Study shows one federal food program may lead to lower health-care expenditures


A woman and her daughter count out food vouchers while shoping for groceries in the GrowNYC Greenmarket in Union Square in New York City. According to a Gallup poll released earlier this month, 20% of American adults struggled to buy enough food at some point in the last year.
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As the national debate over health-care costs continues, it’s good to learn that one government program appears to be lowering medical expenditures for those Americans who need it most.

Stanford Health Policy’s Sanjay Basu, an assistant professor of medicine and a primary care physician and epidemiologist, has published new research that indicates participation in the federal Supplemental Nutrition Assistant Program (SNAP) is associated with lower health-care expenditures by about $1,400 a year, per participant.

The researchers, who published their results in this week in JAMA Internal Medicine, conducted a cohort study of about 4,450 adults with income below 200 percent of the federal poverty threshold. These individuals participated in the 2011 National Health Interview Survey and the 2012-1013 Medical Expenditure Panel Survey.

Of the 4,447 adults enrolled in the study, 1,889 were SNAP participants and 2,558 were not. Compared with other low-income adults, and using models adjusted for demographic and socioeconomic variables, SNAP was associated with lower estimated annual health-care expenditures of $1,409.

That seems like a pretty big figure, which would indicate programs that address food insecurity may have a large impact in reducing health-care spending over time. Basu agrees.

“Our results suggest that spending on preventative programs like SNAP, which is associated with improvement in nutrition, may be helping us prevent some of the large burden of chronic illness we see in our country from nutrition-related diseases like type 2 diabetes,” Basu said. “Those ultimately are much more expensive to treat than to prevent.”

The Supplemental Nutrition Assistance Program (SNAP) is the nation’s largest anti-food insecurity program, serving approximately one in seven Americans, according to the U.S. Department of Agriculture. SNAP provides a monthly cash benefit to participants that supplements household budgets by allowing food purchases, with some restrictions like alcohol.

“Eligibility for the program is set federally, but enrollment policies vary by state, and these policies can make it easier or harder to enroll, thus subtly encouraging or discouraging participation,” the authors wrote. Basu was senior author of the study; Seth Berkowitz, a faculty member at Massachusetts General Hospital and Harvard Medical School, was the lead author.

Basu said that in the past, some analysts had simply presented the finding that people enrolled in SNAP had higher health-care expenditures than those not enrolled in the federal food program, even when adjusting for factors like income.

“But we know that people who are enrolled in SNAP are systematically different from those not in SNAP, not just for easily-measured reasons, but also for factors not commonly measured in health expenditure datasets, like neighborhood conditions and social strife,” Basu said.

So they used some novel methods to control for unmeasured factors, by applying a new statistical strategy that helped them use random variations in SNAP policy to mimic a trial.

“These variations influence similar people to either have an easier time or a harder time to enroll in SNAP, kind of like a randomized trial flips a coin to put people on a treatment or placebo,” Basu said. “And when we accounted for these unmeasured factors, we found that SNAP was actually associated with health-care savings, contrary to prior analyses that didn’t account for these factors,” he said.

The results of the study have several policy indications, the authors wrote.

“Prioritizing ways to make it easier for eligible Americans to enroll in SNAP is likely to be a feasible way to help reduce health-care costs,” they said. “This may be of particular interest to states because of differences in the funding source between SNAP and health care costs.”

As an entitlement program, SNAP benefits are paid for by the federal government, while Medicaid, which would likely see some of the savings if health-care costs are reduced, the authors note, is paid for jointly by states and the federal government.

“Therefore, state policies regarding SNAP enrollment may help off-load state Medicaid budgets,” they said.

Though not directly addressed in the study, the findings also have implications for ongoing discussions about modifying SNAP, including eligibility restrictions, funding structure and changes in benefit levels.