multiplying of conflicts where we have unanswered questions about the meaning of the First Amendment in this context, about the right to travel in this context, about due process in this context — about these sort of clashing state laws and choosing which one applies,” said , a law professor at the University of California-Davis who specializes in the politics and history of reproductive rights.

Alabama has one of the in the country — with no exceptions for rape or incest. The law was  approved by the state legislature in 2019 and remained at the ready should Roe v. Wade be overturned. It took effect immediately when the Supreme Court did just that on June 24, 2022, in the decision.

At the time, Yellowhammer Fund was getting about 100 calls a week from people seeking financial help with getting an abortion, Fountain said.

For more than two years, the organization has been unable to help such callers.

“The thing with the ban was it was so vague that it was incredibly hard to interpret, especially if you weren’t a person that was legally inclined,” Fountain said. “So the effect that it had, which was its intention, was a chilling effect.”

During that time, Yellowhammer continued to promote reproductive justice and maternal and infant health through community efforts such as distributing diapers, formula, menstrual supplies, and emergency contraception.

Beyond the alarm created by the statutory language in Alabama’s abortion ban, fears were stoked by Alabama’s attorney general, Steve Marshall, Fountain said.

Almost seven weeks after the 2022 Dobbs decision, Marshall said in a radio interview that groups that assist people seeking an abortion in another state could face criminal prosecution.

“There’s no doubt that this is a criminal law and the general principles that apply to a criminal law would apply to this, with its status of the Class A felony, that’s the most significant offense that we have as far as punishment goes under our criminal statue, absent a death penalty case,” Marshall said in the TV editor Jeff Poor.

“If someone was promoting themselves out as a funder of abortion out of state, then that is potentially criminally actionable for us,” Marshall said.

Marshall was explicitly referring to such groups as Yellowhammer Fund, Fountain said.

“He mentioned the group from Tuscaloosa that helps people get to care, which is Yellowhammer Fund,” Fountain said. “He all but ‘@’d us.”

Yellowhammer Fund and other abortion rights groups filed the on July 31, 2023.

In , U.S. District Judge of the Middle District of Alabama in Montgomery, agreed with them, saying Marshall would be violating both First Amendment free speech rights and the constitutional right to travel if he tried to bring criminal charges.

Thompson also warned against overlooking the “broader, practical implications of the Attorney General’s threats,” in the matter of Alabama trying to enforce laws outside the state.

“For example,” Thompson wrote in his ruling, “the Alabama Attorney General would have within his reach the authority to prosecute Alabamians planning a Las Vegas bachelor party, complete with casinos and gambling, since casino-style gambling is outlawed in Alabama.”

Another group involved in the case, in Tuscaloosa (formerly West Alabama Women’s Center), also resumed work that had been paused.

“We have spent the last few years worried that if we had provided any form of information to patients about where they could access a legal abortion, that that is something that the attorney general might try to prosecute us over,” said Robin Marty, WAWC’s executive director.

Before the Dobbs decision, WAWCprovided abortion as part of its services. It continues to offer free reproductive health care, including prenatal care, contraception, and HIV testing.

Clinical staffers at WAWC weren’t allowed even to suggest to someone that they could leave the state to get an abortion, Marty said.

“There is nothing harder than looking into somebody’s face when they are in crisis and saying, ‘I’m sorry, I just can’t help you anymore,’” Marty said. “That was really wearing on my staff because our job was to provide the best information possible. And to know that we could not give them the full care that they required was heartbreaking.”

With the ruling, WAWC can now offer “all-options counseling,” which includes information on how and where patients can access abortion services in other states, Marty said.

“If they do not feel like they are able to continue the pregnancy, we can tell them, ‘OK, you are this far along, so you are able to go this clinic in North Carolina, because you’re under their limit” for gestational age, “or you can go to this clinic in Illinois because you’re under their limit,’” Marty said. “We’ll be able to tell them exactly where they can go and even be able to help them with the referral process along the way.”

The attorney general could file an appeal, but now it’s unclear whether his office will do so. Marshall’s office did not respond to NPR’s request for an interview, but in a statement said, “The office is reviewing the decision to determine the state’s options.”

But legal expert Ziegler said she’d be surprised if Marshall didn’t file an appeal, given his office’s vigorous defense in the lawsuit.

In addition, the potential political costs of pursuing that kind of prosecution may have eased, because states like and have already taken legal action regarding out-of-state abortion providers, said Ziegler.

On the other hand, the attorney general might not appeal because his office was the defendant in the lawsuit, and he may not want to draw attention to the case, Ziegler said.

If Marshall did file an appeal, it would go to the U.S. Court of Appeals for the 11th Circuit, which Ziegler called conservative-leaning. The case could ultimately go to the U.S. Supreme Court, Ziegler said, which may have to weigh in more on abortion-related cases, such as when it in Idaho in June 2024.

“I think the takeaway is that the U.S. Supreme Court is going to be more involved than ever in fights about reproduction and abortion, not less, notwithstanding the fact that Roe is gone,” Ziegler said.

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“I can’t tell you the number of patients who I see who come in with advanced disease, who have full-time jobs,” Givens said. “They haven’t seen a physician in years. They can’t afford it. They don’t have coverage.”

This spring, the Mississippi Legislature considered but ultimately failed to expand Medicaid, which would have extended coverage to around 200,000 low-income residents. Mississippi is one of that haven’t expanded Medicaid, the state and federal health insurance program for people with low incomes or disabilities.

Seven of those states are in the South. But as more conservative-leaning states like North Carolina adopt it, the drumbeat of support, as one Southern state lawmaker put it, grows louder.

Advocates for expanding Medicaid say opposition is largely being driven by political polarization, rather than cost concerns.

Givens, who is also chair of the board of trustees for the Mississippi State Medical Association, which supports Medicaid expansion, said the federal government would pay for the of it and that most Mississippians . “Why does that not translate when it comes to policy?” Givens asked. “It’s called the stupidity of politics. Period.”

Givens pointed to Arkansas as a potential model for Mississippi because the state has similar demographics and expansion has been in place there for a decade. “Look at what has worked for them and what needs to be tweaked,” he said. “For me, that’s just common sense.”

In states that have not expanded Medicaid, hundreds of thousands of people fall into the “coverage gap,” meaning they earn too much to qualify for Medicaid but are not eligible for subsidies to help pay for private insurance. Those in the coverage gap also can’t afford premiums and other out-of-pocket expenses on employer-sponsored insurance even if they are eligible.

The coverage gap is not an issue in states that have expanded Medicaid. In those states, a single person making up to 138% of the poverty level, or about $20,000 a year, can get on Medicaid. Someone making more than that can get subsidies for private health insurance.

For the first time in Mississippi, both the and proposed expanding Medicaid during the legislative session that ended in May. In the end, the efforts fizzled at the last minute.

Had the proposed bills succeeded, some who are stuck in the coverage gap would have gained access to Medicaid.

, a Republican who supports expansion, acknowledged the political hurdles. “It’s President Obama’s signature piece of legislation. It’s known as Obamacare,” White said. “So, there are a lot of political dynamics centered around it that probably never allowed it to get off the ground.”

White said this year was different because of increased support from the business community.

“I kidded some of my fellow Republicans. I said, ‘Come for the savings, if you will, and then you can stay for the salvation and the good things that it does to improve people’s lives,’” White said. “If you can’t get there because it’s the right or compassionate thing to do to help these individuals, get there because it makes sense from a business standpoint.”

In neighboring Alabama, politics also thwarted . Although the state legislature didn’t vote on any direct expansion bills, there was an attempt to include expansion language in — specifically, a provision to allocate some gambling profits to rural health systems.

Ultimately, the Alabama bill was stripped down, and the funding for rural health was removed.

If Alabama expanded Medicaid, at least 174,000 more people would be covered, according to Â鶹ŮÓÅ. But the connection to Obamacare remains a stumbling block in Alabama’s Republican-dominated state legislature.

“Just the partisan nature of this is definitely a problem,” said , an assistant professor of political science at the University of Alabama. Wagner said that most Alabama voters support expansion and that other states have adopted the programs after mounting public pressure.

“A lot of rural voters are Republicans. And so your own constituents are being hit by this and you’re not addressing it,” she said. “If the pressure gets high enough and sentiment shifts, maybe that’s going to be enough to push them.”

The main disagreement in the Mississippi Legislature revolved around work requirements — recipients would have to show they were working part-time or in school.

White said many of his Republican colleagues view extending health coverage through Medicaid as “some form of welfare, some form of giveaway, some form of expanding government.”

Opponents of Medicaid expansion in Alabama are also concerned about potential impacts on the workforce of what they call free health care.

“If you open up this federal subsidized program for hundreds of thousands of people, then it could actually hurt that labor participation rate, give them another reason not to go to work, to stay at home,” said senior director of fiscal policy at the , a research group that says it is committed to limited government.

The federal Centers for Medicare & Medicaid Services, or CMS, would have to issue a waiver to allow an expansion plan with a work requirement — something the Biden administration hasn’t done for any state.

This spring, Mississippi came close to a compromise bill that included a work requirement, something that needs a CMS waiver. Had the bill passed and CMS denied the waiver, expansion still would not have taken effect, and the state would have had to apply for the waiver from CMS every year, hoping for approval under a future — potentially more conservative — presidential administration.

That’s what happened in Georgia. In 2020, the Trump administration for a work requirement as part of a limited expansion effort. CMS later rescinded the waiver under the Biden administration, leading to a lawsuit. A federal judge ruled in favor of Georgia, reinstating the work requirement provisions.

However, only about 2,300 people are enrolled — which is fewer than half of 1% of the more than who could gain access if Medicaid were fully expanded, according to Â鶹ŮÓÅ. The state’s alternative expansion plan has cost taxpayers at least $26 million, according to Â鶹ŮÓÅ, with nearly all of it going to administrative and consulting fees, not medical care for low-income residents.

As public support for expansion continues to grow in holdout states, North Carolina, the most recent Southern state to pass Medicaid expansion, may offer a glimpse of the future. Since its adoption last year, more than have become eligible.

“But it still took a long time,” said , a vice president and director of the Program on Medicaid and the Uninsured at Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News. “It took the governor who continually supported expansion, and the legislature finally came to endorse and pass the expansion.”

Rudowitz said the fiscal incentive under the played a role in moving the needle in North Carolina and could help ignite debate in other holdout states. But ultimately, she said, the reasons the Affordable Care Act was established continue to be the strongest motivators.

“Without expansion, there are more people who are uninsured. Hospitals and other providers are not able to get reimbursement because individuals are uninsured,” Rudowitz said. “Those are the underlying issues that existed pre-ACA and continue to exist, particularly in states that haven’t adopted expansion.”

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For people who live nearby, it’s no mystery why the equipment is in relatively pristine shape: Children don’t come here to play.

“Because kids are smart,” explained , an artist and urban designer who lives about a block away on Dumaine Street. “It’s the adults who aren’t. It’s the adults who built the playground under the interstate.”

Hunter’s Field is wedged directly beneath the elevated roadbeds of the Claiborne Expressway section of Interstate 10 in the city’s 7th Ward.

There are no sounds of laughter or children playing. The constant cuh-clunk, cuh-clunk of the traffic passing overhead makes it difficult to hold a conversation with someone standing next to you. An average of 115,000 vehicles a day use the overpass, according to .

“I have never seen a child play here,” Stelly said.

Stelly keeps a sharp eye on this area as part of her advocacy work with the , a group of residents and business owners dedicated to revitalizing the predominantly African American community on either side of the looming expressway.

For as long as she can remember, Stelly has been fighting to dismantle that section of the highway. She’s lived in the neighborhood her entire life and said the noise is oftentimes unbearable. “You can sustain hearing damage,” she said. Now, she’s helping collect new noise and air pollution data to show it needs to be taken down.

The was built in the 1960s, when the construction of interstates and highways was a symbol of progress and economic development in the U.S.

But that supposed progress often came at a great cost for marginalized communities — especially predominantly Black neighborhoods.

When it was built, the “Claiborne Corridor,” as it’s still sometimes known, tore through the , one of the nation’s oldest Black neighborhoods.

For more than a century before the construction of the expressway, bustling Claiborne Avenue constituted the backbone of economic and cultural life for Black New Orleans. Back then, the oak-lined avenue was home to more than 120 businesses. Today, only a few dozen remain.

What happened to Claiborne Avenue isn’t unique. directly through low-income minority neighborhoods, dividing communities and polluting the air.

In Montgomery, Alabama, I-85 the city’s only middle-class Black neighborhood and was “designed to displace and punish the organizers of the civil rights movement,” according to , a community planning professor at Auburn University. In Nashville, planners intentionally looped I-40 around a white community, and sent it a prominent Black neighborhood, knocking down hundreds of homes and businesses. Examples like this exist in .

The federal government has started working on ways to confront the damage highway construction continues to do to low-income and minority communities. An initiative established in the called the seeks to do just that: reconnect neighborhoods and communities that were divided by infrastructure.

But there’s wide disagreement on the best way to do that, and some strategies are likely to do little to limit the health effects of living near these highways. What’s unfolding in New Orleans shows how challenging it is to pick and fund projects that will help.

Competing Visions for the Claiborne Expressway

Stelly’s group, the Claiborne Avenue Alliance, submitted for Reconnecting Communities Pilot money. It wanted $1.6 million in federal funds primarily for public engagement, data collection, and feasibility planning to work to assess whether it would be possible to remove the expressway altogether, with a plan to raise $400,000 more to cover costs.

And it seemed possible its grant proposal would succeed, since even the as a textbook example of the biased planning history in a published statement about the Reconnecting Communities Pilot. Ultimately, though, the federal Department of Transportation, the agency charged with allocating the program’s money, denied the Claiborne Avenue Alliance’s grant request.

Instead, the Department of Transportation offered requested in a competing made by the city of New Orleans and the state of Louisiana. That plan called for a $47 million grant from Reconnecting Communities to do overpass improvements, remove some on- and off-ramps, and, most significantly, create the “Claiborne Innovation District” to promote public life and cultural activities under the highway. DOT granted just $500,000 for the project.

Stelly said she likes a few aspects of the city-state proposal, notably the plan to remove on- and off-ramps to improve pedestrian safety beneath the expressway and other public safety projects, like better lighting and dedicated pedestrian and bicycle lanes.

But, notably, Stelly called the idea of creating an entertainment space and market beneath the highway misguided and ridiculous. Would it be a waste of scarce government funds?

“It’s a foolish idea because you’re going to be exposed to the same thing” as the neglected playground, Stelly said. “You’re going to be exposed to the same levels of noise. It’s not a wise decision to build anything under here.”

Using Science to Inform Policy

Since her group’s proposal was denied, Stelly and her organization are turning to a new strategy: helping with funded by the Environmental Protection Agency on the expressway’s health impacts. They hope the data will support them in their efforts to remove the highway from their neighborhood.

In addition to noise impacts, the EPA-funded study is looking at the health impacts of pollution under the Claiborne Expressway — especially harmful pollutants like particulate matter 2.5, or PM 2.5.

These microscopic particles, measuring 2.5 microns or less in diameter, are released from the tailpipes of passing vehicles, said Adrienne Katner, an associate professor at the Louisiana State University School of Public Health, who is the principal investigator on the EPA study. They’re so small that, when inhaled, they lodge deep in the lungs. From there, they can migrate to the circulatory system, and then spread and potentially affect every system in the body.

“So the heart, the brain,” said Katner. “If a woman is pregnant, it can cross the placental barrier. So it has a lot of impacts.”

Katner and her team of researchers are beginning the study by taking preliminary readings with monitors at different points along the expressway. Completing the research and publishing the data will likely take two to three years.

One of Katner’s monitoring sites is Hunter’s Field Playground. Graduate researcher Jacquelynn Mornay said the noise levels registered there could cause permanent hearing damage after an hour or so of exposure. The pollution levels recorded hover around 18 micrograms per cubic meter.

“It should be at most — at most — 12,” said Beatrice Duah, another graduate student researcher. “So it is way over the limits.”

Residents and workers occupying the homes and businesses lining the area under the expressway are exposed daily to these levels of noise and pollution. When complete, this EPA study will join a decades-long body of research about how traffic pollution affects the human body.

“We’re not inventing the science here,” Katner said. “All I’m doing is showing them what we already know and then documenting it, giving them the data to then inform and influence policy. That’s all I can do.”

‘Removal Is the Only Cure’

Eventually, the study’s findings could help other communities divided by infrastructure across the country, Katner said.

“A lot of cities are going through this right now and they’re looking back at their highway systems,” she said. “They’re looking back at the impacts that it’s had on a community and they’re trying to figure out what to do next. I’m hoping that this project will inform them.”

Amy Stelly said she’s always known the air she and her neighbors breathe isn’t safe, but she’s hopeful that having concrete data to support her efforts will do more to persuade policymakers to address the problem. That could mean taking down the dangerous on- and off-ramps — or scrapping what she considers to be the wasteful plan of putting a market and event space under the highway overpass.

Stelly sees only one true solution to the problems posed by the Claiborne Expressway, only one way to really right the wrongs done to her community.

“Removal is the only cure,” Stelly said. “I’m insisting on it because I’m a resident of the neighborhood and I live with this every day.” And, she said, “the science tells us there’s no other way.”

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New Orleans Emergency Medical Services has been busy this summer, responding to heat-related emergency calls and transporting patients to nearby hospitals.

At the city’s main ambulance depot, the concrete parking lot seemed to magnify the sweltering heat, circulating the air like a convection oven. Capt. Janick Lewis and Lt. Titus Carriere demonstrated there how they can load a stretcher into an ambulance using an automated loading system. Lewis wiped sweat from his brow as the loading arm whirred and hummed, raising the stretcher into the ambulance — “unit,” in official terminology.

But mechanical assistance isn’t the best thing about the upgraded vehicles. “The nicest thing about being assigned a brand-new unit is it has a brand-new air conditioning system,” Lewis said.

The new AC is much more than a luxury for the hard-working crews. They need the extra cooling power to help save lives.

“The No. 1 thing you do take care of somebody is get them out of the heat, get them somewhere cool,” Lewis said. “So the No. 1 thing we spend our time worrying about in the summertime is keeping the truck cool.”

Like much of the country, New Orleans has been embroiled in a heat wave for weeks. As a result, New Orleans EMS is responding to more calls for heat-related conditions than ever before, Lewis said. During the third week of July, the city’s public EMS crews responded to 29 heat-related calls — more than triple what they handled during the same period last year.

Scientists say dangerous heat levels — and the stress they put on human bodies and medical systems — will likely keep increasing. Health systems nationwide face serious funding and staffing challenges that could make it harder to keep up.

New Orleans EMS is no exception. In April, it reported operating with only . The city’s chief of EMS has called for increased funding for higher wages to attract more workers. Local private ambulance services like Acadian Ambulance Services pay staffers between $50 and $70 per hour. The city’s EMS department can’t compete.

Lewis said they’re making do with the resources they have and prioritizing one-time expenses like new ambulances to help them meet the challenges they’re facing.

“We’re going to provide the care everybody needs, regardless of how hot it gets,” Lewis said. “We’d love to have all the help in the world, but we’re getting the job done with what we have right now.”

When a human being is exposed to high levels of heat for too long, their core body temperature rises. Once core body temperature exceeds 100 degrees Fahrenheit, . If not quickly addressed, that can prompt an escalating cascade of health problems.

The first stage is heat exhaustion, Carriere explained: “That means you’re hot, you may have an elevated temp, but you also have what’s called diaphoresis, which means your body is sweating, is still trying to compensate and cool yourself off.” You’ll also likely have other symptoms like weakness, dizziness, or a headache.

Carriere said that if a person can quickly get out of the heat and into an air-conditioned place, generally they’ll recover from heat exhaustion on their own. Otherwise, their core temperature will continue to rise.

As internal body temperature approaches 104 degrees, people start to suffer from heatstroke.

“Once you move to heatstroke, your body stops compensating,” Carriere said. “You stop sweating. You’re hot. You’re dry. And your organs are basically frying themselves from the inside out.”

When a person stops sweating, it becomes even harder for the body to cool itself down. During heatstroke, people may experience other severe symptoms like an altered state of mind, confusion, and a rapid, erratic pulse. They may even lose consciousness.

Without medical intervention, heatstroke can be deadly. EMS responders start treatment immediately after they arrive on the scene. “We’ll get them on a gurney, get them into the unit, start removing their clothing, and put ice packs wherever applicable to try to cool them down,” said Carriere.

Once a heatstroke patient is loaded into the ambulance, the crew races them to a nearby hospital, Carriere said. At University Medical Center, New Orleans’ largest hospital, doctors and nurses will continue efforts to quickly lower the person’s body temperature and replace fluids by IV, if necessary.

“When the patient ends up at the hospital, we’re going to continue that cooling process,” said Jeffrey Elder, medical director for emergency management at UMC. “We’re going to put them in an ice water bath,” and, he added, “we may use some misting fans and some cold fluids to get their body temperature down to a reasonable temperature while we’re supporting all the other bodily functions.”

Getting a patient’s core temperature down as quickly as possible is what will ultimately save their life. One way doctors can speed that along is by burying a patient in ice. In some parts of the country, doctors have placed patients inside body bags prepacked with pounds of ice. Body bags are especially useful in these cases because they are waterproof and designed to closely fit the human form.

UMC’s emergency room doesn’t use body bags, but during the summer staffers keep bags of ice ready at all times.

“On the stretcher, we’ll use some of the sheets as kind of a barrier,” Elder said. “And while they’re on the stretcher, we’ll just put the ice on them right then and there.” Hospital staffers will continue to work to cool a patient down until their temperature gets below 100.

Elder said that while it always gets hot in New Orleans during the summer, his emergency room has been treating more heat-related illnesses in 2023 than ever before. A few patients have died from the heat. UMC has been struggling with staffing challenges since the beginning of the pandemic, just like many other hospital systems elsewhere. But to prepare for an influx of patients with heat-related illnesses, UMC has prioritized staffing of the emergency department, Elder said.

Across the country, meteorological events like heat waves and heat domes will become more frequent and intense in the future, according to the Centers for Disease Control and Prevention.

“Extreme summer heat is increasing in the United States,” said , a health scientist with the CDC’s . “And climate projections are indicating that extreme heat events will be more frequent and intense in the coming decades.”

Health infrastructure will be challenged to keep up to treat patients suffering from extreme heat exposure. In New Orleans, both first responders and doctors say they expect to see more patients with heat-related illnesses.

“We haven’t even gotten to the hottest part yet, which is typically August to September,” said Carriere. “So I’m expecting it to get pretty bad.”

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Last year was a tough one for farmers. Amid such as corn and soybeans, for supplies like , as well as the Trump tariffs and the , many farms weren’t profitable last year.

And now, the enhanced Affordable Care Act subsidies that many Americans, including farmers, relied on to purchase health insurance are gone, having .

James Davis, 55, who grows cotton, soybeans, and corn in northern Louisiana, said he didn’t know how he and his wife would afford coverage. Their share of their insurance premium quadrupled for 2026, jumping to about $2,700 a month.

“You can’t afford it,” Davis said. “Bottom line. There’s nothing to discuss. You can’t afford it without the subsidies.”

More than a quarter of the agricultural workforce purchases health insurance through the individual marketplace, according to , a health information nonprofit that includes Â鶹ŮÓÅ Health News.

That 27% rate is much higher than the overall population’s — only .

Farmers are used to facing challenges such as unpredictable weather and fluctuating commodity prices. But the loss of the enhanced subsidies, coupled with challenging economic conditions, will make coverage unaffordable for many.

Without major intervention from Washington, farmers say they’ll have to choose between being uninsured or leaving the farm work behind for a job that offers health insurance.

A Gamble for Farmers

Farming is dangerous work. Agricultural workers spend much of their time outside and exposed to the elements. Many of their duties can lead to injury or illness. They drive and operate heavy machinery, work with toxic chemicals, and handle large animals.

The rate of work-related deaths for farmers is .

The financial toll of non-fatal farm injuries is also significant. from the University of Nebraska Medical Center found that the average cost of a farming injury was $10,878 in medical care and $4,735 in lost work.

It’s essential that farmers can purchase comprehensive insurance, said , a rural sociologist and associate professor of agricultural health and safety at Pennsylvania State University, where she studies the social and economic needs of farm households.

In a , Becot found that more than 20% of U.S. farm households had medical debt exceeding $1,000 and that more than half were not confident they could cover the costs of a major illness or injury.

“That shows you the level of vulnerability and concerns that farmers are facing,” she said.

Mental health is also a concern. as likely to die by suicide compared with the general population. Mental health hotlines that serve rural communities have an in calls.

These concerns around farmers’ , coupled with a , conjures memories of the farm crisis of the 1980s, said , a vice president at the industry group . During that decade, there was a raft of foreclosures, and .

“We’re really afraid of what’s going to happen,” Klein said.

Farmers can be reluctant to acknowledge that they rely on government-subsidized insurance, said Meghan Palmer, 43, who runs a dairy farm in northeastern Iowa with her husband, John, 45.

“We’re not handout-takers,” Palmer said.

More than 40% of dairy farmers lack health insurance — among all agricultural sectors.

But going uninsured is not an option for the Palmers.

During their first year of marriage, the couple recalled, they were uninsured and had to pay out-of-pocket for two unexpected health crises: Palmer had an appendectomy, and her husband needed stitches after getting kicked in the face by one of his cows.

“It was stupid of us,” Palmer said of the decision to forgo coverage.

But this year, the combined out-of-pocket monthly cost of their plans is increasing by more than 90%, to $368.18. Their total 2026 deductible is $7,200.

Palmer is a registered nurse who picks up shifts on an as-needed basis, allowing her the flexibility to prioritize her work on the farm. She’s now searching for a job with health benefits. But she worries a job that doesn’t allow her to keep up with the farm work will create a greater burden for her husband.

“John is working exhausted most of the time,” she said. “That’s when mistakes get made and you end up in the ER.”

Political Consequences

Even after the enhanced subsidies expired at the end of 2025, the Palmers estimate their income will still be low enough that they’ll qualify for some tax credits to purchase coverage.

However, under the GOP’s One Big Beautiful Bill Act, , so if the Palmers have a surprisingly profitable 2026, they’ll be forced to pay some, or even all, of that subsidy back at tax time.

A farmer’s income can vary drastically year to year, Becot said, partly because commodity prices can fluctuate rapidly.

Some farmers might deliberately choose to not expand their businesses, because too much profit might mean they lose access to health care subsidies.

Farmers who are insured through Medicaid have similar concerns, Becot said. But prioritizing health care affordability by suppressing operational growth can have long-term consequences for a farm’s success.

Palmer, in Iowa, and Davis, in Louisiana, are both upset that lawmakers aren’t more sensitive to the economic demands of farming and how those have coincided with rising health costs.

President Donald Trump recently pledged $12 billion in one-time to row crop farmers, but that’s not going to stop health care costs from ballooning.

Republicans are aware that health care affordability is a problem and have put forth proposals, said , a political scientist at the University of Northern Iowa. But most don’t support extending the enhanced ACA subsidies, because they don’t see them as a good solution to the problem of rising health care costs.

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One of the plaintiffs, the reproductive justice nonprofit , wasted no time in returning to one of its core missions: to provide financial support to traveling patients.

“The decision came at about 5:30. I think we funded an abortion at 5:45 — because that’s how severe the need is, that’s how urgent it is that we get back to the work that we’re doing,” said Jenice Fountain, executive director of Yellowhammer Fund, which advocates for abortion access.

On April 2, the U.S. Supreme Court heard oral arguments on whether South Carolina can from the state’s Medicaid program. This came just days after Planned Parenthood received notice that the Trump administration from the Title X Family Planning Program for nine of the group’s affiliates.

“We’re just seeing kind of a multiplying of conflicts where we have unanswered questions about the meaning of the First Amendment in this context, about the right to travel in this context, about due process in this context — about these sort of clashing state laws and choosing which one applies,” said , a law professor at the University of California-Davis who specializes in the politics and history of reproductive rights.

Alabama has one of the in the country — with no exceptions for rape or incest. The law was  approved by the state legislature in 2019 and remained at the ready should Roe v. Wade be overturned. It took effect immediately when the Supreme Court did just that on June 24, 2022, in the decision.

At the time, Yellowhammer Fund was getting about 100 calls a week from people seeking financial help with getting an abortion, Fountain said.

For more than two years, the organization has been unable to help such callers.

“The thing with the ban was it was so vague that it was incredibly hard to interpret, especially if you weren’t a person that was legally inclined,” Fountain said. “So the effect that it had, which was its intention, was a chilling effect.”

During that time, Yellowhammer continued to promote reproductive justice and maternal and infant health through community efforts such as distributing diapers, formula, menstrual supplies, and emergency contraception.

Beyond the alarm created by the statutory language in Alabama’s abortion ban, fears were stoked by Alabama’s attorney general, Steve Marshall, Fountain said.

Almost seven weeks after the 2022 Dobbs decision, Marshall said in a radio interview that groups that assist people seeking an abortion in another state could face criminal prosecution.

“There’s no doubt that this is a criminal law and the general principles that apply to a criminal law would apply to this, with its status of the Class A felony, that’s the most significant offense that we have as far as punishment goes under our criminal statue, absent a death penalty case,” Marshall said in the TV editor Jeff Poor.

“If someone was promoting themselves out as a funder of abortion out of state, then that is potentially criminally actionable for us,” Marshall said.

Marshall was explicitly referring to such groups as Yellowhammer Fund, Fountain said.

“He mentioned the group from Tuscaloosa that helps people get to care, which is Yellowhammer Fund,” Fountain said. “He all but ‘@’d us.”

Yellowhammer Fund and other abortion rights groups filed the on July 31, 2023.

In , U.S. District Judge of the Middle District of Alabama in Montgomery, agreed with them, saying Marshall would be violating both First Amendment free speech rights and the constitutional right to travel if he tried to bring criminal charges.

Thompson also warned against overlooking the “broader, practical implications of the Attorney General’s threats,” in the matter of Alabama trying to enforce laws outside the state.

“For example,” Thompson wrote in his ruling, “the Alabama Attorney General would have within his reach the authority to prosecute Alabamians planning a Las Vegas bachelor party, complete with casinos and gambling, since casino-style gambling is outlawed in Alabama.”

Another group involved in the case, in Tuscaloosa (formerly West Alabama Women’s Center), also resumed work that had been paused.

“We have spent the last few years worried that if we had provided any form of information to patients about where they could access a legal abortion, that that is something that the attorney general might try to prosecute us over,” said Robin Marty, WAWC’s executive director.

Before the Dobbs decision, WAWCprovided abortion as part of its services. It continues to offer free reproductive health care, including prenatal care, contraception, and HIV testing.

Clinical staffers at WAWC weren’t allowed even to suggest to someone that they could leave the state to get an abortion, Marty said.

“There is nothing harder than looking into somebody’s face when they are in crisis and saying, ‘I’m sorry, I just can’t help you anymore,’” Marty said. “That was really wearing on my staff because our job was to provide the best information possible. And to know that we could not give them the full care that they required was heartbreaking.”

With the ruling, WAWC can now offer “all-options counseling,” which includes information on how and where patients can access abortion services in other states, Marty said.

“If they do not feel like they are able to continue the pregnancy, we can tell them, ‘OK, you are this far along, so you are able to go this clinic in North Carolina, because you’re under their limit” for gestational age, “or you can go to this clinic in Illinois because you’re under their limit,’” Marty said. “We’ll be able to tell them exactly where they can go and even be able to help them with the referral process along the way.”

The attorney general could file an appeal, but now it’s unclear whether his office will do so. Marshall’s office did not respond to NPR’s request for an interview, but in a statement said, “The office is reviewing the decision to determine the state’s options.”

But legal expert Ziegler said she’d be surprised if Marshall didn’t file an appeal, given his office’s vigorous defense in the lawsuit.

In addition, the potential political costs of pursuing that kind of prosecution may have eased, because states like and have already taken legal action regarding out-of-state abortion providers, said Ziegler.

On the other hand, the attorney general might not appeal because his office was the defendant in the lawsuit, and he may not want to draw attention to the case, Ziegler said.

If Marshall did file an appeal, it would go to the U.S. Court of Appeals for the 11th Circuit, which Ziegler called conservative-leaning. The case could ultimately go to the U.S. Supreme Court, Ziegler said, which may have to weigh in more on abortion-related cases, such as when it in Idaho in June 2024.

“I think the takeaway is that the U.S. Supreme Court is going to be more involved than ever in fights about reproduction and abortion, not less, notwithstanding the fact that Roe is gone,” Ziegler said.

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“I can’t tell you the number of patients who I see who come in with advanced disease, who have full-time jobs,” Givens said. “They haven’t seen a physician in years. They can’t afford it. They don’t have coverage.”

This spring, the Mississippi Legislature considered but ultimately failed to expand Medicaid, which would have extended coverage to around 200,000 low-income residents. Mississippi is one of that haven’t expanded Medicaid, the state and federal health insurance program for people with low incomes or disabilities.

Seven of those states are in the South. But as more conservative-leaning states like North Carolina adopt it, the drumbeat of support, as one Southern state lawmaker put it, grows louder.

Advocates for expanding Medicaid say opposition is largely being driven by political polarization, rather than cost concerns.

Givens, who is also chair of the board of trustees for the Mississippi State Medical Association, which supports Medicaid expansion, said the federal government would pay for the of it and that most Mississippians . “Why does that not translate when it comes to policy?” Givens asked. “It’s called the stupidity of politics. Period.”

Givens pointed to Arkansas as a potential model for Mississippi because the state has similar demographics and expansion has been in place there for a decade. “Look at what has worked for them and what needs to be tweaked,” he said. “For me, that’s just common sense.”

In states that have not expanded Medicaid, hundreds of thousands of people fall into the “coverage gap,” meaning they earn too much to qualify for Medicaid but are not eligible for subsidies to help pay for private insurance. Those in the coverage gap also can’t afford premiums and other out-of-pocket expenses on employer-sponsored insurance even if they are eligible.

The coverage gap is not an issue in states that have expanded Medicaid. In those states, a single person making up to 138% of the poverty level, or about $20,000 a year, can get on Medicaid. Someone making more than that can get subsidies for private health insurance.

For the first time in Mississippi, both the and proposed expanding Medicaid during the legislative session that ended in May. In the end, the efforts fizzled at the last minute.

Had the proposed bills succeeded, some who are stuck in the coverage gap would have gained access to Medicaid.

, a Republican who supports expansion, acknowledged the political hurdles. “It’s President Obama’s signature piece of legislation. It’s known as Obamacare,” White said. “So, there are a lot of political dynamics centered around it that probably never allowed it to get off the ground.”

White said this year was different because of increased support from the business community.

“I kidded some of my fellow Republicans. I said, ‘Come for the savings, if you will, and then you can stay for the salvation and the good things that it does to improve people’s lives,’” White said. “If you can’t get there because it’s the right or compassionate thing to do to help these individuals, get there because it makes sense from a business standpoint.”

In neighboring Alabama, politics also thwarted . Although the state legislature didn’t vote on any direct expansion bills, there was an attempt to include expansion language in — specifically, a provision to allocate some gambling profits to rural health systems.

Ultimately, the Alabama bill was stripped down, and the funding for rural health was removed.

If Alabama expanded Medicaid, at least 174,000 more people would be covered, according to Â鶹ŮÓÅ. But the connection to Obamacare remains a stumbling block in Alabama’s Republican-dominated state legislature.

“Just the partisan nature of this is definitely a problem,” said , an assistant professor of political science at the University of Alabama. Wagner said that most Alabama voters support expansion and that other states have adopted the programs after mounting public pressure.

“A lot of rural voters are Republicans. And so your own constituents are being hit by this and you’re not addressing it,” she said. “If the pressure gets high enough and sentiment shifts, maybe that’s going to be enough to push them.”

The main disagreement in the Mississippi Legislature revolved around work requirements — recipients would have to show they were working part-time or in school.

White said many of his Republican colleagues view extending health coverage through Medicaid as “some form of welfare, some form of giveaway, some form of expanding government.”

Opponents of Medicaid expansion in Alabama are also concerned about potential impacts on the workforce of what they call free health care.

“If you open up this federal subsidized program for hundreds of thousands of people, then it could actually hurt that labor participation rate, give them another reason not to go to work, to stay at home,” said senior director of fiscal policy at the , a research group that says it is committed to limited government.

The federal Centers for Medicare & Medicaid Services, or CMS, would have to issue a waiver to allow an expansion plan with a work requirement — something the Biden administration hasn’t done for any state.

This spring, Mississippi came close to a compromise bill that included a work requirement, something that needs a CMS waiver. Had the bill passed and CMS denied the waiver, expansion still would not have taken effect, and the state would have had to apply for the waiver from CMS every year, hoping for approval under a future — potentially more conservative — presidential administration.

That’s what happened in Georgia. In 2020, the Trump administration for a work requirement as part of a limited expansion effort. CMS later rescinded the waiver under the Biden administration, leading to a lawsuit. A federal judge ruled in favor of Georgia, reinstating the work requirement provisions.

However, only about 2,300 people are enrolled — which is fewer than half of 1% of the more than who could gain access if Medicaid were fully expanded, according to Â鶹ŮÓÅ. The state’s alternative expansion plan has cost taxpayers at least $26 million, according to Â鶹ŮÓÅ, with nearly all of it going to administrative and consulting fees, not medical care for low-income residents.

As public support for expansion continues to grow in holdout states, North Carolina, the most recent Southern state to pass Medicaid expansion, may offer a glimpse of the future. Since its adoption last year, more than have become eligible.

“But it still took a long time,” said , a vice president and director of the Program on Medicaid and the Uninsured at Â鶹ŮÓÅ, a health information nonprofit that includes Â鶹ŮÓÅ Health News. “It took the governor who continually supported expansion, and the legislature finally came to endorse and pass the expansion.”

Rudowitz said the fiscal incentive under the played a role in moving the needle in North Carolina and could help ignite debate in other holdout states. But ultimately, she said, the reasons the Affordable Care Act was established continue to be the strongest motivators.

“Without expansion, there are more people who are uninsured. Hospitals and other providers are not able to get reimbursement because individuals are uninsured,” Rudowitz said. “Those are the underlying issues that existed pre-ACA and continue to exist, particularly in states that haven’t adopted expansion.”

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For people who live nearby, it’s no mystery why the equipment is in relatively pristine shape: Children don’t come here to play.

“Because kids are smart,” explained , an artist and urban designer who lives about a block away on Dumaine Street. “It’s the adults who aren’t. It’s the adults who built the playground under the interstate.”

Hunter’s Field is wedged directly beneath the elevated roadbeds of the Claiborne Expressway section of Interstate 10 in the city’s 7th Ward.

There are no sounds of laughter or children playing. The constant cuh-clunk, cuh-clunk of the traffic passing overhead makes it difficult to hold a conversation with someone standing next to you. An average of 115,000 vehicles a day use the overpass, according to .

“I have never seen a child play here,” Stelly said.

Stelly keeps a sharp eye on this area as part of her advocacy work with the , a group of residents and business owners dedicated to revitalizing the predominantly African American community on either side of the looming expressway.

For as long as she can remember, Stelly has been fighting to dismantle that section of the highway. She’s lived in the neighborhood her entire life and said the noise is oftentimes unbearable. “You can sustain hearing damage,” she said. Now, she’s helping collect new noise and air pollution data to show it needs to be taken down.

The was built in the 1960s, when the construction of interstates and highways was a symbol of progress and economic development in the U.S.

But that supposed progress often came at a great cost for marginalized communities — especially predominantly Black neighborhoods.

When it was built, the “Claiborne Corridor,” as it’s still sometimes known, tore through the , one of the nation’s oldest Black neighborhoods.

For more than a century before the construction of the expressway, bustling Claiborne Avenue constituted the backbone of economic and cultural life for Black New Orleans. Back then, the oak-lined avenue was home to more than 120 businesses. Today, only a few dozen remain.

What happened to Claiborne Avenue isn’t unique. directly through low-income minority neighborhoods, dividing communities and polluting the air.

In Montgomery, Alabama, I-85 the city’s only middle-class Black neighborhood and was “designed to displace and punish the organizers of the civil rights movement,” according to , a community planning professor at Auburn University. In Nashville, planners intentionally looped I-40 around a white community, and sent it a prominent Black neighborhood, knocking down hundreds of homes and businesses. Examples like this exist in .

The federal government has started working on ways to confront the damage highway construction continues to do to low-income and minority communities. An initiative established in the called the seeks to do just that: reconnect neighborhoods and communities that were divided by infrastructure.

But there’s wide disagreement on the best way to do that, and some strategies are likely to do little to limit the health effects of living near these highways. What’s unfolding in New Orleans shows how challenging it is to pick and fund projects that will help.

Competing Visions for the Claiborne Expressway

Stelly’s group, the Claiborne Avenue Alliance, submitted for Reconnecting Communities Pilot money. It wanted $1.6 million in federal funds primarily for public engagement, data collection, and feasibility planning to work to assess whether it would be possible to remove the expressway altogether, with a plan to raise $400,000 more to cover costs.

And it seemed possible its grant proposal would succeed, since even the as a textbook example of the biased planning history in a published statement about the Reconnecting Communities Pilot. Ultimately, though, the federal Department of Transportation, the agency charged with allocating the program’s money, denied the Claiborne Avenue Alliance’s grant request.

Instead, the Department of Transportation offered requested in a competing made by the city of New Orleans and the state of Louisiana. That plan called for a $47 million grant from Reconnecting Communities to do overpass improvements, remove some on- and off-ramps, and, most significantly, create the “Claiborne Innovation District” to promote public life and cultural activities under the highway. DOT granted just $500,000 for the project.

Stelly said she likes a few aspects of the city-state proposal, notably the plan to remove on- and off-ramps to improve pedestrian safety beneath the expressway and other public safety projects, like better lighting and dedicated pedestrian and bicycle lanes.

But, notably, Stelly called the idea of creating an entertainment space and market beneath the highway misguided and ridiculous. Would it be a waste of scarce government funds?

“It’s a foolish idea because you’re going to be exposed to the same thing” as the neglected playground, Stelly said. “You’re going to be exposed to the same levels of noise. It’s not a wise decision to build anything under here.”

Using Science to Inform Policy

Since her group’s proposal was denied, Stelly and her organization are turning to a new strategy: helping with funded by the Environmental Protection Agency on the expressway’s health impacts. They hope the data will support them in their efforts to remove the highway from their neighborhood.

In addition to noise impacts, the EPA-funded study is looking at the health impacts of pollution under the Claiborne Expressway — especially harmful pollutants like particulate matter 2.5, or PM 2.5.

These microscopic particles, measuring 2.5 microns or less in diameter, are released from the tailpipes of passing vehicles, said Adrienne Katner, an associate professor at the Louisiana State University School of Public Health, who is the principal investigator on the EPA study. They’re so small that, when inhaled, they lodge deep in the lungs. From there, they can migrate to the circulatory system, and then spread and potentially affect every system in the body.

“So the heart, the brain,” said Katner. “If a woman is pregnant, it can cross the placental barrier. So it has a lot of impacts.”

Katner and her team of researchers are beginning the study by taking preliminary readings with monitors at different points along the expressway. Completing the research and publishing the data will likely take two to three years.

One of Katner’s monitoring sites is Hunter’s Field Playground. Graduate researcher Jacquelynn Mornay said the noise levels registered there could cause permanent hearing damage after an hour or so of exposure. The pollution levels recorded hover around 18 micrograms per cubic meter.

“It should be at most — at most — 12,” said Beatrice Duah, another graduate student researcher. “So it is way over the limits.”

Residents and workers occupying the homes and businesses lining the area under the expressway are exposed daily to these levels of noise and pollution. When complete, this EPA study will join a decades-long body of research about how traffic pollution affects the human body.

“We’re not inventing the science here,” Katner said. “All I’m doing is showing them what we already know and then documenting it, giving them the data to then inform and influence policy. That’s all I can do.”

‘Removal Is the Only Cure’

Eventually, the study’s findings could help other communities divided by infrastructure across the country, Katner said.

“A lot of cities are going through this right now and they’re looking back at their highway systems,” she said. “They’re looking back at the impacts that it’s had on a community and they’re trying to figure out what to do next. I’m hoping that this project will inform them.”

Amy Stelly said she’s always known the air she and her neighbors breathe isn’t safe, but she’s hopeful that having concrete data to support her efforts will do more to persuade policymakers to address the problem. That could mean taking down the dangerous on- and off-ramps — or scrapping what she considers to be the wasteful plan of putting a market and event space under the highway overpass.

Stelly sees only one true solution to the problems posed by the Claiborne Expressway, only one way to really right the wrongs done to her community.

“Removal is the only cure,” Stelly said. “I’m insisting on it because I’m a resident of the neighborhood and I live with this every day.” And, she said, “the science tells us there’s no other way.”

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New Orleans Emergency Medical Services has been busy this summer, responding to heat-related emergency calls and transporting patients to nearby hospitals.

At the city’s main ambulance depot, the concrete parking lot seemed to magnify the sweltering heat, circulating the air like a convection oven. Capt. Janick Lewis and Lt. Titus Carriere demonstrated there how they can load a stretcher into an ambulance using an automated loading system. Lewis wiped sweat from his brow as the loading arm whirred and hummed, raising the stretcher into the ambulance — “unit,” in official terminology.

But mechanical assistance isn’t the best thing about the upgraded vehicles. “The nicest thing about being assigned a brand-new unit is it has a brand-new air conditioning system,” Lewis said.

The new AC is much more than a luxury for the hard-working crews. They need the extra cooling power to help save lives.

“The No. 1 thing you do take care of somebody is get them out of the heat, get them somewhere cool,” Lewis said. “So the No. 1 thing we spend our time worrying about in the summertime is keeping the truck cool.”

Like much of the country, New Orleans has been embroiled in a heat wave for weeks. As a result, New Orleans EMS is responding to more calls for heat-related conditions than ever before, Lewis said. During the third week of July, the city’s public EMS crews responded to 29 heat-related calls — more than triple what they handled during the same period last year.

Scientists say dangerous heat levels — and the stress they put on human bodies and medical systems — will likely keep increasing. Health systems nationwide face serious funding and staffing challenges that could make it harder to keep up.

New Orleans EMS is no exception. In April, it reported operating with only . The city’s chief of EMS has called for increased funding for higher wages to attract more workers. Local private ambulance services like Acadian Ambulance Services pay staffers between $50 and $70 per hour. The city’s EMS department can’t compete.

Lewis said they’re making do with the resources they have and prioritizing one-time expenses like new ambulances to help them meet the challenges they’re facing.

“We’re going to provide the care everybody needs, regardless of how hot it gets,” Lewis said. “We’d love to have all the help in the world, but we’re getting the job done with what we have right now.”

When a human being is exposed to high levels of heat for too long, their core body temperature rises. Once core body temperature exceeds 100 degrees Fahrenheit, . If not quickly addressed, that can prompt an escalating cascade of health problems.

The first stage is heat exhaustion, Carriere explained: “That means you’re hot, you may have an elevated temp, but you also have what’s called diaphoresis, which means your body is sweating, is still trying to compensate and cool yourself off.” You’ll also likely have other symptoms like weakness, dizziness, or a headache.

Carriere said that if a person can quickly get out of the heat and into an air-conditioned place, generally they’ll recover from heat exhaustion on their own. Otherwise, their core temperature will continue to rise.

As internal body temperature approaches 104 degrees, people start to suffer from heatstroke.

“Once you move to heatstroke, your body stops compensating,” Carriere said. “You stop sweating. You’re hot. You’re dry. And your organs are basically frying themselves from the inside out.”

When a person stops sweating, it becomes even harder for the body to cool itself down. During heatstroke, people may experience other severe symptoms like an altered state of mind, confusion, and a rapid, erratic pulse. They may even lose consciousness.

Without medical intervention, heatstroke can be deadly. EMS responders start treatment immediately after they arrive on the scene. “We’ll get them on a gurney, get them into the unit, start removing their clothing, and put ice packs wherever applicable to try to cool them down,” said Carriere.

Once a heatstroke patient is loaded into the ambulance, the crew races them to a nearby hospital, Carriere said. At University Medical Center, New Orleans’ largest hospital, doctors and nurses will continue efforts to quickly lower the person’s body temperature and replace fluids by IV, if necessary.

“When the patient ends up at the hospital, we’re going to continue that cooling process,” said Jeffrey Elder, medical director for emergency management at UMC. “We’re going to put them in an ice water bath,” and, he added, “we may use some misting fans and some cold fluids to get their body temperature down to a reasonable temperature while we’re supporting all the other bodily functions.”

Getting a patient’s core temperature down as quickly as possible is what will ultimately save their life. One way doctors can speed that along is by burying a patient in ice. In some parts of the country, doctors have placed patients inside body bags prepacked with pounds of ice. Body bags are especially useful in these cases because they are waterproof and designed to closely fit the human form.

UMC’s emergency room doesn’t use body bags, but during the summer staffers keep bags of ice ready at all times.

“On the stretcher, we’ll use some of the sheets as kind of a barrier,” Elder said. “And while they’re on the stretcher, we’ll just put the ice on them right then and there.” Hospital staffers will continue to work to cool a patient down until their temperature gets below 100.

Elder said that while it always gets hot in New Orleans during the summer, his emergency room has been treating more heat-related illnesses in 2023 than ever before. A few patients have died from the heat. UMC has been struggling with staffing challenges since the beginning of the pandemic, just like many other hospital systems elsewhere. But to prepare for an influx of patients with heat-related illnesses, UMC has prioritized staffing of the emergency department, Elder said.

Across the country, meteorological events like heat waves and heat domes will become more frequent and intense in the future, according to the Centers for Disease Control and Prevention.

“Extreme summer heat is increasing in the United States,” said , a health scientist with the CDC’s . “And climate projections are indicating that extreme heat events will be more frequent and intense in the coming decades.”

Health infrastructure will be challenged to keep up to treat patients suffering from extreme heat exposure. In New Orleans, both first responders and doctors say they expect to see more patients with heat-related illnesses.

“We haven’t even gotten to the hottest part yet, which is typically August to September,” said Carriere. “So I’m expecting it to get pretty bad.”

This article is from a partnership that includes , , and Â鶹ŮÓÅ Health News.

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