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Patrick J. Tolosky is a family physician in Maine and preventive medicine fellow.
“I understand doc, it’s just hard to eat healthy sometimes” said my patient, Jonathan. “You said the SNAP application got submitted though, right?” I asked, sitting opposite the exam table. “Yes … never could have done it without the social worker. I know it’s important to stay fed during treatment, but also hoping it can help with the kids, they eat like horses,” said Jonathan. I chuckled. “I’m hopeful … Let’s look at your numbers.”
I went to medical school with a specific interest in becoming a family doctor with a focus on preventing disease before it ever occurs. I remember learning in class how 20 percent of health outcomes are related to the clinical care people receive in total, such as medications or outpatient clinical care, or hospital treatment. Socioeconomic factors like employment status and food insecurity, by contrast, account for almost 50 percent of health outcomes. Patients often mention how many barriers they face in striving for good health like losing a good paying job, or the difficulty of using public transportation to get to the grocery store.
The Republican reconciliation bill, passed by the house on May 22, includes a wide variety of provisions that include significant cuts to programs like Medicaid and would increase the number of Americans without health insurance over time. However, what I am most worried about as a physician is the effects on SNAP (Supplemental Nutrition Assistance Program).
Food insecurity is correlated to myriad diseases including diabetes, obesity, osteoporosis, cardiovascular disease, delays in early childhood development and mental health disorders. Significantly reducing the SNAP budget would increase the risk of many diseases in our population and corresponding costs, which is somewhat ironic as one of the proposed advantages of the current reconciliation bill is to save money over time. For example, the prevalence of diabetes from 2015 to 2030 is on track to rise by over 50 percent to over 54 million Americans, with corresponding healthcare costs potentially reaching over $620 billion. SNAP cuts will worsen that crisis, and that is just one example.
Conversely, according to The Center on Budget and Policy Priorities, SNAP improves food security, is associated with improved current and long term health, leads to better access to preventive healthcare services and lowers healthcare costs.
Doctors know how important healthy food is, however it is frustrating counseling patients on lifestyle related illnesses like high blood pressure, heart disease, and diabetes and encouraging them to eat healthier when we know they cannot due to structural barriers like poverty and not being able to buy fresh produce due to finances.
This is not a theoretical issue being discussed in the faraway halls of Congress, but legislation that will have very real crippling effects for the state of Maine and our people. Currently, the total estimated cost of food insecurity in Maine is over $700 million per year from increased need for special education, lost productivity, and preventable health conditions. According to projections from Full Plates Full Potential, a nonprofit organization focused on ending food insecurity in children in Maine that I work with, the hardest hit populations from SNAP cuts will be veterans, households with children, disabled individuals and our elders. Food banks will have difficulty staying stocked, Maine farmers will suffer with decreased spending from SNAP customers (whose SNAP dollars count double toward fresh produce at Farmers Markets through the Maine Harvest Bucks program) and even make it more difficult for school districts to fund school meals through SNAP programming. Cutting SNAP will worsen our state’s health, increase costs, and weaken our food system.
As a primary care doctor in the healthcare system, I can attest to how our system is often too reactive, waiting for disease to develop before treating it. We talk about prevention but it is hard to achieve. SNAP is not a silver bullet for ending the hunger crisis in Maine, but it is one of the most powerful preventive health measures we have.
Jonathan, our patient from the beginning of our story, is not a far fetched example, but embodies the day-to-day experience of tens of thousands of Mainers, our neighbors. I encourage you to reach out to our federal legislators to encourage them to protect this incredibly valuable program and continue to invest in the health of our communities and oppose the current reconciliation bill that will be going to the Senate in the coming days.
