By Sarah Lippert
The Supplemental Nutrition Assistance Program (SNAP) is the largest anti-hunger program in the United States, serving nearly 2 million Americans in 2022 alone. Despite its proven success in reducing food hardships among recipients, the decades-old program has not been immune to ongoing debates around eligibility criteria and benefit amounts.
Given the strong evidence correlating food hardships to unfavorable, high-cost health care outcomes like emergency department visits and hospitalizations, the results of these debates may have significant implications for health care systems.
“It’s hard to think of a social inequity that doesn’t lead to a health inequity,” Rajan Sonik, PhD’17, associate research professor at Heller, says. “Health care outcomes are also really critical, because they are an understandable, costly consequence of these inequities. That creates the opportunity to inform policy changes that a broader swath of stakeholders, beyond just the highest-level policymakers, will care about.”
Sonik has spent the bulk of his career pursuing a practical understanding of how social policies operate to influence health care outcomes and disparities. He currently leads three ongoing research studies funded by the National Institutes of Health that examine these inequities and their potential implications. The studies take advantage of unique policy changes that allow deep inferences into the impact of increasing and decreasing SNAP amounts. More specifically, Sonik is analyzing the disproportionate impact of the program on racial and ethnic minorities and people with disabilities.
Sonik’s longest-running study began in 2020 and continues to evaluate the effects of the wrongful loss of SNAP benefits on individuals and families. A SNAP system error led to a “natural experiment” that mistakenly and arbitrarily terminated SNAP for over 200,000 people, despite the recipients still being eligible for the support. For this project, Sonik is using SNAP data that has been linked with medical claims data, allowing him and his collaborators to assess the effects of these SNAP losses on preventive health care utilization, adverse clinical events, and health care expenditures.
Concluding in 2028, the second and third studies will each investigate the effects of pandemic-related changes to SNAP and other social welfare programs. One leverages recipient-level differences in how the Families First Coronavirus Response Act increased benefits during the early stages of the COVID-19 pandemic. The other leverages state-level variation in state-specific approaches to unwinding these benefit increases.
Sonik shares that preliminary data from all three studies suggest his initial hypothesis will be confirmed: SNAP losses are associated with worse health care outcomes, plus elevated disparities for racial and ethnic minorities and people with disabilities.
Another initial finding relates to how the effects of adding versus taking away benefits differ. “Giving more support appears to have measurable benefits, but the harm of removing benefits has been noticeably larger,” Sonik says. “When somebody is living at a level of poverty to be eligible for these programs, pulling one thread like food support can unravel everything quickly, whereas undoing the damage of living with limited resources is likely a longer process.”
Sonik’s studies have potential implications at the local, state, and national levels in the short and long term. “One hope for this sort of research is for it to inform estimates of the financial impacts of proposed policy changes,” Sonik says. “It can allow for informed analyses that do not simply assume ‘giving fewer benefits saves money.’ Instead, we will have rigorous data on how failing to address social ills like hunger will reverberate beyond the four corners of welfare programs — including in areas like health care costs and economic productivity.”