The Social Burden of PFAS “Forever Chemicals” in California

In 2019, the Nordic Council of Ministers estimated the socioeconomic costs related to the negative human health and environmental impacts from the use of certain PFAS. The report found the costs of inaction in the European Economic Area countries to be between €52–€84 billion (2018 EUR) due to various health impacts. The report used data specific to Nordic countries as well as other European countries, the United States, and Australia, where relevant. Scaling this analysis based on the population of California, we estimate minimum health care costs for California to be between $5.5 and 8.7 billion (2025 USD) annually, as described below. 

In the Nordic Council report, annual health-related costs in the European Economic Area included the following well-studied impacts: 

• Costs attributable to increased deaths due to kidney cancer from occupational exposure were estimated to be €12.7–€41.4 million, based on the “value of a statistical life” (an estimate of how much people are willing to pay to reduce the risk of death).
• Health costs for PFAS exposures in communities near manufacturing sites or with elevated levels of PFAS in their drinking water were estimated at €41–€49 billion based on all-cause mortality.
• Health costs due to background levels of exposure from drinking water, food, or consumer products were estimated at €11–€35 billion, based on mortality due to hypertension. 

Importantly, even though these estimates are larger than the 2024 EPA estimate of the benefits of the national drinking water standards—because the Nordic Council report considers additional health effects and exposures from all sources—its findings are still likely conservative. Due to data limitations, the majority of the quantified costs were based on exposure to just the two most widely studied PFAS: PFOA and PFOS. Additional health care costs would be incurred due to exposure to the many other PFAS in our environment. Importantly, there are non-quantified health care costs associated with other conditions caused by PFAS exposure (e.g., liver damage, thyroid disease, decreased fertility, and testicular cancer). For example, the Nordic Council estimated that 3,354 cases of low birth weight per year would occur in impacted communities in the European Union, incurring additional medical costs and resulting in impaired child cognitive development. It also found that children experience 1.5 million additional days of fever due to PFAS immunotoxicity. Lastly, the health costs are based solely on mortality and the value of a statistical life and do not consider increased health care or insurance costs, loss of quality of life, or loss of productivity.

The Nordic Council had previously concluded that its estimates were generalizable to the United States (due to similar PFAS serum levels in the two populations); in a follow-up analysis, this health-related estimate was translated to the United States based on exchange rates and population differences, estimating the total equivalent cost as $37–$59 billion (2018 USD) annually. Taking inflation into account, this estimate would translate to $47–$75 billion today (2025 USD). Scaling the above cost estimates based on the California population, which is 11.64 percent of the U.S. population, the health care cost estimate for California is between $5.5 and $8.7 billion (2025 USD) annually for just the mortality impact from a handful of the known health impacts of just two PFAS. 

Reducing people’s exposure to PFAS, through remediation and/or reduction in PFAS use, would lower the health impacts and related health care costs. However, this would only happen over a long period of time, due to the persistence and bioaccumulation of PFAS. 

One of the most effective ways to reduce PFAS exposure is through drinking water remediation, since it is a major route of exposure and technologically feasible. Based on known water contamination in California and EPA cleanup cost estimates from 2024, providing safe drinking water to Californians would cost a minimum of $161 million (2025 USD) each year, with a more likely estimate of $217 million annually (2025 USD). 

Briefly, this estimate was calculated based on PFAS concentrations in drinking water from testing that was completed through March 2025 from the Safe Drinking Water Act’s Unregulated Contaminant Monitoring Rule (UCMR 5). We considered public water systems (PWS) to be detected in excess of the EPA’s 2024 federal drinking water standards if their average PFAS levels were above 4.0 parts per trillion (ppt) for PFOA or PFOS; 10 ppt for PFHxS, PFNA, or HFPO-DA; or a hazard index of 1 for mixtures containing two or more of PFHxS, PFNA, HFPO-DA, and PFBS. The cost to come into compliance with the federal drinking water standards was based on the EPA’s 2024 estimates of the mean annualized costs to treat or change water sources (tables C-9 and C-13), based on PWS source (groundwater or surface water), system type (e.g., community versus non-transient noncommunity), owner type (public or private), and the size of the population served. Of note, the EPA’s 2024 cost estimates for coming into compliance are mean annualized costs that take into consideration the high up-front capital costs needed to build a water treatment facility and the lower, recurring costs that are required to keep the facility running over many years. The costs are presented as spread out, or “annualized,” over the course of the lifetime of the system, even if the initial capital costs are front-loaded. 

Based on systems tested under UCMR 5 to date, California would need to spend approximately $161 million to remediate drinking water with known contamination exceeding the 2024 federal drinking water standards. If untested water systems are assumed to have the same likelihood of PFAS contamination as those already tested (16 to 27 percent, based on system size), this would add a further $56 million (2025 USD) per year, for an estimated total value of $217 million (2025 USD) per year. Still, the true cost of providing safe drinking water for all Californians is likely much higher. 

In particular, the 2024 federal drinking water standards cover just six of the many PFAS that have been found in California drinking water. Additionally, this estimate does not include costs that could be borne by small, private wells or transient noncommunity water systems (e.g., water at camping grounds) that are not covered by the federal standards.

Another way to estimate PFAS cleanup  costs for drinking water is to scale the EPA’s $1.5 billion estimate for remediating drinking water across the United States to the population of California. This results in an annualized cost of approximately $190 million (2025), which aligns well with our above estimates. Furthermore, costs already documented within California, summarized below, support these estimates, indicating that treating drinking water in California will cost hundreds of millions per year for decades to come. 

And regardless of how the EPA proceeds in its repeal and delay of PFAS standards—which would be an unlawful act under the Safe Drinking Water Act’s “anti-backsliding” provision —some states, like California, have been moving to adopt the agency's 2024 standards in their own statutes or regulations. Stepping back further, the costs of complying with the EPA’s 2024 standards are an indicator of the costs of cleaning up PFAS in drinking water to protect public health.

Dozens of cities and water districts in California, along with the U.S. Department of Defense, have already begun to address high levels of PFAS in drinking water by implementing water and environmental remediation projects, to the tune of more than $571 million—with $1.13 billion more in spending planned. These early investments have jump-started California’s compliance efforts with the national drinking water standards and help to reduce future compliance costs, PFAS health harms, and associated health care costs. 

Safer States and Toxic-Free Future previously compiled publicly available expenditures on PFAS removal from drinking water. In the appendix, we have expanded this partial accounting. These costs are onetime expenses for specific projects—money that has already been spent or allocated—and are not annualized, nor do they include ongoing maintenance costs. Rather, these costs represent a multiyear total of capital investment and capture the most expensive phase of each project. Nor are these costs directly responsive to the drinking water standards since some of these costs precede the federal standards. So while these existing expenditures may overlap with the projected costs, they do not necessarily do so. What they do show is that significant costs are already being incurred because of PFAS pollution, and this is consistent with what we expect from the above estimates of expected cleanup costs.

More than $331 million has been spent in California on water treatment projects by individual municipalities or water districts from December 2019 to present. These costs are spread across just 12 water providers, serving around 1.9 million people. We found $491 million in additional estimated costs for planned or ongoing projects in other water districts. Water districts in wealthier communities have brought projects online faster, while smaller, more disadvantaged communities are largely waiting on grant allocations. 

The ongoing annual operations and maintenance costs for the PFAS treatment plants can range from a few hundred thousand dollars to more than $2 million per well, depending on the volume of water needing treatment. The majority of the cost likely comes from the replacement and disposal of the resin used to filter the water, which itself becomes PFAS-contaminated waste and may require additional treatment or special handling. 

Separately, the Department of Defense has spent an additional $240 million on environmental investigations and cleanup at 77 military installations in California, with at least $633 million more in spending planned in the coming years. This cleanup goes beyond just drinking water treatment, with additional work on soil remediation.