In 2017, the Bipartisan Policy Center (BPC) launched a 13-member task force to explore strategies for promoting healthy nutrition through public programs and policies related to food and health. The task force focused on what it says are opportunities to strengthen and improve the Supplemental Nutrition Assistance Program (SNAP), which provides food assistance to more than 40 million Americans each month at an annual cost of approximately $70 billion.
“While food security remains a key policy priority, recent years have also seen increased awareness of the direct link between diet quality and health—and growing concern about high rates of obesity and related chronic diseases in the U.S.,” says the BPC. “These trends have many complex causes, among them a food environment that often promotes less nutritious choices and changing work-life demands that make it more difficult, especially for many low-income families, to access fresh ingredients and prepare healthy meals.
“Against this backdrop, states and the federal government, which together provide millions of Americans—including many SNAP recipients—with health care coverage through Medicaid and Medicare, are in a unique position to make a difference. Their efforts to increase nutrition awareness, promote a healthier food environment, and support better diet choices, especially among vulnerable populations, could have far-ranging benefits for all Americans with a shared stake in improving health outcomes and reducing health care costs.”
The task force has released specific recommendations, summarized below, targeting four distinct areas of opportunity: prioritizing nutrition in SNAP, strengthening the SNAP-Education Program, aligning SNAP and Medicaid, and coordinating federal and state agencies and programs.
Prioritize nutrition in SNAP
- Make diet quality a core SNAP objective. SNAP’s current core objectives (food security and fiscal integrity) should be continued and supplemented with an additional, congressionally mandated focus on diet quality and healthy nutrition.
- Eliminate sugar-sweetened beverages from the list of items that can be purchased with SNAP benefits. Specifically, the agriculture secretary, in consultation with the health and human services secretary, should produce a careful and precise definition of sugar-sweetened beverages to remove from the list of items that can be purchased with SNAP benefits.
- Support healthy purchases by continuing and strengthening incentives for purchasing fruits and vegetables. Research shows that positive incentives for healthy eating, when paired with restrictions on SNAP-eligibility for sugar- sweetened beverages, are more effective than either intervention by itself. Pilot programs should continue to explore effective ways to encourage increased consumption of fruits and vegetables.
- Authorize funds for the U.S. Department of Agriculture (USDA) to conduct a range of evidence-based pilots to improve SNAP participants’ diets. Specifically, the task force recommends $100 million over five years to pilot comprehensive, multipronged interventions that address the core objectives of diet quality, food security and fiscal responsibility.
- Consolidate USDA authority over the agency’s nutrition standards and nutrition-education efforts. The pending merger of the USDA’s Food and Nutrition Service (FNS) and the USDA Center for Nutrition Policy and Promotion (CNPP) is the ideal moment to consolidate responsibility for overseeing the FNS’s nutrition and public health missions through a new FNS deputy administrator/CNPP director position.
- Authorize the USDA to collect and share store-level data on all products purchased with SNAP funds. Collecting and sharing store-level SNAP food-purchase data would provide the appropriate level of detail to answer key public health and programmatic questions while avoiding the privacy concerns of collecting purchase data on individual recipients.
- Strengthen SNAP retailer standards to improve the food environment for all shoppers. The USDA should implement new stocking rules that increase the availability of healthy foods at SNAP retailers. In addition, the USDA should study the feasibility of including evidence-based product-placement strategies and restrictions on the marketing of unhealthy products in SNAP retailer standards.
- Create a robust SNAP-Education infrastructure to support implementation and evaluation of the program. Priorities include enhancing technical assistance from the USDA regional offices, reducing planning and reporting burdens, restructuring state reports to focus on program impact, developing new tools and components, and sharing best practices.
- Realign the Expanded Food and Nutrition Education Program (EFNEP) to enable it and SNAP-Education to work synergistically while avoiding duplication. Currently, the scope of EFNEP overlaps with that of SNAP-Ed. Changing EFNEP’s mission from direct nutrition education for the public to instead focus on (1) training SNAP-Ed administrators and programmatic staff on nutrition, physical activity, and obesity prevention; and (2) evaluating obesity-prevention strategies and interventions would help states implement more effective, evidence-based programs for improving diet quality among SNAP recipients.
Align SNAP and Medicaid
- Coordinate SNAP and Medicaid to improve nutrition and diet-related health outcomes.The USDA and U.S. Department of Health and Human Services should use their waiver authorities to encourage states to experiment with promising strategies for improving health and nutrition through SNAP.
- Work across congressional agriculture and health committees to better align SNAP, Medicaid, Medicare, and other federal programs to improve the health of participants. Joint hearings and select committees could be helpful in identifying potential synergies; a more ambitious and transformational step would be to move toward portfolio budgeting in which all nutrition- and health-related programs, expenditures, and tax policies are considered together.
- Prioritize nutrition within the Medicaid program. This could comprise expanding screening and counseling services, testing the use of incentives to improve nutrition, and including outcome-based measures of malnutrition in quality-based payment systems.
Coordinate federal and state agencies and programs
- Align programs and data collection related to food and nutrition across the USDA and other federal agencies. Food assistance, nutrition education, and research programs should be aligned across federal agencies, including the Health Resources and Services Administration, the Indian Health Service, the Centers for Disease Control and Prevention, the Defense Department, the Veteran’s Health Administration, and the Commerce Department.
- Reduce barriers to sharing data and coordinating outreach across state-administered federal programs. Federal agencies should clarify how states may use and share data generated by administering different federal programs; in addition, the Office of Management and Budget should explore methods for allocating state administrative costs that promote more data sharing and more efficient outreach.
- Adopt modern technologies for state program administration. The ability to contract with a broader range of transactions processors would help states modernize SNAP electronic benefits transfer technology and reduce program costs. Updated benefits management and enrollment systems could also improve data sharing and program performance.
Industry reactions to the report so far have been mixed.
Food Marketing Institute (FMI) Chief Public Policy Officer and SVP, Government Relations, Jennifer Hatcher objected to the task force’s recommendations, stating:
“After nearly three years and dozens of public hearings, it is unfortunate that the Bipartisan Policy Center lacks credibility as an integral part of the policy process in its release today of proposals related to SNAP that have been previously considered and rejected. Among the BPCs recommendations are the imposition on food retailers of additional fees without any apparent added benefits to program participants, as well as the costly collection and reporting of store-level sales data that would constitute an anti-competitive food retail environment.
“FMI and its members are focused on working with lawmakers and current Administration officials to identify real and thoughtful reforms that will improve the efficiencies and outcomes of the program, rather than increase costs for all customers. Sadly, the BPCs eleventh-hour proposals are a distraction to a serious effort to develop a Farm Bill that can move through Congress and strengthen SNAP.”
Greg Ferrara, the National Grocers Association (NGA) EVP of advocacy, public relations and member services expressed concerns as well:
“America’s independent supermarket operators have long been partners with federal and state government entities in the SNAP food delivery system, efficiently serving millions of low-income households, including families with children, the elderly, and disabled.
“We are concerned with any proposal that would limit consumer choice in the marketplace and put new administrative burdens and fees onto retailers, who survive on 1-2 percent average profit margins. In addition to paying $70 billion a year in credit card interchange fees, retailers take on large equipment, compliance, and training expenses to participate in the SNAP program. Adding further costs would harm the ability of Main Street grocers to serve local communities and low-income populations.
“On behalf of the independent supermarket industry, we look forward to working with various stakeholders to improve the SNAP program and ultimately the lives of those Americans who are currently living in poverty.”
Tom Stenzel, president and CEO of the United Fresh Produce Association, took a more positive stance:
“The BPC’s new report is a critically important step forward to advance the conversation about how to maximize nutrition and healthy eating in the nation’s primary feeding program, SNAP. The BPC Task Force is to be commended for its clear linkage that healthy eating among SNAP recipients will have a direct positive impact on health outcome and reduce national healthcare costs.
“SNAP serves over 40 million individuals annually, nearly half of those children, and is important in reducing hunger and food insecurity. But the BPC report highlights a pressing need for SNAP to focus more on health and nutrition to better serve its beneficiaries. The report includes a number of policy recommendations to boost healthy eating among SNAP recipients, including important incentives to consume more fruits and vegetables. Only one in 10 Americans eat the recommended servings of fruits and vegetables, with consumption even lower for those living in poverty.
“In the last decade, the federal government has made significant strides to better align feeding programs with sound nutrition, including adding fruit and vegetable vouchers to the Women, Infant and Children (WIC) food package, and clearly linking early childcare, school breakfast and lunch programs to reflect the Dietary Guidelines for Americans. It is now time for a serious discussion about how SNAP can be modernized to reflect the nutritional needs and health realities of SNAP recipients.
“United Fresh Produce Association has long worked to ensure that the nation’s feeding programs are nutrition-focused and that its beneficiaries have access to fruits and vegetables through policies like the Food Insecurity and Nutrition Incentive (FINI) program in SNAP, the cash value voucher (CVV) for fruits and vegetables in WIC, and programs including the Fresh Fruit and Vegetable (FFVP) and minimum serving requirements in child nutrition programs. We stand ready to work with policymakers to ensure that the SNAP program begins to reflect these same health priorities to better serve its recipients’ health outcomes and reduce ever-increasing national healthcare costs.”