Health Impact Assessment of Proposed Changes to the Supplemental Nutrition Assistance Program

With the current state of the economy, many American families face tough choices about how to use their resources. Low-income households often lack the funds to meet basic needs, including adequate housing, home energy, health care, and food. The Supplemental Nutrition Assistance Program is the federal government’s principal mechanism for alleviating hunger, improving nutrition, and increasing the food purchasing power of such households. 

From fiscal year 2007 to 2012, federal spending on SNAP grew from $34.8 billion to $80.4 billion. This growth was attributed to several factors, including the rise in poverty and unemployment during the Great Recession, which led to higher participation rates; changes in state eligibility practices; and a temporary increase in benefit amounts conferred by the American Recovery and Reinvestment Act (ARRA). 

However, the Congressional Budget Office predicted in 2012 that SNAP spending would fall when the ARRA benefit increases expired in November 2013 and as the economy continued to recover.

Federal spending on SNAP was a central dispute during the 112^th and 113^th Congressional deliberations over the Farm Bill reauthorization. The Senate and House introduced several bills that sought to reduce SNAP spending by changing the procedures that states use to determine eligibility and the benefit amount that some participating households would receive.

To inform Congressional deliberations on this issue, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, conducted a health impact assessment to investigate the potential health implications of the proposed changes to SNAP. HIAs identify the potential health effects of a proposed policy, project, or program to inform policymakers, those affected by a decision, and others with an interest in the outcome.

HIAs also offer practical options for maximizing the health benefits while minimizing the health risks.  

A note on the methodology: The methods used to conduct this HIA were a systematic literature review; analysis by Mathematica Policy Research using a model developed for the United States Department of Agriculture to aid in SNAP administration; interviews with SNAP participants; and interviews with SNAP administrators at the state and local levels.

The HIA findings suggest that the policy changes that Congress considered for SNAP eligibility and benefit amounts could place the health of many low-income Americans at risk by:

• Lowering SNAP benefit amounts for some households.
• Reducing the number of people eligible for SNAP.
• Increasing food insecurity (i.e., difficulty obtaining enough to eat).
• Increasing poverty levels.

Based on these findings, the Health Impact Project offered the following recommendations to help address some of the potential health effects:

1. Raise the asset limit for SNAP eligibility. Allowing low-income families to build a small amount of savings or other assets while remaining on SNAP could contribute to better overall health by helping families to move out of poverty and improving their ability to weather unexpected financial emergencies.
2. Monitor health effects. Because the HIA found strong connections between SNAP and participants’ health, the United States Department of Agriculture (USDA) should consider including health effects and related medical costs in implementing current SNAP monitoring and evaluation research.

These actions, however, would not fully mitigate the issues raised by this assessment. The changes considered for eligibility and benefit determination were scored by the Congressional Budget Office to reduce spending on the SNAP program. Yet the analysis in this HIA demonstrates that the identified health impacts, such as a possible increase in diabetes, could push medical costs much higher, with implications for state and federal medical spending. These possible costs should be balanced against the projected spending reductions.

Read the white paper for a full report on the analysis and findings from the HIA.