Policy Should Never Put a Child’s Health at Risk

Sep 26, 2019, 9:30 AM, Posted by

Mother bottle feeding her young son.

When I was a full-time pediatrician, I worked at a practice in the City of Philadelphia whose primary patients were teenage mothers and their children. Most of their parents were low-income with little to no outside support. Their lives were hard. Very hard. Many of the parents (grandparents to the newborns) were forced to choose between paying rent some weeks and having enough food to feed their children and grandchildren.  

I remember in particular one mother and her infant son who came to see me after he was born. She was scared because the baby was having trouble gaining weight, due in large part to the family not being able to afford much food. His grandmother was worried; given all the research showing how critical nutrition is to developing brains, I was concerned as well. Fortunately, the practice I worked in was a collaborative one, meaning that not only did we doctors work side-by-side with nurse practitioners, but also closely with social workers. And one of our social workers immediately went to work to get this family, in which the grandmother—who was the head of the household—worked full-time, enrolled in the Supplemental Nutrition Assistance Program (SNAP).

These are the types of situations and circumstances where SNAP is an absolutely essential lifeline. SNAP is the largest nutrition assistance program in the United States, helping to feed some 36 million people each month. SNAP provides temporary but critical support to help people who are struggling to gain access to nutritious, affordable food; nearly two-thirds of SNAP participants are children, older adults, and people with disabilities. It has a proven track record of helping families avoid poverty and hunger during difficult times, such as after losing a job or suffering a major injury or illness, while helping families achieve self-sufficiency and reducing health disparities.

Unfortunately, our social worker faced one bureaucratic challenge after another to get this family the food assistance it so desperately needed. The administrative burdens were significant—even for someone who had helped enroll multiple families previously—and as a result, the family’s eligibility was delayed by several months. While our practice worked hard to connect the family to food resources in the community to fill the gap, the little boy continued to have an extremely difficult time. The situation became so dire that we were on the verge of having to bring in the child welfare authorities to have the child removed from the home.

Child Food Insecurity Rate

Then, finally, a breakthrough. A new policy in Pennsylvania, known as broad-based categorical eligibility (BBCE), allowed people, particularly working families, enrolled in the Temporary Assistance for Needy Families (TANF) program to automatically qualify for SNAP. As it turned out, the baby’s grandmother was enrolled in TANF, meaning that when she automatically qualified for SNAP as a result, the baby and his mother were immediately enrolled as well. As the family started receiving that crucial extra support to buy the food it needed, the baby’s weight and well-being improved markedly. And just as importantly, the family was able to stay together. 

There are millions of families just like this one who depend every day on the support SNAP provides. Yet, inexplicably, a proposed new rule could take that support away. 

Earlier this summer, the U.S. Department of Agriculture proposed a rule change to SNAP that would eliminate states’ ability to adopt or maintain BBCE policies. The effects of this rule would be completely devastating to families across the country. An RWJF-funded analysis from our partners at Mathematica found that the rule would cause approximately 1.9 million SNAP households—coming out to nearly 3.6 million people—to lose program eligibility.  

The Urban Institute followed with a closer look at who would be impacted, including:

In fact, some of the most significant anticipated consequences of this rule come straight  from USDA’s own regulatory impact analysis, which predicts potential increases in poverty and food insecurity; billions of dollars in increased administrative costs for both the federal and state governments to administer the program; and millions of dollars in increased administrative costs for current and new SNAP applicants. USDA also estimates that approximately 500,000 children will also lose automatic access to free school meals if this rule takes effect, further exacerbating food insecurity for vulnerable children and making it harder for them to succeed in school. 

Data released this month from the U.S. Census Bureau confirms just how effective SNAP is at turning participants’ lives around. SNAP cut the U.S. poverty rate from 14.3 percent to 13.2 percent between 2016 and 2018, lifting 3.1 million people out of poverty in 2018 alone.  

Yet the department’s own conclusions show that this rule is fundamentally at odds with the mission and purpose of SNAP. Rather than providing people with access to nutritious food, this rule would take it away. Rather than making it easier for people to sign up and enroll, this rule would make it far more complicated. Rather than making it simpler for federal and state agencies to administer the program, this rule would make it more difficult.  

I remember vividly the faces and stories of my patients. And since the day this rule was introduced, I have often thought of that young mother and her baby son, struggling mightily to get enough food to eat and make ends meet, until they were finally saved by a social worker with compassion and a state policy with heart.   

The first rule of being a doctor is to do no harm. The same principle should apply to public policy, yet this proposal clearly fails that test.

Learn how many people would be impacted by this rule in your state.


about the author

Don Schwarz

Donald Schwarz, former senior vice president, guided the Foundation’s strategies and worked closely with colleagues, external partners, and community leaders to build a Culture of Health in America, enabling everyone to live their healthiest life possible.