Real World Economics: Elasticities help explain tariffs’ impact

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Edward Lotterman

Donald Trump keeps flipping and flopping on tariffs. Many are scheduled to kick in on Aug. 1, but who knows. Nevertheless, U.S. households and businesses need to gird their loins for the biggest and fastest economic adjustments since the Japanese attack on Pearl Harbor brought us into World War II.

As things play out, we will make adjustments to what we buy, what we can sell, where we will work and now we will spend our free time.

How much will consumers cut their consumption of taxed imported goods? How much will we shift to substitutes or spend our money on unrelated alternatives?

How fast will domestic production of items hit with import taxes grow, as Trump suggests? And what about production ramping up in countries facing 10% U.S. tariffs when the historic dominant exporter faces 50% rates by the U.S.?

Economics offers us a tool to understand these issues — ones that will be critical over the next decade. It’s called “elasticities,” and it’s one of the fundamental concepts in economic analysis.

Elasticities explains and measures the degree to which changes in one variable affect another variable. Applied broadly they facilitate comparisons between different products, different eras, different countries and different currencies. The key is that they use objective percentage changes rather than subjective changes in quantity and value.

Start with an example of Mexican avocados facing high U.S. tariffs. Guacamole lovers like me wonder how much and how quickly U.S. production might increase. Not considering elasticities, ag economists might analyze historical data and conclude, “When avocado prices go up by 10 cents a pound, U.S. production increases by 232,000 crates per year.”

How does that compare to, say, Spain? “When the price there goes up by half a euro per kilo, output increases by 32,000 metric tons.” OK, what about fresh sweet corn? “Well, for every 25-cent increase per dozen ears, U.S. production goes up by 317,000 bushels.”

See the problem? How many avocados per crate or pounds of avocados? How many ears of corn per bushel? Using this approach, one must examine many years of data to get statistically valid conclusions. But doing that, we then would also have to consider that the overall buying power of a U.S. dollar has fallen by half since 1998 and that Europe now uses euros rather than francs, guilders and marks?

The solution is to ignore price and quantity units. Applying elasticities, we can pose all the changes in percentage terms. “When the price of avocados rises 10%, U.S. consumption falls by 4% … ”

You can apply that comparison to Spain or sweet corn or asparagus without getting into pounds, kilos, cases, bushels, dollars, euros or any other unit. You can analyze changes in price-quantity relationships in the 1960s when we ate a half pound of avocados per person annually and could get fresh sweet corn over a 60-day season. Now we eat nine pounds per person per year and can buy corn over at least 120 days. Forget quantity units. Ignore price changes. The percentage relationships alone give analytic power.

These “elasticities” can be used in all sorts of economic relationships. The common element is that we look at the percentage change in one variable relative to the percentage change in a related one.

Consider common examples:

• “By what percentage does U.S. consumption of avocados fall when their price increases by 15%?” That is an elasticity of demand, specifically their “own-price elasticity.”

• “By what percentage does U.S. consumption of corn chips fall when avocado prices increase by 15%?” That is an elasticity of demand, but a “cross-price” one where we look at the relationship between the price of one good and the consumption of a related good.

• By what percentage do consumer purchases of chunky tomato salsa rise when the price of avocadoes drops by 12%? That is also a “cross-price elasticity,” but one for products that are “substitutes” for each other. The prior example of chips and a key guacamole ingredient involve “complements,” or things that are consumed together. For consumers, salsa and guac compete with each other.

Then look at the producer side.

• By what percentage does U.S. production of avocados rise when import prices increase by 15%? That’s an elasticity of supply. The idea of related goods that are complements or substitutes similarly applies to supply and production as well as consumption.

• If the price of gasoline falls, what happens to production of paving asphalt? It increases because asphalt is a “complement in production” of refining crude oil into fuels. With lower prices, more gasoline is sold, more crude oil refined and more asphalt produced, even if the price of asphalt stays the same.

The common term for “complement” here would be “by-product.” When we had many integrated steel mills, higher steel output increased percentage production of Portland cement made from blast furnace slag even if cement prices had not changed a dime.

In Minnesota, despite predominance of corn and soybeans, oats and barley remain viable and are competing crops using near-identical inputs. They are “substitutes in production.” Oats is ideal for horses. When Canterbury Downs and hundreds of associated horses came in, the local price of oats rose compared to barley. Planted acres of oats increased slightly and barley fell.

In Manitoba, barley and canola are substitutes for farmers. Bad crops of corn and soy in the U.S. corn belt may reduce output of corn and soy oil, increasing prices. This may reduce next year’s sowing of barley in Manitoba. Farmers may plant more canola in the hopes of catching at least the tail end of the vegetable oil price increase.

Applications of elatsticies are almost endless and can be used to understand virtually all cause-and-effect relationships. Pollution: By what percentage would China’s emissions of carbon drop if the price of its coal increased 15%? Education: By what percentage do completed family sizes for Rwandan women fall for every 10% increase in the numbers of them who complete secondary school? Development: By what percentage does conversion of Brazil’s “campos cerrados” dry forests to farmland increase for every 5% increase in Chinese household incomes and thus of pork consumption?

Now let’s apply this to how the U.S. economy adjusts to Trump’s enormous tariff shock — regardless of whether it even shows up in actual price and quantity data.

The June Consumer Price Index showed an increase in the price of toys. Over time, how many fewer toys will parents buy? Will kids simply have to play with them longer? Will people buy more durable toys? Will trips to waterparks or minigolf outings make up for less lavish birthday bonanzas?

Furniture prices also went up. Will prices of used items at yard sales spike? Will skilled restorers have long waiting lists? With some women’s clothing also showing increases, will skilled tailors who can restyle and spiff up used dresses, tops and pants be able to raise rates without losing customers? Will charity shops see more buyers? Fewer donations? Both? Will someone seeking a master’s degree in consumer econ get funding from Goodwill for a thesis forecasting how used clothing donations and sales will respond to higher U.S. import tariffs?

Understand that nearly all elasticities vary with the length of time available for both producers and consumers to make adjustments. In the short run, it is hard for a coffee shop to change either menu or suppliers. Given more time, it can. Building a new brass foundry might take two years. In the meantime, industrial brass casting users will have to pay more for imports, eating some of the costs and passing some along.

So don’t believe assertions that tariffs will be a one-time price shock. Intertwined economic relationships are highly complex. Predicting details of how everything will fall out is nigh impossible.

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St. Paul economist and writer Edward Lotterman can be reached at stpaul@edlotterman.com.

33 summer book recommendations featuring some of 2025’s best novels and more

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Summertime means vacations — and vacations mean books. (And sunscreen and cold drinks. But mostly books.)

The season is traditionally a busy one for publishers, who often release some of their most exciting titles over the next few months. This summer is no exception: July, August, and September will see the publication of page-turning fiction and fascinating nonfiction.

Whatever your tastes, you’re bound to find something in these 33 books worth buying from your favorite local store and taking to the beach (or just your backyard) with an iced beverage in hand.

“I Want to Burn This Place Down” 

Author: Maris Kreizman 

What It’s About: The debut book from culture blog pioneer and Literary Hub columnist Kreizman is the funny and angry account of her disillusionment with the Democratic Party (among other U.S. institutions) and her move further to the left over the past several years. 

Publication Date: Out now

“Cry for Me, Argentina: My Life As a Failed Child Star” 

Author: Tamara Yajia

What It’s About: Los Angeles-based comedian Yajia grew up in both Argentina and the U.S., and she worked as a child actress before reaching her teen years. Her book chronicles not only the misadventures of growing up in an oddball family, but also creative endeavors that include joining a band and putting on her own one-woman show.

Publication Date: Out now

“Archive of Unknown Universes” 

Author: Ruben Reyes Jr. 

What It’s About: Southern California native Reyes had a very good 2024. His debut book, the short story collection “There Is a Rio Grande in Heaven,” was published to glowing reviews and was a finalist for the California Book Award and the Story Prize. His first novel follows two young people who use a device that can look into alternate versions of lives to discover the truth about their Salvadoran families.

Publication Date: Out now

“Wanting” 

Author: Claire Jia 

What It’s About: The debut novel from Los Angeles author Jia, who also writes for television and video games, follows Lian, a woman in Beijing whose life is changed when her longtime friend, Wenyu, comes back to China after spending a decade in California. Wenyu lets Lian in on a long-kept secret that throws Lian’s life into disarray.

Publication Date: Out now

“Sunburn” 

Author: Chloe Michelle Howarth 

What It’s About: Irish author Howarth’s novel, set in a small town in the early 1990s, tells the story of Lucy, a young woman who chafes against the expectation that she’ll marry a man and have kids. She develops romantic feelings for her best friend, Susannah, who doesn’t want to keep their relationship a secret.

Publication Date: Out now

“Make Your Way Home” 

Author: Carrie R. Moore 

What It’s About: Moore, the inaugural writer-in-residence at the Steinbeck Writers’ Retreat, makes her book debut with this short story collection that tells the story of Black men and women searching for home in various locations across the American South.

Publication Date: Out now

“The Payback”

Author: Kashana Cauley 

What It’s About: Television writer Cauley’s first novel, “The Survivalists,” was a hit with critics. She brings the same insight and dark humor to her new one. Partially set in the Glendale Galleria, the novel follows Jada, a recently unemployed woman on the run from the “Debt Police” who teams up with two friends in an attempt to take down her student loan company.

Publication Date: Out now

“No Body No Crime” 

Author: Tess Sharpe 

What It’s About: The latest novel from California-raised author Sharpe (“The Girl in Question”) tells the story of Mel Tillman, a rural private investigator who goes searching for her long-lost friend Chloe — a woman who she fell in love with as a teenager, and with whom she killed a boy who had been terrorizing them. She does find Chloe, but that leads to a whole new mess of trouble, and the two are forced to go on the run.

Publication Date: Out now

ALSO SEE: 17 must-read summer romance novels

“The Dance and the Fire”

Author Daniel Saldaña París, translated by Christina MacSweeney

What It’s About: Saldaña París, who writes fiction, poetry, and essays, is one of Mexico’s most exciting and acclaimed writers. His latest novel follows three high school friends — once members of a love triangle — who reunite in Cuernavaca as wildfires threaten the city.

Publication Date: July 29

“Black Genius: Essays on an American Legacy”

Author: Tre Johnson 

What It’s About: Journalist and educator Johnson’s book is a reflection on the innovations of brilliant Black creators, artists, and everyday people. He tackles subjects including fashion inspired by 1990s street art, and the comedy of pioneering performer and author Dick Gregory.

Publication Date: July 29

“Tonight in Jungleland: The Making of ‘Born to Run’” 

Author: Peter Ames Carlin 

What It’s About: Journalist Carlin told the story of alternative-rock legends R.E.M. in his last book. In his newest one, he returns to a favorite subject: Bruce Springsteen, about whom he wrote a book, “Bruce,” in 2012. The new one tells the story behind the recording of the Boss’s classic 1975 album. (Fans who prefer the stark, acoustic Bruce might also want to read Warren Zanes’ book about the making of “Nebraska,” and see the movie based on it, which opens in October.)

Publication Date: Aug. 5

“Moderation”

Author: Elaine Castillo

What It’s About: Bay Area native Castillo made literary waves with her debut novel, “America Is Not the Heart,” in 2018. Her new novel introduces readers to Girlie Delmundo, a virtual reality moderator whose life becomes complicated when she falls for her company’s co-founder.

Publication Date: Aug. 5

“We Should All Be Birds”

Author: Brian Buckbee with Carol Ann Fitzgerald

What It’s About: Montana author Buckbee was reeling from the loss of a loved one and from a mysterious illness that left him unable to read or write because of agonizing headaches. His life is changed when he encounters an injured baby pigeon and nurses it back to health. Buckbee wrote the memoir with help from his fellow author Fitzgerald.

Publication Date: Aug. 5 

“Blessings and Disasters: A Story of Alabama” 

Author: Alexis Okeowo 

What It’s About: New Yorker staff writer Okeowo, who won the 2018 PEN Open Book Award for “A Moonless, Starless Sky: Ordinary Women and Men Fighting Extremism in Africa,” returns with a book about her family and her home state — it’s an innovative mix of memoir and journalism.

Publication Date: Aug. 5

“Songs for Other People’s Weddings”

Author: David Levithan with songs by Jens Lekman

What It’s About: The new novel from Levithan (“Boy Meets Boy”) follows a wedding singer whose girlfriend has gone to New York to work, leaving him unhappy and confused. The book contains original songs by Swedish indie-pop singer Lekman.

Publication Date: Aug. 5

“Putting Myself Together: Writing 1974 –”

Author: Jamaica Kincaid

What It’s About: The latest offering from Antiguan American author Kincaid (“The Autobiography of My Mother”) collects her nonfiction writing over the past 50 years, including pieces about her move to New York at the age of 16 and her interest in gardening.

Publication Date: Aug. 5

“Open Wide”

Author: Jessica Gross

What It’s About: “Hysteria” author Gross’s latest is a surreal, darkly comic novel about an awkward radio host who becomes obsessed with a surgeon and former soccer player she meets at a party, and is determined to do whatever it takes to get close to him.

Publication Date: Aug. 5

ALSO SEE: ​12 new books to send restless readers on a summer road trip

—-

“Hotshot: A Life on Fire”

Author: River Selby

What It’s About: Selby, who has written essays on fire preparation for this newspaper, had a challenging early life, surviving homelessness, drug abuse and sexual assault. Their life changed when they were hired as a “hotshot” wildland firefighter; this memoir tells the story of life on the job and examines how climate change and colonization have forced the world to enter a new, terrifying era.

Publication Date: Aug. 12

“Seduction Theory”

Author: Emily Adrian

What It’s About: “Everything Here Is Under Control” author Adrian returns with a novel about two married creative writing professors whose marriage is rocked by infidelity. It’s one of the summer’s most anticipated novels.

Publication Date: Aug. 12

“If You Don’t Like This, I Will Die: An Influencer Memoir”

Author: Lee Tilghman 

What It’s About: Better known as “Lee From America,” Tilghman was a wellness influencer with a large following and a steady income. But she was hiding something: Her constant need for attention and likes was hurting her to the point that she entered a mental health facility. This book tells the story of her decision to give up her carefully curated online life.

Publication Date: Aug. 12

“Rehab: An American Scandal” 

Author: Shoshana Walter

What It’s About: Pulitzer Prize finalist Walter’s new book is an exposé of how the U.S. fumbled its response to the opioid crisis by focusing on punishment over rehabilitation. She tells the story of four real people in the book, including a woman in a Los Angeles suburb who started investigating for-profit rehab programs after her son died in a sober living home.

Publication Date: Aug. 12

“To Lose a War: The Fall and Rise of the Taliban”

 Author: Jon Lee Anderson

What It’s About: New Yorker staff writer Anderson is a veteran of war-zone reporting. His latest book collects his pieces about Afghanistan, covering the period before the September 11, 2001, terror attacks to the Taliban’s return to power in 2021.

Publication Date: Aug. 12

“What We Left Unsaid”

Author: Winnie M. Li 

What It’s About: The third novel from Li, following the well-received “Dark Chapter” and “Complicit,” follows the three estranged Chu siblings on a road trip to visit their ailing mother; their voyage takes them on Route 66 and to the Grand Canyon.

Publication Date: Aug. 19

“Where Are You Really From” 

Author: Elaine Hsieh Chou

What It’s About: California author Chou delighted readers with her 2022 debut, the funny and sweet novel “Disorientation.” She’s following that up with this short story collection that spans genres, including one about a mail-order bride from Taiwan who is shipped to California in a cardboard box.

Publication Date: Aug. 19

“The Story of CO2 Is the Story of Everything: How Carbon Dioxide Made Our World”

Author: Peter Brannen

What It’s About: Brannen, the science journalist and “The Ends of the World” author, explains how carbon dioxide is more important than most of us realize. While it’s true that the chemical compound is contributing to climate change, it also has made the world a livable place for billions of years.

Publication Date: Aug. 26

“Mercy”

Author: Joan Silber

What It’s About: Silber is one of America’s most underappreciated fiction authors. In her new novel, her first since “Secrets of Happiness” in 2021, she tells the story of Ivan, a man living in 1970s New York who is haunted by his decision to leave his best friend in a hospital emergency room after the two experiment with heroin. 

Publication Date: Sept. 2

“Wrecking Ball: Race, Friendship, God, and Football”

Author: Rick Bass

What It’s About: Bass is a double threat, known for his beautiful fiction and incisive nonfiction about the natural world. His latest is a departure: a chronicle of his unlikely stint playing semi-pro football in Brenham, Texas, in his sixties. 

Publication Date: Sept. 2

“Mother Mary Comes to Me”

Author: Arundhati Roy 

What It’s About: Roy’s debut novel, “The God of Small Things,” was a literary sensation when it was published in 1997. Her latest book — its title inspired by the Beatles’ “Let It Be” — is a memoir about her relationship with her mother, Mary Roy, the Indian women’s rights activist who died in 2022.

Publication Date: Sept. 2

“The Shadow of the Mammoth”

Author: Fabio Morábito, translated by Curtis Bauer

What It’s About: The latest book from Mexican poet Morábito to be translated into English is a short story collection that touches on themes such as loneliness, imagination, and deception. Morábito’s first story collection, “Mothers and Dogs,” also translated by Bauer, is also worth seeking out.

Publication Date: Sept. 2

ALSO SEE: 33 new books you’ll want to read this summer from independent publishers

“The Belles”

Author: Lacey N. Dunham 

What It’s About: The debut novel from Dunham is a perfect fit for readers into the dark academia genre. The book tells the story of Deena Williams, who attends a private college in 1951 and joins an alliance with five other students. Deena has a secret past, though, that she fears might be revealed.

Publication Date: Sept. 9

“Kaplan’s Plot”

Author: Jason Diamond 

What It’s About: Diamond is the author of the critically acclaimed nonfiction books “Searching for John Hughes” and “The Sprawl”; his debut novel follows Elijah Mendes, who moves back to Chicago to care for his ailing mother. He discovers that his family owns a Jewish cemetery, which leads him to explore their secret history, bringing him closer to his mother.

Publication Date: Sept. 16

“The Wilderness” 

Author: Angela Flournoy 

What It’s About: Flournoy’s majestic debut, “The Turner House,” was a finalist for the National Book Award. Her new novel, 10 years in the making, follows five Black women navigating their sometimes messy lives over the course of 20 years.

Publication Date: Sept. 16

“Articulate: A Deaf Memoir of Voice”

Author: Rachel Kolb

What It’s About: Stanford-educated Kolb made history as the first signing deaf Rhodes scholar at Oxford University. In her memoir, she writes about learning American Sign Language and spoken language, and how people express themselves and communicate with one another.

Publication Date: Sept. 16

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Movie review: Ari Aster grapples with recent past in ‘Eddington’

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In every one of his films, writer/director Ari Aster has unpacked a trauma, usually his own. In the folk horror film “Midsommar,” it was relationships, while in “Hereditary,” “Beau Is Afraid,” and his short film, “The Strange Thing About the Johnsons,” he dove into family trauma to horrifying and absurdly comic ends. In his new film, “Eddington,” Aster tackles a collective American trauma using the most American of genres, the Western. That he trains his lens on recent history might feel too hot to handle, but it doesn’t mean that we can or should look away.

“Eddington” takes place in “late May 2020,” that’s how recent the history. In fictional Eddington, New Mexico, Sheriff Joe Cross (Joaquin Phoenix) is so inexplicably riled by draconian mask mandates that he impulsively decides to run for mayor against the charismatic incumbent, Ted Garcia (Pedro Pascal). But his goofy DIY campaign of misspelled signs and ranting through a speaker mounted on his sheriff’s vehicle is quickly disrupted by the explosive Black Lives Matter movement that sweeps through this small town.

In this desert setting, with characters both buffoonish and evil at once, there’s a distinctly Coen brothers slant to “Eddington.” At the center of the sausage roll is a bleak and bloody Western neo-noir, enveloped by the flaky dough of a deeply cynical COVID-set social satire that skewers The Way Things Were in 2020, and tries to understand or explain why these events made seemingly everyone go insane.

Very few characters are spared Aster’s ire. Ted Garcia is disingenuous, virtue-signaling and probably corrupt, though he presents as a thoughtful, socially aware politician. The BLM protesters have specious motives. Law enforcement is incompetent and dangerous. Joe’s wife Louise (Emma Stone) and mother-in-law Dawn (Deirdre O’Connell) are at home, falling down conspiracy theory rabbit holes fed to them by YouTube cult leaders (Austin Butler in Manson mode as Vernon). And while everyone is sniping at each other over their long-term, small-town interpersonal histories, the town is being quietly sold off to build a hyperscale data center called Solidgoldmagikarp (a reference to a phrase that throws off ChatGPT).

With a large ensemble cast and intertwining storylines, “Eddington” seems complicated, but is rather simple, especially because the story is largely seen through Joe’s perspective, which devolves into a paranoid, right-wing fever dream. If Pascal, Stone or Butler’s appearances feel like glorified cameos, their characters frustratingly opaque, that’s because it’s how Joe experiences Ted, Louise and Vernon, from a blinkered, limited point of view.

Things only get worse as Joe’s jealousy and ambition get the best of him, exacerbated by the stress of the protests, and his compulsion to both perform for and consume social media. Joe enters a protest fracas armed with only a ring light, which he then uses for a stump speech at a local restaurant, in which he weaponizes Louise’s past trauma and makes wild allegations about Ted, setting the stage for his own downfall.

Through this humiliation ritual as character study, Aster is trying to track how and why many of the older white men of this country have lost their minds. Is it the phones? The fear of losing power? The American obsession with guns, or all of the above? If there are elements of the film that feel underbaked, we can attribute that to Joe’s own limited understanding of his town, his family and his function, which is constantly under threat, by Ted, his mother-in-law and these protesters.

Aster sharply illustrates how screen-dependent our lives have become, dictating our communication and understanding of the world. He argues that we should be more skeptical of what we see online, even as bigger and bigger data centers are built to power the machines that fill our unending appetite for more and more data. The Solidgoldmagickarp center isn’t given much screen or story time, but it’s the most important part of “Eddington,” looming in the background as our next existential threat.

These big ideas are the data center of “Eddington,” and the filmmaking is elegantly crafted too, lensed by cinematographer Darius Khondji, with long tracking shots reminiscent of classic Western filmmaking, gunfights going down in the dusty streets, Native American trackers hot on the tail of a predator that stalks this town.

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‘Eddington’ review: Joaquin Phoenix and Pedro Pascal, once upon an early COVID time in the West

What Aster finds when he pops the hood on COVID is that the man in the white hat has lost his quick draw, and that while this is no country for old men, they won’t go down without a fight, their stranglehold on America deadly. It may not be a pretty portrait, but it’s one worth taking in anyway.

‘Eddington’

3 stars (out of 4)

MPA rating: R (for strong violence, some grisly images, language, and graphic nudity)

Running time: 2:28

How to watch: In theaters July 18

Doulas, once a luxury, are increasingly covered by Medicaid — even in GOP states

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By Lauren Sausser, Katheryn Houghton, KFF Health News

As a postpartum doula, Dawn Oliver does her best work in the middle of the night.

During a typical shift, she shows up at her clients’ home at 10 p.m. She answers questions they may have about basic infant care and keeps an eye out for signs of postpartum depression.

After bedtime, she may feed the baby a bottle or wake the mother to breastfeed. She soothes the infant back to sleep. Sometimes, she prepares meals for the family in a Crock-Pot or empties the dishwasher.

She leaves the following morning and returns, often nightly, for two or three weeks in a row.

“I’m certified to do all of it,” said Oliver, of Hardeeville, South Carolina, who runs Compassionate Care Doula Services. It takes a village to raise a child, as the adage goes, but “the village is not what it used to be,” Oliver said.

Doulas are trained to offer critical support for families — before delivery, during childbirth and in those daunting early days when parents are desperate for sleep and infants still wake up around the clock. While doulas typically don’t hold a medical or nursing degree, research shows they can improve health outcomes and reduce racial health disparities.

Yet their services remain out of reach for many families. Oliver charges $45 an hour overnight, and health insurance plans often don’t cover her fees. That’s partly why business “ebbs and flows,” Oliver said. Sometimes, she’s fully booked for months. Other times, she goes several weeks without a client.

That may soon change.

(Dreamstime/TNS) (Dreamstime/Dreamstime/TNS)

Two bipartisan bills, introduced in separate chambers of the South Carolina General Assembly, would require both Medicaid, which pays for more than half of all births in the state, and private insurers to cover the cost of doula services for patients who choose to use one.

South Carolina isn’t an outlier. Even as states brace for significant reductions in federal Medicaid funding over the next decade, legislatures across the country continue to pass laws that grant doula access to Medicaid beneficiaries. Some state laws already require private health insurers to do the same. Since the start of 2025, Vermont lawmakers, alongside Republican-controlled legislatures in Arkansas, Utah, Louisiana and Montana, have passed laws to facilitate Medicaid coverage of doula services.

All told, more than 30 states are reimbursing doulas through Medicaid or are implementing laws to do so.

Notably, these coverage requirements align with one of the goals of Project 2025, whose “Mandate for Leadership” report, published in 2023 by the conservative Heritage Foundation, offered a blueprint for President Donald Trump’s second term. The document calls for increasing access to doulas “for all women whether they are giving birth in a traditional hospital, through midwifery, or at home,” citing concerns about maternal mortality and postpartum depression, which may be “worsened by poor birth experiences.” The report also recommends that federal money not be used to train doctors, nurses, or doulas to perform abortions.

The Heritage Foundation did not respond to an interview request.

Meanwhile, the idea that doulas can benefit babies, parents, and state Medicaid budgets by reducing costly cesarean sections and preterm birth complications is supported by a growing body of research and is gaining traction among conservatives.

A study published last year in the American Journal of Public Health found that women enrolled in Medicaid who used a doula faced a 47% lower risk of delivering by C-section and a 29% lower risk of preterm birth. They were also 46% more likely to attend a postpartum checkup.

“Why wouldn’t you want somebody to avail themselves of that type of care?” said Republican state Rep. Tommy Pope, who co-sponsored the doula reimbursement bill in the South Carolina House of Representatives. “I don’t see any reason we shouldn’t be doing that.”

Pope said his daughter-in-law gave birth with the assistance of a doula. “It opened my eyes to the positive aspects,” he said.

Amy Chen, a senior attorney with the National Health Law Program, which tracks doula reimbursement legislation around the country as part of its Doula Medicaid Project, said lawmakers tend to support these efforts when they have a personal connection to the issue.

“It’s something that a lot of people resonate with,” Chen said, “even if they, themselves, have never been pregnant.”

Conservative lawmakers who endorse state-level abortion bans, she said, often vote in favor of measures that support pregnancy, motherhood, and infant health, all of which these doula reimbursement bills are intended to do.

Some Republicans feel as if “they have to come out in favor of that,” Chen said.

Health care research also suggests that Black patients, who suffer significantly higher maternal and infant mortality rates than white patients, may particularly benefit from doula care. In 2022, Black infants in South Carolina were more than twice as likely to die from all causes before their 1st birthday as white infants.

That holds true for women in rural parts of the country where labor and delivery services have either closed or never existed.

That’s why Montana lawmakers passed a doula reimbursement bill this year — to narrow health care gaps for rural and Indigenous communities. To that end, in 2023, the state enacted a bill that requires Medicaid to reimburse midwives for home births.

Montana state Sen. Mike Yakawich, a Republican who backed the Democratic-sponsored doula reimbursement bill, said pregnant women should have someone to call outside of a hospital, where health care services can be costly and intimidating.

“What help can we provide for moms who are expecting? My feeling is, it’s never enough,” Yakawich said.

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Britney WolfVoice lives on the Northern Cheyenne Indian Reservation in southeastern Montana, about two hours from the closest birthing hospital. In early July, she was seven months pregnant with her fourth child, a son, and said she planned to have a doula by her side for the second time in the delivery room. During WolfVoice’s previous pregnancy, an Indigenous doula named Misty Pipe brought cedar oil and spray into the delivery room, rubbed WolfVoice’s back through contractions, and helped ensure WolfVoice’s husband was the first person their daughter saw.

“Being in a hospital, I felt heard for the very first time,” WolfVoice said. “I just can’t explain it any better than I felt at home. She was my safe place.”

Pipe said hospitals are still associated with the government forcibly removing children from Native American homes as a consequence of colonization. Her goal is to help give people a voice during their pregnancy and delivery.

Most of her clients can’t afford to pay for doula services out-of-pocket, Pipe said, so she doesn’t charge anything for her birth services, balancing her role as a doula with her day job at a post office.

“If a mom is vulnerable, she could miss a prenatal appointment or go alone, or I can take time off of work and take her myself,” Pipe said. “No mom should have to birth in fear.”

The new state law will allow her to get paid for her work as a doula for the first time.

In some states that have enacted such laws, initial participation by doulas was low because Medicaid reimbursement rates weren’t high enough. Nationally, doula reimbursement rates are improving, Chen said.

For example, in Minnesota, where in 2013 lawmakers passed one of the first doula reimbursement bills, Medicaid initially paid only $411 per client for their services. Ten years later, the state had raised the reimbursement rate to a maximum of $3,200 a client.

But Chen said it is unclear how federal Medicaid cuts might affect the fate of these state laws.

Some states that haven’t passed doula reimbursement bills, including South Carolina, might be hesitant to do so in this environment, she said. “It’s just a really uncertain time.”

©2025 KFF Health News. Distributed by Tribune Content Agency, LLC.