COLUMBIA, SC — South Carolina’s leaders want permission to limit the types of food that poor people can buy with food stamps, an effort that they say is aimed at improving health and reducing obesity.
Gov. Nikki Haley plans public meetings in the coming months to gather input for a potential request to the U.S. Department of Agriculture — which runs the Supplemental Nutrition Assistance Program, commonly called food stamps — for a waiver to restrict food-stamp purchases.
The state better come up with something truly innovative.
The two formal requests to restrict food-stamp purchases that reached the Agriculture Department in recent years were turned down by the federal government. Multiple other requests have been shot down by state legislatures before they could make it to the feds.
It is worth seeking a waiver if the state wants to try out some new ideas, said Ed Frongillo, chair of the Department of Health Promotion, Education and Behavior at USC. “But it’s important for (the state) to understand why the (U.S.) Department of Agriculture would be potentially concerned about restrictions on foods,” he added.
The concept seems simple to some: When poor people receive government money to buy food, the government should be able to limit those purchases to healthful foods. Obesity leads to many health problems that a healthier diet theoretically would reduce, saving the government money in the form of lower health-care bills for the poor.
Those are the arguments used by Haley and her directors of the Department of Social Services, which coordinates food stamps in the state, and the Department of Health and Environmental Control, tasked to fight obesity.
Yet the issue is extremely complicated.
In 2007, the Agriculture Department wrote an 11-page position paper explaining why restricting use of food stamps is a bad idea.
The Agriculture Department’s basic arguments are:
• There are no clear standards for defining foods as healthy or not healthy. For instance, based on some criteria, diet soda would be better for you than orange juice.
• Enacting food restrictions would make a huge program even more complex and costly. The typical supermarket carries 40,000 products, with new versions arriving almost daily. While computer checkout systems might be able to keep straight what is deemed healthful and not healthful, keeping those systems up to date will be a real chore, especially in small stores with older equipment.
(Stores do something similar now for the federal government-approved Women, Infants and Children food program. But that program has strict standards met by only a small percentage of grocery products, and only about 700 S.C. stores take part in it.)
• No evidence exists that food-stamp use contributes to poor diet or obesity. Some health advocates argue this point, but the Agriculture Department cites inconclusive studies. For instance, studies indicate food-stamp recipients buy more unhealthy sugary drinks but fewer sweet and salty snack foods, also unhealthy, than non-recipients.
‘Against freedom of choice?’
Based on past efforts in other states, South Carolina leaders face a tough task.
From 2009 through 2011, legislation limiting food-stamp purchases has been introduced in at least nine states. None of the proposals got out of their own legislatures.
Haley is taking a slightly different route, asking Social Services and Health and Environmental Control to come up with a waiver request, and avoiding the legislative debate.
But even that approach faces high hurdles.
In the past decade, at least two other proposals to restrict food-stamp use made it to the Agriculture Department — one by Minnesota in 2004 for candy and soft drinks and one by New York City in 2009 for soft drinks. (Mississippi submitted a limited waiver request last year, but the state withdrew it before the Agriculture Department responded.)
Minnesota and New York City were shot down by the feds.
Did partisan politics play a role? Evidently not. The Minnesota request came during a Republican presidential term, and the New York City request during a Democratic term. The state efforts that died in legislatures were in states as varied politically as Democratic California and Republican Texas.
Food and beverage manufacturers have lobbied all sides against food-stamp changes, citing many of the reasons detailed in the Agriculture Department report.
For example, when Catherine Templeton, director of the Health and Environmental Control, first broached the idea of a food-stamp waiver in January, the S.C. Beverage Association quickly sent her a lengthy, detailed argument against it.
Advocates for the poor also have campaigned against restrictions.
“People in poverty are operating in very constrained situations already,” USC’s Frongillo said. “The idea of singling out constrained people goes against freedom of choice.”
Reward, not punish?
The Agriculture Department also has concerns about the impact of any restrictions on the cost of food for the poor. About 30 percent of food-stamp recipients in 2011 reported earned income and 60 percent reported other government-provided income. Many used that income to pay for food to supplement their food stamps, which max out at about $35 a person per week.
Many food-stamp recipients also live in areas with few food shopping choices, making it more difficult to find inexpensive healthful foods if limits are set on what they can purchase, according to the Agriculture Department.
Cutting the sugary drinks and candy from diets would help. But a 1999 study of food-stamp purchases found only 8.4 percent of purchases were in those categories, compared with 54.5 percent going to meats, fruits and vegetables.
Despite all of the Agriculture Department’s concerns, the agency left the door open slightly to some future restrictions on purchases in its rejection letter to New York City.
“We would like to look to potential alternative collaborations such as private-public partnership to design, implement, and evaluate an anti-obesity intervention targeting consumption and associated behaviors while encouraging healthy choices,” the letter stated.
Researchers at Arizona State University made the case for changes in the food-stamp program in a report released in 2011, and nutrition professor Punam Ohri-Vachaspati, an author of the report, says she will be following South Carolina’s effort closely. She said the state needs to pay attention to what other states have tried and failed.
“In my opinion, items that can be easily identified at the store and have no nutritional contribution should be the target for restriction-based strategies,” Ohri-Vachaspati said.
But Ohri-Vachaspati and USC’s Frongillo note the USDA is more interested in rewarding food-stamp users for healthy choices than penalizing them for unhealthy choices. One such effort already has been approved in many states — increasing the value of SNAP money when it is used at local farmers markets.
Work with grocery stores?
In South Carolina, several small grants paid for doubling SNAP money when it was used at farmers markets. But the incentive had little impact, according to the state Department of Agriculture. Only $283,937 of the $1.4 billion in food stamps spent in South Carolina last year were redeemed at the 82 farmers markets set up to accept SNAP money, according to the U.S. Department of Agriculture.
The state Agriculture Department is working to come up with a plan to expand the fruits-and-vegetables encouragement program to grocery stores, where most food-stamp recipients do their shopping. One study indicated 83 percent of food-stamp purchases are in large grocery stores.
A small project in Massachusetts called the Health Incentives Pilot already is testing that idea. The project rewarded about 7,500 food-stamp users an extra 30 cents of benefits for every dollar spent on fresh fruits and vegetables. A report on the pilot is due this year, detailing whether the rewards improved diet and/or health.
South Carolina could come up with an incentive-based program. But Haley, Templeton and Department of Social Services director Lillian Koller mentioned only restrictions when they announced plans to request a waiver. At the press conference announcing the state would put together a waiver request, Koller contended the open process of seeking input at public meetings would increase the chances of the waiver eventually being approved.
Arizona State’s Ohri-Vachaspati would like to see some state come up with an innovative restriction plan.
“While a restrictive program is likely to have implementation challenges, well-designed pilot projects can shed more light on how these challenges can be overcome,” the Arizona State report said.
Just across the border from Arizona, Mexico has taken an even broader approach at leveraging food assistance to improve the lives of the poor. In some areas of that country, the amount of government food assistance is higher if poor people ensure their children stay in school and make well-care visits to physicians.
For South Carolina to succeed on its waiver request, it likely will have to take the opposite approach and hone in on a small region or a small segment of the food market. Incentives also have a better chance than restrictions.
Even if the state’s waiver request fails, USC’s Frongillo sees benefit in the journey.
“The fact that we’re even talking about this is good,” he said.
Reach Holleman at (803) 771-8366.