12 to 19 million US households cannot afford their water bills, and in Cleveland, families below 50% of the poverty line spend over 12% of their income on water — three times the EPA's affordability threshold

The EPA's December 2024 Water Affordability Needs Assessment — the first comprehensive federal study of water affordability — found that between 12.1 million and 19.2 million US households (9–15% of all households) cannot afford their water and sewer bills. The combined water and sewer bill for a typical household increased 24% over the past five years (2019–2024). In cities like Cleveland and Birmingham, Alabama, combined bills already exceed the EPA's own affordability threshold of 4.5% of median household income. In Cleveland specifically, more than half of households earning below 50% of the federal poverty level spend over 12% of their income on water — meaning water costs alone consume more than one dollar of every eight these families earn. When water is unaffordable, people face impossible choices. Families choose between paying the water bill and buying food, paying rent, or buying medicine. Unpaid bills trigger disconnection, and water shutoff in many jurisdictions legally makes a home uninhabitable — effectively functioning as an eviction. In some states, children can be removed from homes without running water by child protective services. Utilities compound the problem by adding disconnection fees and late fees to overdue balances, making reconnection even more expensive. The 2024 Detroit water affordability case study documented how rate increases driven by aging infrastructure repair create a death spiral: as infrastructure degrades, rates rise to fund repairs, poorer residents can't pay, the utility's revenue base shrinks, and rates must rise further. The problem persists because the United States is one of the only developed countries without a federal water affordability assistance program. The Low Income Household Water Assistance Program (LIHWAP), created during COVID-19, was a temporary measure that has since expired. Unlike energy assistance (LIHEAP), which has permanent federal funding, water affordability has no permanent federal safety net. Water utilities are structured as self-funded enterprises that must recover their costs through rates, and when those costs rise — driven by mandatory lead pipe replacement, PFAS treatment, and infrastructure repair — the bill goes to ratepayers. Without federal subsidies for low-income households, the cost of fixing America's water infrastructure falls disproportionately on the people least able to pay. The EPA's own 2024 report recommended establishing a permanent federal water assistance program, but Congress has not acted.