The increasing frequency and severity of extreme heat events is an intersectional issue that poses significant risk to human health and livelihood. This article examines the challenges and opportunities of addressing the health consequences of extreme heat events in the United States. American federalism and political polarization constrain innovation and hamper the development and implementation of solutions to mitigate negative health consequences of extreme heat. The United States is unprepared for the health consequences of extreme heat events. Fragmentation of the medicolegal death investigation system contributes to an underreporting of heat-related mortality in federal repositories. Without reliable data, the scope of heat-related mortality cannot be fully understood and this limits the ability to effectively intervene. Despite this gap in our knowledge, it is clear that there are profound socioeconomic and racial disparities in health, and extreme heat events will amplify these disparities. We consider opportunities for local government action in this area, yet, federal leadership is required to bolster national efforts in addressing extreme heat.