After eight months of fighting over food stamps, Congress has passed a farm bill that favors the AAFP's advocacy priorities as outlined in a letter to leaders of the Senate and House agriculture committees.
The Academy's Dec. 6 letter,(3 page PDF) signed by AAFP Board Chair Michael Munger, M.D., of Overland Park, Kan., called on the committees to safeguard funding for the Supplemental Nutrition Assistance Program (SNAP) and the Emergency Food Assistance Program, two crucial anti-hunger initiatives. Because an estimated 20 percent of Americans depend on federal food assistance, the AAFP told the committees, such programs are vitally important to family physicians' patients, many of whom suffer health consequences linked to inadequate nutrition.
In a win for the estimated 42.2 million Americans living in food-insecure households, the final bill, the Agriculture Improvement Act of 2018,(www.congress.gov) does not add new administrative requirements to SNAP, such as proposed stricter work requirements that the Congressional Budget Office estimated(www.cbo.gov) would have pushed some 1.2 million Americans off their benefits.
Also in alignment with the AAFP's anti-hunger aims, the bill does not reduce individuals' or families' SNAP benefits. (Its primary change to SNAP is the addition of a National Accuracy Clearinghouse, meant to prevent people from receiving SNAP benefits in multiple states.)
The Academy recognizes the final bill as a positive step toward addressing food insecurity, a key social determinant of health (SDOH). Nearly 60 percent of family physicians who responded to a 2017 AAFP survey had screened patients for SDOH, including food insecurity; 52 percent reported having referred patients to community-based social services.
In addition to SNAP, the final farm bill allocates resources to nutrition education programs such as SNAP Education(snaped.fns.usda.gov) and devotes $20 million over five years to the Harvesting Health pilot program. The latter aims to let states and nonprofit groups, in tandem with hospitals and health care organizations, "prescribe" fruits and vegetables to low-income patients.
The bill also answers the AAFP's call for investment in rural health by recognizing telehealth services as one weapon in the fight against opioid addiction. According to American Farm Bureau Foundation data(www.fb.org) cited in the Academy's letter, 74 percent of American farmers and farm workers say they've been affected by the opioid crisis. The Academy has made robust support of telehealth part of its mission to address this crisis.
In a move that prevents what the Academy advised the committees would have been "a step away from important and needed consumer protections" under the Patient Protection and Affordable Care Act, the final bill omitted language that would have allowed employers to buy association health plans (AHPs) from the Department of Agriculture (USDA). That provision would have permitted the department to offer loans and grants to ranches, farms and other agribusiness entities to set up AHPs, a prospect some experts have considered ill-advised, given the plans' spotty track record.(khn.org)
The compromise bill reconciles House and Senate versions that both centered on SNAP but in starkly different ways. The final bipartisan bill eliminates language in the Senate version that would have blocked the administration from tightening state restrictions on work requirement waivers without congressional approval.
The USDA is expected to propose an updated rule on work requirement waivers early next year. The AAFP will monitor any proposed changes to SNAP or other anti-hunger programs that are critical to its preventive and health care priorities.
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