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In pain so bad he couldn鈥檛 stand, Chris Meek was rushed to the hospital with a life-threatening ruptured gallbladder. When he emerged from surgery, he learned he had kidney cancer that thankfully hadn鈥檛 yet spread.

Meek, a social studies teacher in Wilmington, North Carolina, was 47 at the time. But he remained confused for years about why, as someone seemingly not at risk, he had gotten cancer until Emily Donovan, a parent of students at his school, gave a guest talk about high levels of harmful forever chemicals known as PFAS in North Carolina’s environment. When Donovan mentioned kidney cancer, the possible cause of Meek’s diagnosis finally clicked.

Until then, Meek said, he 鈥渉ad no idea what PFAS was.鈥�

Last year, the Environmental Protection Agency set the first federal drinking water limits for PFAS, or perfluoroalkyl and polyfluoroalkyl substances, finding they increased the risk of cardiovascular disease, certain cancers and babies being born with low birth weight.

In a decision with consequences for tens of millions of Americans, the Trump administration is expected to soon say whether it intends to stand by those strict standards and defend the limits against a water utility industry challenge in federal court.

PFAS in drinking water created a crisis for many communities

In North Carolina, runoff from a Chemours plant contaminated the Cape Fear River, creating a crisis for cities like Wilmington that use it for drinking water. Amid public outcry, Wilmington effectively eliminated it from tap water.

Other U.S. communities 鈥� often near military bases or industrial sites 鈥� did the same when test results were frightening and public pressure, local leadership or state law forced PFAS-laden wells offline or prompted installation of expensive filtering systems, according to Mark White, drinking water global practice leader at the engineering firm CDM Smith.

The EPA said the PFAS found in North Carolina, often called GenX chemicals, can be toxic to the kidney. While other types of PFAS may raise kidney cancer risk, little research has focused on the link between kidney cancer and GenX, according to Sue Fenton, director of the Center for Human Health and the Environment at North Carolina State University. Chemours said evidence doesn’t support arguments that GenX at low levels is a health threat. The company has sharply reduced PFAS discharges.

So far, sampling has found nearly 12% of U.S. water utilities are above the recently set EPA limits, but most aren’t above by much. Forcing this group to reduce PFAS more than doubles the rule鈥檚 health benefits but roughly triples its costs, the EPA has said.

The Biden administration鈥檚 rule set standards for two common types of PFAS at 4 parts per trillion, effectively the lowest level at which they can be reliably detected. Standards for several other PFAS chemicals were set, too, and utilities must meet those levels by 2029.

PFAS have had wide uses over the decades

Manufactured by companies like Chemours and 3M, PFAS were incredibly useful in many applications -鈥� among them, helping clothes to withstand rain and ensuring that firefighting foam snuffed out flames. But the chemicals also accumulate in the body. As science advanced in recent years, evidence of harm at far lower levels became clearer.

EPA Administrator Lee Zeldin has championed fossil fuels and the rollback of major clean air and water rules. His history with PFAS is more nuanced; during his time as a New York congressman, he supported legislation to regulate forever chemicals in drinking water.

鈥淚t鈥檚 an issue that touches people in a very tangible way across the political spectrum, including in Lee Zeldin鈥檚 former district,” said Melanie Benesh, vice president of government affairs at the nonprofit Environmental Working Group.

Zeldin has offered clues about what the EPA could do. The agency estimated the rule would cost about $1.5 billion annually and Zeldin said recently that communities struggling to afford a fix for PFAS that are just above the standard might be handled differently than wealthy places with lots of it.

鈥淲hat we are going to have to be is extremely thoughtful in figuring this out,鈥� he said.

On Monday, the EPA said it will establish an agency lead for PFAS, develop wastewater limits for PFAS manufacturers and investigate sources that pose an immediate danger to drinking water, among other actions.

EPA decision looms on whether to let the rule stay as it is

Soon, the EPA must tell a federal appeals court in Washington whether the rule should stand or be rewritten, although weakening it could be complicated because the Safe Drinking Water Act prevents new rules from being looser than previous ones. The agency could, however, encourage exemptions and deadline extensions, according to Erik Olson, an attorney with the nonprofit Natural Resources Defense Council supporting the current standards in the court case.

Consider Avondale, Arizona, outside of Phoenix, which produces PFAS results modestly above the limits. Officials have done detailed testing and are planning to enhance water treatment. All told, lowering PFAS may cost Avondale more than $120 million, according to Kirk Beaty, the city鈥檚 public utility director.

That鈥檚 money a city like Avondale 鈥渏ust doesn鈥檛 have sitting in a back room somewhere,” Beaty said, adding he鈥檒l defer to federal experts to dictate what鈥檚 acceptable.

鈥淲e鈥檙e hoping we鈥檙e a little further ahead of everybody else. If the regulation changes, well you know, we may let off the gas a little bit, we may not,鈥� he said, adding that it is hard to justify spending extra money to do more than what鈥檚 required when the cost falls on residents.

If the government decides higher amounts of PFAS are acceptable, that could confuse people, especially in areas where the public is already concerned.

鈥淚f we enter into a gray area over what鈥檚 healthy and what鈥檚 not healthy, then utilities are at risk of being caught up in a debate for which they have no real responsibility nor expertise to decide on,鈥� said Karine Roug茅, CEO for municipal water at Veolia North America, a water operations company.

Industry group says the rule goes too far and is too costly

The American Water Works Association, an industry group, filed the court challenge to the new rule. It agrees that certain PFAS should be regulated but argues the EPA鈥檚 standards go too far, underestimate costs and are 鈥渘either feasible nor cost-effective.鈥� There are serious consequences for residents’ water bills, it says.

The burden of complying will fall heavily on small utilities that can least afford it. Many water providers already struggle to maintain their existing infrastructure, some experts say. On top of everything else, they face new requirements to replace lead pipes. The AWWA wants the EPA to extend the PFAS and lead deadlines by two years.

There is money available to help. The Bipartisan Infrastructure Law provided $9 billion for chemicals like PFAS and utilities have won multibillion-dollar settlements against PFAS polluters that help as well.

Meek, who successfully recovered after surgery from cancer and is now 59, is planning to sue over his illness. He once didn鈥檛 second-guess using tap water. Now he reaches for bottled water.

Donovan, who introduced Meek to PFAS and helped start Clean Cape Fear, says if the government鈥檚 standards are weakened, it鈥檒l relieve pressure on utilities to effectively treat the water.

Previously, 鈥渙ur local utilities could tell us publicly that the water met or exceeded all state and federal guidelines because there weren鈥檛 any,鈥� she said.

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The Associated Press receives support from the Walton Family Foundation for coverage of water and environmental policy. The AP is solely responsible for all content. For all of AP鈥檚 environmental coverage, visit https://apnews.com/hub/climate-and-environment