We see the value of the federal government’s Supplemental Nutrition Assistance Program (SNAP) almost every day. It allows some of our patients to meet a basic human need: to eat. In our medical practices, we are intimately aware of the inextricable link between poor diet and health: arteries hardened, nerves numbed, and cancers caused. This is why we are concerned about farm bills working their way through Congress that threaten the SNAP program.
Last month, the House of Representatives passed the Agriculture and Nutrition Act of 2018 (H.R. 2, also known as the Farm Bill), which could have immensely harmful consequences for the health of millions of Americans. It includes a proposed reform of SNAP that creates an arduous and draconian work requirement that would compel roughly 7 million recipients to prove they work at least 20 hours per week or are pursuing job training. If they don’t, they risk losing SNAP benefits.
The documentation to demonstrate that won’t be a simple process for many.
SNAP beneficiaries are already required to provide excessive documentation to get food assistance, which sets the bar for receiving services unacceptably high and puts people at risk of food insecurity. The House bill would further increase this burden by requiring monthly proof of meeting the work requirement. The application process and ongoing work reporting may be perceived as being so onerous that they discourage people from applying who could and should qualify for SNAP.
We are concerned about the fate of our patients — mothers who work the equivalent of multiple jobs in the informal sector as caregivers, the elderly, people with disabilities or illness — who may not meet the requirements related to work, disability, child rearing, or caregiving for the disabled. An estimated 2 million people stand to lose food assistance or face reductions in what they receive. This will unequivocally take a toll on the nation’s health through hunger, stress, fatigue, increased infections, and increased reliance on cheap but less nutritious foods that lead to diabetes and cardiovascular disease.
The House bill penalizes SNAP beneficiaries who have an unexcused lapse in meeting the work requirement by taking away their benefits for a year; subsequent infractions result in the loss of benefits for three years. This includes people whose health conditions limit their ability to work but who do not meet SNAP’s disability exemption. We are concerned about our patients with chronic, debilitating disease such as lupus or Crohn’s disease that cause them to miss work in the midst of an inflammatory flare, perhaps driven by poor access to nutrition in the first place.
During a time when the economy is at near full employment, ineffective work requirements do nothing to aid those who participate in the program or improve our collective economic wellbeing. We favor food policies that help both health and the economy. The USDA economic impact model suggests that every dollar spent on SNAP is an economic multiplier, yielding roughly $1.80 in economic activity. And since a large share of SNAP recipients live in rural regions, the subsidy often supports small business such as local food retailers and grocers, hurting the very constituents and political base that’s driving this reform.
The Senate has just passed its version of the farm bill. It continues to support food assistance programs at current funding levels without including the work requirement. The two bills must now go to a joint House and Senate congressional conference, where they will emerge as some amalgamation of the two.
A new survey of registered voters by the Johns Hopkins Bloomberg School of Public Health’s Center for a Livable Future found that nearly two-thirds oppose cuts to SNAP. We hope that senators and representatives will listen to their constituents and not end or cut benefits for 2 million people by increasing requirements and bureaucracy.
These changes and cuts would hurt patients and families all across the country. As physicians, we believe that food is medicine and that the proposed changes to SNAP would strain our ability to provide health care to those who need it most, as we are pulled to address both food insecurity and its needless complications during our clinical encounters. At a time when diet-related diseases are the leading cause of death in the U.S., we should ensure that food becomes more accessible and more secure rather than the opposite.
Andrew Goldstein, M.D., is an internal medicine primary care physician and Akash Goel, M.D., is a gastroenterologist. Both are health policy advocates and work in New York City.