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.

By DAVID FISCHER

WEST PALM BEACH, Fla. (AP) — With record temperatures hitting the U.S., pet owners have to protect their four-legged family members from dangers like heat stroke and dehydration.

But keeping an animal the size of a small car cool isn’t as easy as bringing it inside to the air conditioning. That’s why Alicia Grace, owner of Pink Flamingo Stables, has to take extra steps to keep her horses safe and healthy in South Florida’s hot and humid climate.

Blazing saddles

A horse is seen grazing at Pink Flamingo Stables on Tuesday, July 8, 2025 in Lake Worth Beach, Fla. The stable owner has to take extra steps to keep her horses safe and healthy in South Florida’s hot and humid climate. (AP Photo/Cody Jackson)

Grace cares for eight full-size horses and three ponies on her Lake Worth Beach property. South Florida has a large equestrian community, especially in Palm Beach County with the National Polo Center located in Wellington. But the climate isn’t ideal for horses, which generally do better in drier, cooler environments, Grace said.

“Not only do we have the heat, but we also have all the humidity,” Grace said. “And with that comes the bugs — flies and mosquitoes — which can actually breed in their cuts and cause all sorts of issues.”

Grace said it’s important to keep the horses hydrated and out of the sun during the hottest parts of the day. All paddocks have shaded areas, and barns are equipped with large fans.

“They always have constant access to water,” Grace said. “We bathe them daily, and we have cooling blankets that you can actually put on after a ride.”

While cats and dogs can be brought inside to cool, conditioned air on especially hot days, that’s not as easy for horses and other large animals.

“They actually do now make air conditioning units for horses, but they are quite expensive,” Grace said. “It is definitely a different animal and definitely requires a lot more care.”

Besides concerns about overheating or dehydration, horses are also vulnerable to algae and fungus that thrive in the South Florida climate.

“We get a lot of flooding during our rainy season, and if the horses are out in that and their hooves get saturated, they can get abscesses, which are pus pockets, and get a lot of problems with their feet,” Grace said.

Hot dogs … and cats

Cats, dogs and other house pets are easier to keep cool, but pet owners still have to remain vigilant during the summer, Palm Beach County Animal Care and Control spokeswoman Arielle Weinberger said. Just like horses, any cats and dogs kept outside need shade and water.

Officials are especially concerned about pet owners leaving dogs and cats inside vehicles. Local laws might vary throughout the state, but it’s illegal to leave animals unattended in vehicles for any amount of time in Palm Beach County, Weinberger said. During hot weather, she said the temperature inside a vehicle can increase 20 degrees in just 10 minutes.

“We want to make sure that no animals are left unattended, and that includes even if the window is cracked, even if the A/C is on,” Weinberger said. “Animals cannot be unattended in a vehicle, it is for their safety.”

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Dog owners especially need to check pavement, Weinberger said. Concrete and asphalt can reach temperatures of up to 125 degrees during the summer months, so finding grass or dirt for pets to walk on is ideal. If that’s not practical, pet owners might need to invest in booties or paw wax.

“If it’s too hot for you to touch with a bare foot or a bare hand, it’s too hot for your pets, as well,” Weinberger said.

People who don’t actually own pets can also help to keep animals safe, whether it’s community cats or local wildlife, by leaving water outside, Weinberger said. Animal control officers will respond to pets and livestock suffering from signs of dehydration or heat stroke, but Weinberger said residents should call local wildlife rescue facilities if they see a raccoon or other wild animal in bad shape.

If an animal seems overheated, it can be cooled down with water on their head, stomach and feet. But if they start to experience symptoms like diarrhea, lethargy, dizziness and vomiting, it’s time to seek medical attention, Weinberger said.

“We want to take them to the vet as soon as possible, because heat stroke can lead to organ failure, and we want to make sure that it doesn’t get to that,” Weinberger said.

Dog days of summer

Matthew Puodziukaitis, 19, of Wellington, regularly brings his mini goldendoodle, Hazel, to the Okeeheelee Park dog area. He said he always brings a bottle of cold water and a bowl for Hazel and any other dogs who might need it.

“The last thing you want is a dog passing out or something bad happening to them out here,” Puodziukaitis said. “They’re basically like a little kid. You want to make sure they’re okay.”

By Christine Benz of Morningstar

If a knowledgeable observer trained his or her sights on my choices, what are the trouble spots they would identify? Here are some of the biggies.

I hold too much employer stock

I understand the tax implications of this, so I might as well sell each lot of restricted stock units as soon as it vests because there’s no tax benefit to hanging on longer. And it’s not like I think I possess some inside knowledge that the shares are likely to outperform the broad market.

Instead, the key culprit here is inertia. There’s a little bit of tax dread mixed in, too, as selling them would trigger a big tax bill. I’ve been in the process of divesting from company stock for the past several years, but the allocation is still high.

I hold too much cash

Even when cash yields are higher, as they are today, inflation still gobbles up most of the interest.

Cash has stacked up in our account following bonuses or other windfalls, or during fallow spending periods like 2020. And it just never feels like an especially great time to move the money into long-term investments.

Perhaps most important, having cash on hand confers valuable peace of mind. I like knowing that almost anything could happen, and we’d be able to cover it without touching our long-term investments. I think of cash as one of my luxury goods.

I don’t hold much in bonds

My husband and I should have a good slug of retirement assets in fixed-income investments at our life stage. But our portfolio is oddly barbelled, with a healthy dose of cash alongside a long-term portfolio that’smainly invested in equities.

In a way, I think the cash and the equities work together from a psychological perspective, with the liquid assets giving us peace of mind to stay the course with stocks.

But the lack of bonds isn’t really deliberate. Instead, inertia is probably the main reason. We set up our long-term portfolios with heavy equity allocations in our 30s, and we’ve never really wavered. But this is something that I’d like to address as retirement approaches.

I don’t have a perfect record with ‘asset location’

There’s a fantastic fund I own—but in our taxable brokerage account. If I could do it again, I’d buy this fund in a tax-sheltered account, because it has made some significant capital gains distributions over the years, which have boosted our household’s annual tax bills.

Asset-location problems can be difficult to fix. Even though our reinvested capital gains have helped boost our cost basis, we would still owe a big tax bill if we liquidated the position because of the fund’s gains.

I’m slow to make IRA contributions

Ideally, IRA contributions would go in right around the first of the year, to benefit from tax-sheltered compounding for a longer period. And our IRAs sit right alongside our taxable brokerage account, so transferring funds from the brokerage account to the IRA and converting them to Roth is simple.

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But I’ve sometimes made those IRA contributions right before the deadline, a full 15 months later than when we were first eligible to make them. I’ve also been slow to make the conversions to Roth, periodically letting a few years’ worth of contributions stack up in our IRAs before converting.

The baby bear market of March 2020 provided a good opportunity to convert all the traditional IRA assets to Roth with no tax repercussions. I’ve been walking the straight and narrow—with timely contributions and conversions —ever since.

This article was provided to The Associated Press by Morningstar. For more personal finance content, go to https://www.morningstar.com/personal-finance

Christine Benz is director of personal finance for Morningstar.

OK, I’ll say it. I’m sick of superheroes. I blame the Marvel Cinematic Universe (36 movies and counting over 17 years) and the DC Extended Universe (43 movies and counting, mostly since the late 1970s). Maybe Earth’s not big enough for two universes. They’re running pretty thin these days, down to rebooting reboots, making sequels for prequels and squeezing every ounce from the intellectual property tube to fill out streaming platform minutes.

But there’s always Superman. The Krypton-born alien, orphaned, sent off into space for survival and then raised by adoptive parents in Kansas. He’s now been with American pop culture for 10 decades (eight in film). Despite an outfit modeled after a circus strongman, he’s become a durable, transcendent symbol of the ultimate immigrant and somehow a simultaneous embodiment of “Truth, Justice, and the American Way.”

Superman’s the classic American good guy, and so the opening of the new “Superman” with David Corenswet is a great time to think about the real good guys and gals in American life — that is, if you can find any. Where are all the good guys and gals in America? What qualifies someone for the title these days?

The idea has definitely shifted. It’s as if by sheer screen volume the fake superheroes overwhelmed the public consciousness. Superheroes are dialed up so high we can’t hear what real heroes sound like anymore. A 2008 poll in Britain found almost a quarter thought Winston Churchill was fake, while a majority of Britons believed Sherlock Holmes was real.

We’ve become confused: We prefer to watch fake heroes on screen rather than expect real ones to emerge in life. And so the fake ones become the only kind of hero we recognize.

The historian Daniel Boorstin described this transition from heroism to fame in his 1961 book “The Image.” He noted that heroes in American history were typically known for great public contribution through immense difficulty and danger. It didn’t matter much what they looked like because their deeds had saved lives and mattered to so many.

But pictures and movies changed everything in the 20th century. Heroes became celebrities. We traded away enduring contributions to the public good in exchange for flimsy, flashy fame that works for a paycheck. Value over values; money over all.

This isn’t hard to see. Look at how college sports has been conquered by contracts and name-image-likeness deals. How law firms kowtowed to an administration making unprecedented demands. How media heavyweights keep bending knees to the same. And let’s not get started with social media “influencers” except to say that doing the right and honest thing has been swept aside by the twin tsunamis of popularity and the Almighty Buck.

Where’s our real truth, our real justice, our real American way?

Not in Congress. The “Big Beautiful Bill” is a perfect example. It might take a Mt. Rushmore makeover to honor the profound contributions to cowardice in the votes surrounding this act. Rep. Jeff Crank, R-Colo., couldn’t vote fast enough to add trillions to the national debt despite arguing, less than a year ago, that Congress is “turning a blind eye to this $35 trillion in debt,” that it’s “unsustainable” and that “we have to get our fiscal house in order, and we have to do this for our children and our grandchildren.”

Or Rep. Chip Roy, R-Texas, long-time fiscal hawk on the debt, who repeatedly railed against the Big Beautiful Bill’s deficit spending in the final stretch. And then he voted for it.

Or Sen. Josh Hawley, R-Mo., known for saying “we must ignore calls to cut Medicaid” because “slashing health insurance for the working poor” would be “both morally and politically suicidal.” That was in May. But come July, Hawley voted to cut Medicaid.

The final vote came down to Sen. Lisa Murkowski, R-Alaska. In a mid-June town hall, she said, “I have made clear very early on that we cannot move forward with a bill that makes cuts to Medicaid.” And yet, despite the fact that nearly 40,000 Alaskans (more than 5% of the state’s population) will likely lose their healthcare coverage as a direct result of the bill, Murkowski caved.

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Sarah Longwell, founder and publisher of the Bulwark, spared nothing in her criticism of Murkowski. She wrote that this one action “defines our pathetic political moment,” embodying:

“Selfishness: I’m taking care of me and mine, the rest of you can pound sand;

Lack of accountability: I know the bill is bad, hopefully someone else will fix it;

Cowardice: I’m scared of Trump and his voters and need to go-along to get along with my GOP colleagues;

Moral rot: I know the difference between right and wrong, and actively chose wrong.”

Not exactly Superman. Sounds more like Lex Luthor at his most self-serving and callous.

We don’t need someone faster than a speeding bullet in the House. We don’t need senators leaping tall buildings in a single bound. We don’t need Superman.

But we do need our Clark Kents and Lois Lanes to step up. We do need our real heroes right now. Maybe Crank or Roy or Hawley or Murkowski will see the movie this weekend. Maybe they’ll find some courage for the next vote.

Maybe.

ML Cavanaugh is the author of the forthcoming book “Best Scar Wins: How You Can Be More Than You Were Before.” A 2002 West Point graduate, Cavanaugh is a retired lieutenant colonel and US Army Strategist who earned two Bronze Star Medals and the Combat Action Badge for his time in the Iraq War. He wrote this column for the Los Angeles Times.