The Fund supports several networks of state health policymakers to help identify, inspire, and inform policy leaders.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis on topics important to state health policymakers, particularly on issues related to state leadership, primary care, aging, and health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest blogs from our thought leaders, including Fund President Christopher F. Koller.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a nonpartisan foundation focused on improving the health of communities and entire populations.
April 13, 2021
Building Back Better
Julia A. Wolfson
Cindy W. Leung
Back to Building Back Better
The Supplemental Nutrition Assistance Program (SNAP), the largest government nutrition assistance program in the United States, provides money for low-income households to purchase food. SNAP has long been an important lifeline for households struggling to afford enough food for their families, but has never been more critical than during the COVID-19 pandemic. During the pandemic, 33% of Americans, including 44% of low-income households, experienced food insecurity,1,2 and SNAP participation swelled by more than 23% compared to 2019. However, many Americans in need remain ineligible for SNAP benefits, SNAP participants still struggle to afford enough food to last throughout the month, and benefits are insufficient to afford a healthy and nutritious diet. Food insecurity and poor nutrition are longstanding problems; even during good economic conditions 11-12% of American households experience food insecurity.3 Food insecurity has serious short- and long-term physical and mental health implications, particularly for children, adults with chronic illness, and older adults. There is now an opportunity to implement changes to SNAP that can address the immediate crisis related to COVID-19, and also address longer-term structural changes needed to help SNAP better achieve its aim of helping participants afford enough nutritious food for a healthy lifestyle.
Throughout the pandemic, several important modifications to SNAP were approved. For example, states were given the option to increase SNAP benefits to the maximum level for the duration of the public health emergency, programs allowing SNAP participants to use benefits to purchase groceries online were expanded, and a temporary 15% increase in benefits was passed. In President Biden’s first days in office he signed several Executive Orders aimed at reducing food insecurity in the United States. One executive action directed the US Department of Agriculture (USDA) to allow the lowest-income SNAP households to receive increased benefits on top of the 15% increase passed by Congress. Another executive action directed the USDA to explore amending the Thrifty Food Plan (TFP), the basis for determining SNAP benefit levels, to reflect the true cost of food in today’s economy. Finally, the recently passed American Rescue Plan Act, extended the 15% increase to SNAP benefits through September 2021.
Despite these positive developments there are numerous actions the Biden Administration and Congress still need to take to further strengthen SNAP so that essential benefits reach the low-income families who need them, enabling the program to realize its goal of allowing participants to purchase food consistent with a healthy diet. Any policies that impact SNAP need to garner broad support across multiple stakeholder groups in order to be effective and prevent unintended consequences. In December 2020, we fielded a national survey of Americans with incomes below 250% of the federal poverty level to gauge their support for eleven SNAP policy modifications (see Figure). Below, we discuss five priorities the new Administration and Congress should pursue to strengthen SNAP, all of which have broad bipartisan support among low-income Americans, an important stakeholder group in SNAP policy discussions and the very constituency SNAP seeks to serve.
Figure. Support for policies to modify the Supplemental Nutrition Assistance Program among low-income Americans in December, 2020 (n = 1,808)
Note: Data come from a national survey of adults in the United States (n = 1,808) with household income below 250% of the federal poverty level (based on household size and annual household income). The survey was fielded from December 4-15, 2020, by PrimePanels using a census matched panel with quotas based on age, sex, and race/ethnicity. Respondents were asked the following question: “The new presidential administration and the new congress will have an opportunity to make changes to SNAP, also known as the Food Stamp Program. SNAP is the largest government program that provides money for low-income individuals and families to purchase food. These next questions are about how strongly you support or oppose potential policy changes to SNAP.” Respondents were then shown the 11 policy options in a random order to prevent priming effects. Two policy options are not shown here: “Require stores that accept SNAP benefits to stock healthy foods and beverages” and “Prohibit stores that accept SNAP benefits from displaying advertisements for unhealthy food and beverages”. Response options were a six-point Likert scale: strongly oppose, oppose, somewhat oppose, somewhat support, support, or strongly support. We created a binary oppose vs. support measure by combining the three oppose response options vs. the three support response options. Data in the figure are derived from cross tabulations of binary policy support and political party affiliation.
First, Congress should increase SNAP benefits for all participants. Congress should raise the minimum SNAP benefit and increase benefits by at least 15% for all participants for the duration of the economic downturn. Longer term reexamination of the TFP is needed to ensure benefit amounts reflect the true cost of a healthy diet, including time spent to prepare food, and variation in regional food prices. Additionally, SNAP benefits are distributed monthly and many SNAP participants run out of food at the end of the month. More frequent benefit distribution (i.e., twice monthly versus once monthly) could help mitigate food insecurity and reduce caloric intake experienced by SNAP participants at the end of the benefit month.
Second, the USDA should expand the use of SNAP for grocery delivery. During the pandemic the USDA has increasingly allowed SNAP benefits to be used to purchase groceries online. However, delivery fees present a barrier for low-income households that may prevent them from using online delivery services that are more convenient and safer during the pandemic. The USDA should temporarily subsidize online delivery fees for SNAP participants during the pandemic and should explore other, permanent options to make online grocery services more accessible.
Third, USDA should increase SNAP’s focus on nutrition. Increased federal funding and program flexibility could allow states to pilot and evaluate programs that incentivize healthy food and beverages purchased with SNAP benefits. The Gus Schumacher Nutrition Incentive Program (GusNIP – formerly the Food Insecurity and Nutrition Incentive program), which was first authorized in 2014 and made permanent in the 2018 Farm Bill, already provides grants for incentive programs to help low-income Americans purchase fruit and vegetables. These programs effectively increase fruit and vegetable purchases among households who receive incentives, but have limited reach. To date, the USDA has never approved state requests to remove certain items such as sugar sweetened beverages from the list of allowable food purchases. In the Biden Administration, the USDA should explore avenues to use incentives, and potentially, disincentives (such as excluding sugar sweetened beverages from allowable purchases), that use the scale and reach of SNAP to facilitate healthy choices. This approach would better align SNAP with the Dietary Guidelines for Americans, which inform federal rules for other USDA nutrition programs. Initial steps in this direction should include SNAP participants’ perspectives in the design of nutrition-focused pilot programs to test the efficacy of these policies and monitor for potential unintended consequences.
Fourth, the USDA should adapt SNAP to reflect the reality of food procurement and preparation. The dual actions of allowing prepared foods to be purchased with SNAP benefits and increasing funding for nutrition education programs would address the false assumption built into the TFP that Americans cook all of their meals from scratch ingredients. This expectation is often not realistic, particularly for the many Americans who work more than one job to make ends meet. For some, knowledge gaps regarding food planning and preparation can be a barrier. By investing in high quality nutrition and culinary education while also allowing prepared foods to be purchased with SNAP, the USDA can build cooking skills and nutrition knowledge that can facilitate healthier eating habits while also recognizing that not all meals are cooked at home.
Finally, the USDA should help college students access SNAP. Waiving the strict work requirements applied to able-bodied adults without dependents (ABAWDs) would address a population particularly vulnerable to food insecurity. The COVID-19 relief package passed by Congress in December 2020 temporarily made this change, but food insecurity during college is a growing problem that predated the pandemic and will require longer-term policy solutions to prevent its numerous adverse outcomes.4
These policy changes have strong bipartisan support from low-income Americans and should be priorities for the Biden Administration and the current Congress. The pandemic has highlighted the precariousness of food security for millions of Americans and exposed underlying structural inequalities that make it difficult for many Americans to consistently afford enough food to feed themselves and their families. SNAP is the most nimble and effective program the US has to quickly alleviate food insecurity, and is a proven way to stimulate the economy. Policies are urgently needed to strengthen SNAP by ensuring everyone who needs SNAP has access to it and that benefits are sufficient to enable participants to purchase foods consistent with federal recommendations for a healthy diet.
 Fitzpatrick KM, Harris C, Drawve G. Assessing US Food Insecurity in the United States During COVID-19 Pandemic. 2020. https://fulbright.uark.edu/departments/sociology/research-centers/community-family-institute/_resources/community-and-family-institute/revised-assessing-food-insecurity-brief.pdf. Accessed April 28, 2020.
 Wolfson JA, Leung CW. Food Insecurity and COVID-19: Disparities in Early Effects for US Adults. Nutrients. 2020;12.
 Coleman-Jensen A, Rabbitt M, Gregory C, Singh A. Household food security in the United States in 2018. ERR-270. Washington, DC: USDA, Economic Research Service;2019.
 Laska MN, Fleischhacker S, Petsoulis C, Bruening M, Stebleton MJ. Addressing College Food Insecurity: An Assessment of Federal Legislation Before and During Coronavirus Disease-2019. Journal of Nutrition Education and Behavior. 2020;52:982-987.
Julia A. Wolfson is an Assistant Professor at the Johns Hopkins Bloomberg School of Public Health in the Department of International Health. She is also an Adjunct Assistant Professor in the Department of Health Management and Policy at the University of Michigan School of Public Health. Dr. Wolfson’s research lies at the intersection of health policy and health behavior and centers on health behaviors, environmental factors, policies, and interventions related to diet quality, food insecurity, and diet-related disease prevention. Previously, Dr. Wolfson enjoyed a career as a chef in fine dining and farm-to-table restaurants. Dr. Wolfson holds a BA from New York University, a MPP from the University of Southern California, and a PhD in public health policy from the Johns Hopkins Bloomberg School of Public Health.
Cindy Leung is an Assistant Professor of Nutritional Sciences at the University of Michigan School of Public Health. Trained as a nutrition epidemiologist, her research focuses on the experience of food insecurity and its negative influence on health across the life course using qualitative and quantitative methods. She is currently a Deputy Editor at Public Health Nutrition and a member of the Board of Editors at the Journal of the Academy of Nutrition and Dietetics. She earned her BA and MPH from the University of California, Berkeley, and her ScD from the Harvard T.H. Chan School of Public Health.
Alyssa Moran is an Assistant Professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health, where she is Core Faculty within the Institute for Health and Social Policy and Impact Specialist in Obesity and the Food System for the Bloomberg American Health Initiative. Dr. Moran’s research, teaching, and practice focus on the implementation and evaluation of governmental policies to improve diet quality, reduce food insecurity, and prevent diet-related chronic diseases. She is a registered dietitian and epidemiologist, earning her MPH in public health nutrition from NYU and ScD in nutrition from the Harvard T.H. Chan School of Public Health.
Back to The Milbank Quarterly Opinion
Apr 13, 2021
Mar 10, 2021
Feb 5, 2021
Get the Latest from the Milbank Memorial Fund
An endowed operating foundation that engages in nonpartisan analysis, collaboration, and communication, with an emphasis on state health policy.