When we come home every evening to join our friends and families for dinner, many of us seldom worry about whether we will have food on the table. For millions of Americans, however, hunger is a very real difficulty as they struggle to feed both themselves and their children. As part of the effort to combat hunger in the United States, physicians should support the continued funding of SNAP, a program implemented by the federal government to answer the challenge of food insecurity.

Since the 1960s, the Supplemental Nutrition Assistance Program, or SNAP, has provided eligible, low-income individuals and families with benefits for food at eligible retail stores. Formerly known as food stamps, this federal program assisted nearly 45 million individuals in 2017, especially households with children, elderly, and disabled persons. Eligibility for SNAP is limited to people with gross incomes up to 130% of the federal poverty line. Families are provided with monthly electronic debit cards to purchase groceries at authorized retailers.

In 2015, SNAP helped 4.6 million Americans rise above the poverty line, including 2 million children. The program also reduced the prevalence of food insecurity by as much as 30%. It also supports the economy; for every $1 billion added to SNAP funding, approximately 18,000 new jobs are created.

Research by the USDA Economic Research Service has found strong correlations suggesting that food insecurity increases the risk of adverse health outcomes and leads to higher healthcare costs. In 2017, food-insecure households spent 45% more on medical care compared to food-secure households. These people had a higher prevalence of heart disease and diabetes, and were more likely to be non-adherent to their medications. Conversely, SNAP participants were healthier and incurred about $1,400 less in medical costs over a year than other low-income individuals. Additionally, children with access to SNAP have improved long-term health, with lower risks of obesity, heart disease, and diabetes.

While SNAP fights to ensure that no American goes hungry, it also encourages work through specific requirements for able-bodied adults without dependents, or ABAWDs. Through the Personal Responsibility and Work Opportunity Reconciliation Act of 1996, non-disabled individuals between the ages of 18 and 49 can only get SNAP for 3 months in 36 months unless they work 80 hours per month, participate in a qualifying educational or training activity, or do unpaid work through special State-approved programs. While the USDA’s Food and Nutrition Service determines its broad policy, states and counties manage its daily activities and administration. Many states request federal permission to waive these time limits due to local economic difficulties. These waivers have been crucial in assisting individuals who live in areas of particular hardship.

Currently SNAP is facing significant changes to its funding and structure. President Trump’s 2019 budget proposes cutting SNAP funding by over $213 billion over the next 10 years and restructuring how benefits are delivered. At least 4 million people would lose eligibility, and many others will have reduced benefits.

The biggest change is that the government will stop its partnership with over 260,000 retail stores around the country and instead provide government-purchased food boxes of nonperishable goods. This would mean that families would have less choice in their food, especially with fresh fruits and vegetables. Also, the states would be left to determine how these food boxes would be distributed and bear its costs.

Furthermore, a portion of these SNAP benefits would be withheld from households, and would ultimately affect 34 million people, or almost 90% of SNAP participants, in 2019. The proposal would also limit waivers for ABAWDs and increase the maximum age, which would severely impact those in high-unemployment areas, the elderly, and the disabled. Additionally, SNAP nutrition education funding would be eliminated, which would severely hinder the program’s goals for improved nutrition.

Proponents of these changes suggest that this will be an effective method of cutting government spending, while providing standardized meals for families. Concerns exist that SNAP creates “food stamp dependency” and increases the risk of childless and disability-free adults relying solely on SNAP benefits instead of working. Some studies by organizations such as the Foundation for Government Accountability report that many ABAWDs who left these programs after certain states renewed these time limits found work within 12 months and experienced a significant increase in their income. However, many studies have found that most people continue to work while remaining on SNAP, and that these waiver restrictions mostly affect people who live in areas without any available work.

While managing government spending is a perpetual aim for every Congress and President, the proposed changes to SNAP have the potential to negatively affect millions of American families, especially children. There would likely be an increase in health-related problems for individuals of all ages who relied on these benefits, which would lead to an increase in healthcare costs. It would also undermine previous efforts at promoting healthy nutrition habits and education. Improving savings in the national budget is a worthy goal, but not at the expense of pushing millions of people closer to hunger.

As physicians, we should make every possible effort to protect families and children from hunger. Please contact your local and federal representatives and encourage them to continue SNAP funding without restructuring the program or withholding SNAP benefits from those in need of assistance.

Vishnu Prathap, MD

References:

Archambault, Josh. “Restoring Work Requirements: An Important Fix To America’s Food Stamp Crisis.” Forbes, Forbes Magazine, 11 Aug. 2015, www.forbes.com/sites/theapothecary/2015/08/11/restoring-work-requirements-an-important-fix-to-americas-food-stamp-crisis/#61d40681a20a.

Belluz, Julia. “45 Million Americans Rely on Food Stamps. Trump Wants to Gut the Program.” Vox, Vox, 23 May 2017, www.vox.com/policy-and-politics/2017/5/23/15675892/food-stamps-snap-evidence-health-poverty-hunger.

Carlson, S, and B Keith-Jennings. “SNAP Is Linked with Improved Nutritional Outcomes and Lower Health Care Costs.” Center on Budget and Policy Priorities, 17 Jan. 2018, www.cbpp.org/research/food-assistance/snap-is-linked-with-improved-nutritional-outcomes-and-lower-health-care.

Ingram, J, and N Horton. “How Kansas’ Welfare Reform Is Lifting Americans Out of Poverty Work.” The Foundation for Government Accountability, 16 Feb. 2016, https://thefga.org/research/report-the-power-of-work-how-kansas-welfare-reform-is-lifting-americans-out-of-poverty.

Office of Research and Analysis. “Food and Nutrition Service.”Food and Nutrition Service, United States Department of Agriculture, Apr. 2012. https://fns-prod.azureedge.net/sites/default/files/BuildingHealthyAmerica.pdf.

Rector, Robert, and Vijay Menon. “SNAP Reform Act Offers Sound Basis for Welfare Policy.” The Heritage Foundation, 9 Jan. 2018, www.heritage.org/hunger-and-food-programs/report/snap-reform-act-offers-sound-basis-welfare-policy.

Rosenbaum, D, et al. “President’s Budget Would Cut Food Assistance for Millions and Radically Restructure SNAP.” Center on Budget and Policy Priorities, 15 Feb. 2018, www.cbpp.org/research/food-assistance/presidents-budget-would-cut-food-assistance-for-millions-and-radically.

“Supplemental Nutrition Assistance Program (SNAP): Able Bodied Adults Without Dependents.” Food and Nutrition Service, United States Department of Agriculture, 26 Feb. 2018,www.fns.usda.gov/snap/able-bodied-adults-without-dependents-abawds.

“Understanding SNAP, the Supplemental Nutrition Assistance Program, Formerly Food Stamps.” Feeding America, 2018, www.feedingamerica.org/take-action/advocate/federal-hunger-relief-programs/supplemental-nutrition-assistance-program.html?referrer=http%3A%2F%2Fwww.feedingamerica.org%2Ftake-action%2Fadvocate%2Ffarm-bill.html.