Exhibit 4:

Association between food security status in 2016 and total healthcare expenditures in 2017, by family health insurance type

Family members’ health insurance	Food security status in 2016	Estimated mean annual total healthcare expenditures in 2017, $	Estimated difference in mean annual total healthcare expenditures in 2017, food insecure versus food secure, $
All members privately insured	Food insecure	$14,024	$2,017**
	Food secure	$12,006	---
All members publicly insured (Medicaid, CHIP, other public, Medicare)	Food insecure	$11,471	$1,855****
	Food secure	$9,616	---
Members with mixed insurance (any combination of private, public, uninsured)	Food insecure	$18,455	$3,531****
	Food secure	$14,924	---

Source: Author’s analysis of study data

Notes: Results represent adjusted mean total family healthcare expenditures by family insurance type. Individual adult and child results were determined using a multivariable two-part model evaluating the association between food insecurity in 2016 and total healthcare expenditures in 2017, controlling for sociodemographics, clinical covariates, and healthcare expenditures in 2016. To determine family level results, we summed the adult and child estimates per family and evaluated the difference in family expenditures by food security. “Family” was defined as two or more persons living in the same household who were related by blood, marriage, or adoption based on the Current Population Survey definition of a family.

^*p<0.10

^**p<0.05

^***p<0.01

^****p<0.001.