When deadly heat hit the Pacific Northwest two years ago, hundreds of people died, including several residents of public housing in Portland. That's where Beth Vansmith lives. She has heart disease, a condition that puts her at higher risk for heat illness, and she remembers how awful she felt with no air conditioner and temperatures soaring up to 116.

"I would get dizzy. I would get nauseous. You know, I'd lose my appetite completely, and it was just so miserably hot," she says.

Vansmith borrowed an "itty bitty" portable air conditioner from her sister, which was still a huge relief and at least allowed her to sleep. "I was sitting like this most of the time next to it," she says during an interview in her one-bedroom apartment, "because it really only cooled like, right here."

As heat waves get worse, air conditioning has come to feel like a must-have even in parts of the U.S. that historically haven't needed it. Those who live in public housing are especially vulnerable to the heat — they're not just low-income, but also disproportionately older, people of color, chronically ill and often living in hotter neighborhoods that lack shade from tree cover. And yet even as extreme heat becomes more common, it remains a struggle for many tenants to get AC.

Much public housing is decades old, built before central air was widely available, and it would be incredibly expensive to add it now. Many tenants get an allowance for utilities that includes heat, but federal rules actually specify that it not cover air conditioning. Residents are allowed to get their own AC units, but Deborah Thrope, of the National Housing Law Project, says most must pay for it and the monthly bills themselves.

"That's when we start seeing families paying well above 30% of their income in rent, which makes these programs less affordable." she says.

A proposal to mandate AC in Texas public housing faced pushback this year

Texas state Rep. Diego Bernal remembers the moment he learned about this problem a few years ago.

He was chatting with a woman who lived in public housing in San Antonio, and she mentioned how brutal the heat was with no AC. He assumed hers was simply broken and offered to send someone to fix it. No, she explained, she was among some 2,400 public housing residents there who had no air conditioner and could not afford to get one.

"It blew my mind, and I was embarrassed," Bernal says. "Not only do I represent the area, but it also is across the street from my middle school. I mean, I knew all kinds of kids who came from there."

Bernal, a Democrat, set out to fix this. The City of San Antonio put up money and helped find other funding to get AC units for all public housing residents. In the process, the Department of Housing and Urban Development rejected the use of a federal grant because the window air conditioners were deemed a temporary upgrade, not permanent.

For the past two years, Bernal proposed bills to mandate or at least encourage air conditioning in federally subsidized housing across Texas. Both failed after affordable housing providers pushed back hard, saying they had no money to make it happen.

Bernal says he understands the public housing system is "wildly underfunded." HUD has an astounding $80 billion construction backlog, and many of its buildings are in disrepair. Still, "it is unsafe and inhumane to expect people to live in Texas, especially central and south Texas, without air conditioning," Bernal says. "So figure it out."

Federal regulations restrict spending on individual air conditioners in public housing

HUD recently updated its safety inspection standards which, for the first time, include a temperature threshold to make sure apartments are warm enough during winter. The National Housing Law Project and others urged it to also include a cooling standard during summer months, but the agency did not.

HUD declined an interview request but says it is "exploring options" for a cooling requirement. It also recently clarified to local housing agencies that they are allowed to spend federal money for air conditioning, though only to set up cooling centers in common areas, not for units in individual apartments.

In a statement to NPR, the agency said, "HUD regulations require that the cost of air conditioning for resident units be paid by the residents, except in the case that elderly or disabled households necessitate it as a reasonable accommodation." In buildings where a local housing agency pays utility expenses, "families must be charged a surcharge or otherwise pay for ... air conditioning."

The public housing agency in New York City cites those federal guidelines, as well as its "current financial hardships," as the reason for a newly announced air-conditioning fee.

When COVID hit, then-Mayor Bill de Blasio used emergency pandemic aid to distribute free ACs to low-income households, including 16,000 in public housing. But with that aid running out, the housing agency says starting in October, tenants must pay $8 a month or give back their AC units.

"I told them they can take it," says 73-year-old Manhattan resident Vera Naseva. She says even that little extra would force her to cut back on food. Plus, her AC is noisy and doesn't fit well in her window, a big problem whenever it rains. "It's leaking and the floor gets wet," she says. "It's not real good."

Still, she hopes the agency changes its mind on the fee, because these days "everybody needs air conditioning."

Research finds air conditioners alone are not the solution

To help better prepare for more extreme events, Portland studied indoor heat in three public housing buildings last summer. Vivek Shandas of Portland State University helped lead it, and says so much research is based on outdoor temperatures from "machines that are flying around the planet." But of course when temperature spike, people go inside.

Some of the findings were surprising. It turned out many apartments with AC didn't cool down as much as expected. Residents also found them too noisy and turned them off, especially at night. Others say they just prefer to do without.

"I'm comfortable, I'm cool, I've got the fan," says Chris Harris, who lives in one of the buildings in the study. She says her sun-blocking drapes are a "godsend" and that "the only time I see sunlight in my apartment ... is when one of the cats gets in the windowsill."

Harris is not wrong. The study found that using things like that, as well as evaporative coolers or awnings over a window, made a big difference.

"Their units were remarkably cool throughout the day and the night. And in fact those were the units that were consistently as cool as those that had the mechanical air conditioning systems," Shandas says.

Still, some apartments reached 90 degrees or more and stayed hot for hours after the outdoor temperature had cooled off. Residents' ability to tolerate such heat varied widely. When researchers sent phone alerts to warn people their place had reached a possibly dangerous level, some actually found it annoying and turned off the alert.

"A lot of people go through heat waves, particularly in public housing, without recognizing that this is a potentially lethal climate induced event that's about to hit them," Shandas says.

The study made clear that residents need more education about heat safety, says Ian Davie, chief operating officer of Home Forward, which manages the public housing buildings in Portland. The agency is holding classes that include "tips for staying cool, how to identify heat related illnesses and then, in a more acute context, what to do if someone is feeling ill, including calling 911," he says.

Despite a tight budget, last year Davie did also allocate a million dollars for air conditioners. That's helped Vansmith, the woman who sat next to her tiny borrowed air conditioner in 2021. (The heat study found that even with it turned on full blast, the temperature in her apartment was 86.) Now she says she has a much better unit that keeps the entire place cool.

Home Forward is also getting energy efficient heat pumps — which both heat and cool — from Portland's clean energy fund. Davie says he started early and created a stockpile and built an entire safety team. When the temperature spikes and requests for AC pour in, he says he'll be ready.