The Future of Food Help in America

3 Dec

HE_Fall2014_Cover_150width_SBy Michael Booth

“Of all the preposterous assumptions of humanity over humanity, nothing exceeds most of the criticisms made on the habits of the poor by the well-housed, well-warmed, and well-fed.”–Herman Melville

I’ve made plenty of those assumptions myself.

That’s why it was long past time to take the SNAP Challenge. Eat for a week using only the same small allotment granted to the average food stamp recipient in Colorado – for me, about $30, or $1.45 a meal. I assumed cheap food was plentiful and full of variety.

I assumed it would be easy to avoid processed, boxed calories and buy fresh produce instead. I assumed that if I bought groceries ahead and had a rigid menu, I’d stop thinking about food all the time. I assumed coffee was in the budget.

Wrong.

Few things ruin the hearty taste of oatmeal like the knowledge you can’t afford anything else for breakfast. Greens grow from dirt but they are not dirt cheap. And just because your menu is fixed doesn’t mean you stop thinking about trades and upgrades – “If they’d just let me use five more dollars, I swear I’d buy broccoli and a bag of oranges.”

My experiences on a SNAP (food stamp) budget were merely annoying, and I’d never claim otherwise, in the face of nearly 50 million Americans and 500,000 Coloradans who rely on the food support program for much of their daily sustenance.

Choosing to eat cheaply is a luxury of the idle. Having to eat cheaply – because of unemployment, or health problems, or lack of education or a fair job – that is the grueling chore of more than a tenth of our population. The reason the SNAP Challenge thrives is because it’s a one-week seminar, massively open to everyone, held at the spot where public policy meets the public.

SNAP Judgments

Robin Dickinson, MD, had her own set of assumptions before strokes and other setbacks put her family on food stamps two years ago. “You don’t go into medical school thinking, ‘I’m going to need food stamps someday,’” said Dickinson, a practicing physician in Englewood.

Before her own illness, she would constantly advise unfortunate patients to seek out Medicaid, or to use the Supplemental Nutrition Assistance Program (the modern moniker for food stamps) to help the family get by for a while. She encouraged her patients to use the MyPlate nutrition plan to get healthier, eating half their food in fruits and vegetables. She thought people had time and interest and knowledge to cook healthy from scratch, starting with the SNAP benefits as a base.

Then the strokes hit, with two young children at home. She couldn’t work a private practice job, having to sleep 20 hours a day to recover. Home and car repairs piled up. They canceled their family health insurance, even as the stroke bills piled up.

“We were down to eating rice and potatoes and oatmeal, and spicing it up with soy sauce until we ran out of soy sauce, Parmesan cheese until we ran out of Parmesan cheese, raisins until we ran out of raisins,” Dickinson said.

At one point she stepped back and re-examined all she had assumed about her poorest patients, even as she gave them good advice. “And I realized it had nothing to do with how hard we were trying, what kind of people we were. Our financial situation was terrible,” she said.

Feeling at the end of her rope, Dickinson called a human services agency, and after explaining her medical disability, was qualified for SNAP over the phone. She remembers vividly the joyful first day of using the unobtrusive Electronic Benefits Transfer card to get new groceries.

“The first time going in – after eating brown-bland food for so long – to get colorful, delicious, flavorful food was so exciting,” she said. “That was like a celebration day for us.”

Budget Crumbs

Passage of a five-year U.S. farm bill in 2014 would seem to let SNAP proponents breathe easier for a while. Negotiators did manage to protect some basic levels of food assistance, despite an $8 billion trim for some states (not Colorado) that had connected food assistance to home heating aid.

That does not mean advocates for the poor are sanguine. Food benefits are stuck at an average of about $130 a month per person. Even that level is subject to political whim: If the fall 2014 elections result in a partisan shift in Washington, D.C., as most commentators assume it will, then Rep. Paul Ryan’s summer poverty blueprint will receive more serious attention. The Wisconsin Republican, considered a conservative thought leader on social programs, has more strongly backed federal aid to the poor, but still wants much of it to be consolidated into the equivalent of block grants to the states.

The libertarian Cato Institute in late 2013 issued a paper calling SNAP “a deeply troubled program. … It has high administrative costs and significant levels of fraud and abuse. The program’s work requirements are weak and frequently evaded at the state level. The program increasingly breeds greater dependence on the government.”

Colorado, meanwhile, is still struggling to meet its own “SNAP Challenge.” The state had long suffered from poor participation rates, meaning hundreds of thousands of state residents were eligible for food aid but were not signed up because of notorious computer problems and a lack of coordinated outreach.

That has gotten better, but is far from a gold star. Statewide SNAP use rose to 508,000 people in fiscal year 2013, up from 252,933 in 2008, in part because of the faltering economy pushing more people into eligibility. But signups improved, too. Though state data lags the budget, 51.4 percent of eligible Coloradans got SNAP in 2011, up markedly from only 35.1 percent in 2008, according to the state Department of Human Services.

The participation gap fences off millions of dollars in economic activity from the Colorado economy – growers, producers and grocers would all be seeing revenue boosts if more eligible consumers received SNAP.

Anti-hunger advocates like Hunger Free Colorado will be carefully watching state and federal policies on SNAP, even as they gear up to protect school nutrition in the five-year reauthorization of that program up for debate in Congress in 2015.

Conservatives’ block-grant idea is a nonstarter, argued Hunger Free Colorado executive director Kathy Underhill.

“The whole point of SNAP is that it can expand and contract, counter-cyclically to the economy,” Underhill said. “So to hobble it that way” – through set amounts in block grants – “would be incredibly damaging.”

$1.40 a Meal

About the time I was talking macroeconomic policy, I also was spending time licking the peanut butter knives.

Underhill said there is no definitive way of knowing how many Coloradans rely on SNAP budgets for all of their food needs, but judging from the thousands of people her organization has interviewed over the years, the number is significant. So it’s not just a random exercise in budgeting to live on $1.40 a meal: it’s walking in other people’s shoes.

If you haven’t had to budget very tightly lately, the grocery store looks something like this: The relatively nutritious foods that get you enough calories on SNAP come packaged in pasta cellophane; egg cartons; rice bags; cans of black beans; and in the child-centered packaging of peanut butter and raw oatmeal. You can afford enough apples and bananas to get you through half the week’s challenge; greens are nearly impossible, but for a sale on zucchini.

Bargains come in unexpected places, at least for those lucky enough to have a car to try more than one grocery store. Trader Joe’s takes EBT cards, and has a jar of pasta sauce for $1.29 that becomes a flavor-saver deep in the challenge week. Get to know your egg recipes – at $5 for four dozen, they are hard to pass up.

Most of the working poor, or the poor looking to work, have little time to plan out the SNAP budget and cook from scratch for cheap nutrition. New York hunger activist Joel Berg has some choice words about that: “Michael Pollan has made a profound contribution to the food dialogue, but he has said poor people have more time than money and so they should spend more time preparing good food,” Berg said. “I don’t think that’s in touch with reality in America. Every hour they are preparing food is an hour they are not looking for a better job or taking care of their children. And they may spend two or three days in line waiting for benefits to which they are legally entitled.”

The business world likes to talk about “opportunity cost,” Berg said – the idea that productive people waste time in bureaucracy and thereby lose money. “The truth is low-income people are already the busiest people on the planet,” Berg said.

Anti-hunger and pro-nutrition advocates have come up with innovative tools. Colorado lawmakers this year passed a tax credit for farmers who donate healthy produce to food banks, which could supplement SNAP households with previously out-of-reach fruits and vegetables.

Leanne Brown wrote a cookbook for food budgets of $4 a day, and used a Kickstarter campaign to jazz it up with beautiful food-porn shots of the menus. Her “Good and Cheap” became an Internet hit. I used it to make a “crustless quiche” – perhaps more realistically known as a frittata – with a kitchen sink of cheap zucchini, onions, garlic and cheese. For dinner – delicious; rolled up in a burrito for lunch the next day – almost as good, though the March of the Cheap Eggs seemed relentless.

Challenged by SNAP

Cathy Kuo recalls those queasy moments from her own family’s SNAP Challenge. Chief marketing officer of cable and Internet provider Wide Open West, Kuo is also on the board of Hunger Free Colorado. Her family agreed to do the challenge with her, pooling what SNAP would have given them to add a few extras.

She used cooking techniques learned from her Chinese mother to stretch a Costco roast chicken by using picked bones for broth and adding rice for soup. “We bought the cheapest soy sauce we could find and it was awful,” she remembered. They found some frozen vegetables that fit the budget, but nothing fresh.“

One of the apples we bought was bad, and that was devastating!” Kuo said. The most surprising thing, she added, was the mental and emotional toll both she and her young daughter felt by the end of the week. She could see her daughter slumping and whining by Friday. For herself, Kuo said, “If you needed a critical decision from me, that was not the week for it. I was having difficulty thinking problems through.”

Cheap But Good

Sometimes the SNAP policy battles come down to a translucent raw chicken carcass sticking up out of a boiling pot.

Many of us seize up at the sight of a whole, raw chicken. Seems like a good idea, really, but where to start? So imagine the intimidation for a single working mom prepping dinner between shifts, with no clue where to start slicing.

Cooking Matters classes try to bring such useful knowledge to families struggling on tight food budgets around the state. Local chefs lead weekly courses in simple but delicious meals at extremely low cost. During downtime at a metro area meeting site, nutritionists from the Anschutz Medical Campus demonstrate the jaw-dropping high sugar levels in soda and other processed foods.

But getting busy families to turn out for the information is one of many frustrating moments for those reaching out to the working poor. On an early July night at Anschutz, four families had signed up, and 15 minutes in, only one family had shown up.

Chef Dennis Taylor ignored the small size of his audience, and focused on engaging three young children brought by Lori Tsosie of Green Valley Ranch. A whole fryer goes for 98 cents a pound, Taylor noted, while chicken breasts cut off the bone by someone else cost $3.99 and up. Taylor sliced off clammy chicken parts while the children alternated between shock and awe. He showed them how to blanch broccoli and carrots for 15 seconds before adding them to a chicken stir-fry to keep them fresher.“

So, you have to learn the value of unprepared food vs. prefabricated foods,” he said.

Tsosie is trying, both on the budget issues and the better-nutrition issues. “I’ve been learning a lot about prices, and how much fat there is in some foods,” she said. “We looked at how much lard is in a Whopper, and we were grossed out.”

Tsosie said she has banned sugar drinks from her house, and because her young kids have already suffered through oral surgery, “They know why.” She has been looking for alternatives – at Anschutz, the whole family sipped from ice water dotted with cucumber slices and mint leaves. “This is really good,” Tsosie said.

Ethics of Choice

Some families give up and head to the junk food aisles.

“If I’m a mom with three kids and you send me to the store with a buck, do I buy a plum, or three boxes of mac & cheese,” Underhill said. She wasn’t really asking a question.

Decrying the families buying soda and chips on SNAP’s EBT cards is a favorite tactic of government-aid opponents. It’s an easy target – in Los Angeles, neighborhood bodegas hang signs saying “All Rockstar Energy Drink Products are EBT Approved.” A 16-ounce can of Rockstar holds 15 teaspoons of sugar in its caffeinated suspension.

These easy charges lead to dubious connections between SNAP and rising obesity. Isn’t it ironic, critics like to say, that those receiving food aid are often the ones ingesting too many of the wrong calories?

A 2012 review called “SNAP to Health” by the Center for the Study of the Presidency and Congress said, “SNAP is a missed opportunity for improving children’s nutrition and preventing obesity.”

But the same center followed up with “The Facts and Fictions” of SNAP and obesity, pointing out with thorough research that the connection between public assistance and excess weight was blurry at best. Some respected studies show a bond with obesity; others show SNAP benefits increase dietary quality in a household.

What the center and other SNAP critiques have recommended is experimentation with dietary incentives or restrictions within SNAP benefits. Private money or public waivers could be used to increase incentives for fruits, vegetables and whole grains, for example. SNAP retailers might have to meet higher standards for what they stock, mixing more produce in with their processed foods. Some trials have shown willingness to spend SNAP on better foods when purchased in nutritionally designed food baskets. With Amazon and others diving into the grocery-delivery business, such private-public partnerships in nutrition have great potential.

Colorado has not seen strong state-level efforts to put nutrition incentives or restrictions into SNAP, said Hunger Free’s Underhill. “People’s purchasing habits are nearly identical, with or without SNAP,” Underhill argued. There is an ethical danger in “the paternalism of eliminating that choice,” she added.

New York’s Berg put it more bluntly, on the idea of blocking certain popular foods for certain people: How can the U.S. government, for example, subsidize corn and corn-sweetened calories, then turn around and ban those food items for certain taxpayers?“

So unless it’s worse than heroin, and banned for everyone, it’s pretty selective to ban it for poor people in a public food program,” Berg concluded. “If it’s a public health threat, then ban it for everyone. Let’s not equate obesity with something wrong with the moral fiber of one economic group.”

Some SNAP critics and advocates do seem to agree on lesser steps, including more record-keeping and transparency in how SNAP money is spent, and where. The “SNAP to Health” report called for it, and food system writer Michele Simon demanded it more pointedly in her 2012 investigation, “Food Stamps: Follow the Money. Are Corporations Profiting from Hungry Americans?”

Simon’s critique estimated how many billions of dollars major brand names like Walmart, Coca-Cola and Kraft Foods, and bank processors like JPMorgan Chase make through SNAP purchases, and said they have worked against nutrition standards and transparency in the program.

The goal, Simon wrote, should be to “develop policies that ensure SNAP resources are used to reduce food insecurity and promote healthier diets, and not to subsidize the profits of the food industry or banks.”

Sneaking Around SNAP

Of course you want to know if I cheated on the SNAP Challenge. And of course, I did. They ask you to keep the rules strict – don’t take free lunch offers from friends or family; don’t use your leftover $8 bottle of arugula-infused, locally-sourced balsamic to make the chicken palatable; don’t walk your plate of rice over to the nearest Thai joint to “borrow” a dash of Sriracha.

Let’s just say my capacity for self-pity is much greater than my affinity for self-denial. I was good in many places. I cooked salmon for a dinner party but had an egg and green chile burrito on my own plate. But I accepted a glass of wine and some fresh garden greens at a friend’s house, while bringing my own sad frittata. To make the undrinkable cheap tea go down better, I snuck some sugar packets from coffee shops. My wife and daughter lifted an extra dessert from a ladies-only 40th birthday party – it tasted like cream cheese and remorse.

Coffee was a tough loss – even the bad stuff was three times as much as cheap tea. Not sure if I’ve ever gone a week without java, since middle school.

Overall, I’d say I stuck to the spirit of the challenge. If If my cheating items were worth some small change, I also had leftovers that would allow me to buy some variety in the next week. Two pounds of uncooked pasta, a dozen eggs, a small jar of peanut butter, some tortillas and cheese. The tea will be donated, though that in itself might be cruel.

There’s a separate question, of course: How did I do for vitamins and essentials? Man should not live on peanut butter alone, though many a third-grader has tried. I sent Anschutz nutritionist Jimikaye Beck my weeklong SNAP menu – tantamount to asking Julia Child to critique a baloney sandwich.

She was kind, but tough. “There is a lack of vegetables in this diet.” Baby carrots could add a vegetable at lunch, she said; frozen broccoli could fit into the budget and nicely into the frittata. The broccoli would also replace some calcium she saw lacking.

Beck worried my cheap pasta was not whole-grain. (It wasn’t.) She wanted to know if I’d gotten the Jif knock-off peanut butter with all the sugar and salt, or something better. (Um … no. Something likely worse.)

I argued back, no doubt irritated by deprivation of dessert, coffee and lettuce. Whole-grain pasta is three times the price! Upscale peanut butter is a rip-off (not to mention I happen to like Jif and its chemical clones).

Beck laughed in my face while pouring me a nice cucumber water. “Yes! Price is a challenge, isn’t it?” Lesson learned.

Shaking Off Stigma

Robin Dickinson’s family became ineligible for further SNAP benefits in August, she said, as her physical recovery allowed her to work more hours as a physician. She was happy for the progress, but also nervous about the transition without a food safety net.“

We’re going to creep over that cutoff, but that doesn’t mean all of a sudden we’re comfortable,” she said. Home and car repairs were put off, as they still had credit card debt. One broken down car could wipe out part of their monthly food plan.

She is more than ready, she said, to grocery shop without the stigma of other people’s judgments. She assumed she could guess what was going through other customers’ heads if they saw her swipe the EBT card over chocolate ice cream for her kids. Or if her cart included a cheap plastic toy as a reward to her special-needs son.

“They may not be thinking that, but it’s hard not to wonder,” Dickinson said. “I’m looking forward to going through that checkout line without worrying about it.”


Michael Booth is the Editor in Chief of Health Elevations.

This article is a feature story of Health Elevations Food Issue: Can Public Policy Trim bad Choices? Download the issue here

HEALTH ELEVATIONS seeks to further the goals of the Colorado Health Foundation by highlighting problems that can be solved, illuminating the people who are making progress in solving them and provoking a new way of looking at complex health issues. HEALTH ELEVATIONS reports on a variety of sources to provide information that can further the work of policymakers, grantees, providers and the engaged public in advancing better health care, health coverage and healthier living.
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