Assessing Health Impacts of Changes to SNAP: A Q&A with Aaron Wernham of the Health Impact Project

Jul 31, 2013, 1:34 PM

The Supplemental Nutrition Assistance Program (SNAP) is the federal government’s principal program for helping low-income families purchase enough food. More than 47 million Americans currently receive SNAP benefits; approximately half of the beneficiaries are children. As part of the debate over the Farm Bill—legislation that authorizes SNAP and other federal nutrition programs—Congress is considering legislation that would cut SNAP benefits and limit who qualifies for the benefits.

Yesterday, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, released a white paper that provides a rigorous, objective and nonpartisan analysis of the potential health impacts of the proposed changes to SNAP.

NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project, along with lead researcher Marjory Givens, to learn more about the study’s findings.

NewPublicHealth: What is the goal of the health impact assessment on the potential changes to the SNAP program?

Aaron Wernham: Congress is deliberating reauthorizing the U.S. Farm Bill, and one of the parts of that is the Supplemental Nutrition Assistance Program or SNAP, which was formerly known as food stamps. This is one of the federal government’s main programs for ensuring that people who have low incomes are able to get enough to eat. We did this health impact assessment because so far the public health effects of these proposed policy changes have not really been a part of the political debate. We wanted to make sure that the best available public health evidence was brought to bear to help ensure that everyone has complete information—those affected by the change, the general public and decision-makers in Congress.

NPH: What’s the big picture on what SNAP has to do with health in the first place?

Wernham: Not having enough to eat—or being what’s called “food insecure”—is attached to a higher risk of a lot of diseases. So, adults who are food insecure have a higher risk of heart disease, high blood pressure, diabetes and some other problems. Children who are food insecure are more likely to be reported by their parents as being in poor health, are more likely to be hospitalized and also have a higher risk for a number of health related problems from asthma, to depression and anxiety. We actually have a number of studies that have looked at the health benefits of receiving SNAP and found, for example, that adults who had access to SNAP when they were children are less likely to have problems in adulthood, such as obesity, high blood pressure and heart disease.

NPH: What did the health impact assessment find?

Wernham: We looked at ways in which the House and Senate have proposed to change how eligibility for SNAP benefits is determined and how the amount of benefits is determined. Both the House and Senate have proposed changes, and we found that as many as 5.1 million people could actually lose eligibility under changes proposed by the House. Under the changes in the Senate, about 500,000 people might receive lower benefit amounts. With the House changes, as many as 1.4 million children and nearly 900,000 older adults would be among those five million people who could be affected. So, for those people, they would lose upward of an average of 35 percent of their total income and would be at higher risk for the health problems that relate to food insecurity.

We also found that this has implications for health costs. We took one example, looking at diabetes, and projected out how, because of the relationship between people’s incomes and rates of diabetes, diabetes rates would change with this policy. The policy could increase poverty rates by as much as half a percent in the United States, and that could translate into about $15 billion in health-related medical costs, both public and private sector health costs, over 10 years. Given that an increase of $15 billion in health care costs on diabetes alone approaches the Congressional Budget Office’s (CBO) projection of $20 billion in savings from changes to SNAP, the health-related costs could well exceed estimated program savings.

There are a couple of caveats. It’s a little bit of an apples-to-oranges comparison inasmuch as CBO’s projections relate only to federal expenditures and the $15 billion of health costs are all medical costs of public and private. And also, the $15 billion is really only an estimate for one single disease of many that could be affected. I think the most important thing about this projection is that it really highlights how unintended consequences for health ought to be part of the debate and should be factored in.

 Givens: As Aaron mentioned, SNAP has been shown in the research to reduce household food insecurity and our analysis suggests that under proposed changes as many as 160,000 to 305,000 more people could become food insecure, which clearly would have short- and long-term health implications.

NPH: It sounds like having less access to food can actually lead to problems that we typically think of as problems of abundance, such as obesity and diabetes. Why does that happen?

Wernham: I should first say, our study didn’t really address the mechanism directly. We did a systematic review of all of the literature on the relationship between food insecurity and health outcomes. Some of the studies that we reviewed do hypothesize reasons for that relationship. For example, one of the factors relates to the cost of buying a nutritious diet. So, some studies have suggested that it is hard for people to afford to eat a healthy diet on a low budget. People have also talked about the fact that poverty sometimes correlates with living in neighborhoods where people have less access to stores that stock healthy foods. So that could be a part of the problem. The bottom line is we don’t fully understand the mechanism, but it is very strongly demonstrated in multiple studies.

Givens: I think that our research suggests that overall many SNAP participants, like most Americans, fail to meet a recommended diet, and so by reducing benefits, you reduce the food purchasing power for a household and therefore make it more difficult to meet a recommended diet.

NPH: Why is this HIA important now?

Wernham: Congress continues to debate these changes and we feel that now that we have this data it’s very important to bring it to light as the policy continues to be in play. We really think it’s critically important that policymakers have information about unintended health consequences in order to make the best-informed decisions that they can.

NPH: Do you have any recommendations for policymakers?

Wernham: We do. The main recommendation relates to the asset limits for SNAP eligibility. One of the things our analysis found is that many of the families who actually have net incomes below the poverty line would lose benefits because they have a modest amount of assets, such as a savings account or more than one car. So, for example, most people who have savings over $2,000 (or over $3,250 for elderly and disabled adults) would lose benefits. That’s really not a lot of money, and so we recommended that in order for families to be able to have a little bit of savings to cushion them in case of an income shock such as losing a job—but still receive SNAP benefits if they’re very low income—that the asset limit for SNAP should be raised.

Givens: Much like our goal with this health impact assessment, we would recommend that policymakers consider health in their decision making and that we have in place an effective monitoring and evaluation systems so that they can effectively make well-informed decisions.

NPH: Anything else to add?

Wernham: The results we released yesterday are part of a health impact assessment that’s still in progress. We are also speaking to stakeholders, including people at the state level who are involved in administering the program and would be affected by these changes as well as people who receive SNAP currently to understand their perspectives on the program, the benefits and the proposed changes.


>> Read the full "Health Impact Assessment of Proposed Changes to the Supplemental Nutrition Assistance Program."

This commentary originally appeared on the RWJF New Public Health blog.