The Wrong Parties Are Paying for the Health Consequences of Climate Change

— Suncor v. Boulder asks the Supreme Court if industry is liable for the damages

Alina Miranda was a teenager when the Marshall Fire ripped through her community in Boulder County, Colorado, in December 2021. She lost her home, her pets, and her journals. She spent weeks sleeping in a laundry room, separated from her parents, due to limited housing options.

Alina was not alone in experiencing loss, displacement, and trauma. Driven by 100 mph windsopens in a new tab or window and record dry conditions, the fire burned 1,084 buildings in densely populated areas, killed two people, and forced 37,000 to evacuate. Families whose homes survived came back to neighborhoods covered in toxic ash. Costs for recovery and cleanup were estimated at $2 billionopens in a new tab or window.

On October 5, 2026, the Supreme Court heard oral arguments in Suncor Energy v. County Commissioners of Boulder County. This is the latest step in an 8-year legal battle that began when Boulder sued ExxonMobil and Suncor in 2018 to pay for the costs of adaptation and recovery as climate disasters, like the Marshall Fire, occur more often.

The case asks a simple question: who should pay for climate damage? The communities living with it, or the companies that profited from it and misled the public and decision-makers for decades about the risk?

For physicians, the answer matters a great deal. Our patients and communities are already paying the price, and so are the health systems we work in. Meanwhile, the companies are asking the justices to dismiss the caseopens in a new tab or window.

The Marshall Fire crisis reflects what we are seeing across the country. Its harm did not stop once the last flame was extinguished. Six months later, one study found that more than half of residentsopens in a new tab or window in surviving homes reported headaches, sore throats, or a strange taste in their mouths, and a companion study found that air inside one home matched downtown Los Angeles on a high-pollution day in the 1990s, with hazardous gases lingering for weeks. Researchers found elevated metals and polycyclic aromatic hydrocarbons in the ash. About a third of respondents still had symptoms long after the blaze.

Then there is what studies don't capture: the child who stops sleeping after an evacuation; the teenager who has lost her home and her routines, and missed weeks of school; the family whose medications and medical equipment burned. As a pediatrician, I know that disasters like this leave lasting psychological harm, and children bear a disproportionate share of it.

Colorado is not unique. Extreme heat is sending more patients to emergency departments. Floods are damaging hospitals and clinics just when communities need them most. Ticks and mosquitoes are moving into regions where clinicians have never had to think about the diseases they carry. Wildfire smoke now reaches patients hundreds of miles from any flame. Each of these harms has a costopens in a new tab or window: in emergency visits, lost school days, hospitalizations, and the rebuilding of public infrastructure. Right now, taxpayers, patients, and health systems pay those costs almost entirely.

Physicians know this story because we have lived it. The tobacco industry knew its products caused disease, spent decades manufacturing doubt, and left the public health system with the bill. What finally forced accountability was state attorneys general and local governments bringing claims under state law in state courts. That wave of litigation produced the 1998 Master Settlement Agreement, worth roughly $206 billion, which funded tobacco control and helped expose the industry's internal documents.

Boulder's case rests on the same principle of holding industry accountable. It argues that these companies knew what their products would do to the climate and misled the public anyway. Research publishedopens in a new tab or window in Science in 2023 found that Exxon's own scientists projected global warming with striking accuracy as early as the 1970s and 1980s.

Fossil fuel companies warn that lawsuits like Boulder's could bring payouts large enough to "crippleopens in a new tab or window" them. Tobacco made the same argument, and so did opioid manufacturers, which followed a similar settlement pathopens in a new tab or window. Each industry faced large, coordinated settlements, and each is still in business. Accountability did not destroy these industries. It made them pay part of the costs they had pushed onto the public.

The companies also warn that fuel prices will rise. Families are already struggling with the cost of groceries, housing, and healthcare, so this worry is real. But if these companies wanted to lower energy costs, they would not lobby against wind and solar projectsopens in a new tab or window, which are now among the cheapest and fastest sources of power to build. They are using a legitimate concern about fuel prices to protect their business, while fighting the policies that could actually lower energy bills.

If the Court sides with Suncor, it could shut down dozens of similar cases brought by states and cities before any of them reaches trial. Imagine if the Court had ruled in the 1990s that states could not bring tobacco claims in their own courts. The Master Settlement Agreement would never have happened, the industry's documents may never have come out, and the public health gains that followed would have come much more slowly, if at all.

A ruling for the companies would not make climate costs go away. It would lock in who pays them: local governments, taxpayers, and the patients in our clinics and hospitals.

Our profession helped make the tobacco case. We can do the same now. Talk with your patients and colleagues about where these costs come from. Ask your medical societies to speak up in court and in public.

Parents often teach their children if you broke it, you fix it. Letting fossil fuel companies off the hook for damage they knowingly caused, and leaving families to pay for it, is neither right nor fair. As climate damage grows, the bill will only get larger. The companies that profited should pay their fair share.