U.S. West Coast droughts and heat waves exacerbate pollution inequality and can evade emission control policies.

Droughts reduce hydropower production and heatwaves increase electricity demand, forcing power system operators to rely more on fossil fuel power plants. However, less is known about how droughts and heat waves impact the county level distribution of health damages from power plant emissions. Using California as a case study, we simulate emissions from power plants under a 500-year synthetic weather ensemble. We find that human health damages are highest in hot, dry years. Counties with a majority of people of color and counties with high pollution burden (which are somewhat overlapping) are disproportionately impacted by increased emissions from power plants during droughts and heat waves. Taxing power plant operations based on each plant's contribution to health damages significantly reduces average exposure. However, emissions taxes do not reduce air pollution damages on the worst polluting days, because supply scarcity (caused by severe heat waves) forces system operators to use every power plant available to avoid causing a blackout.