Support for Supplemental Nutrition Assistance Program (SNAP) Policy Alternatives Among US Adults, 2018

The Supplemental Nutrition Assistance Program (SNAP), the largest federal nutrition assistance program, provides financial assistance for food purchases to 40 million Americans and has an annual budget of more than $65 billion (https://bit.ly/2K3g0l5). Although SNAP benefits can be used to purchase any food or nonalcoholic beverage, with the exception of hot or pre-prepared foods, there is strong interest among public health advocates and policymakers in identifying evidence-based SNAP policies that will promote healthier participant purchases.¹

UNDERSTANDING PUBLIC OPINION IS CRITICAL

Past surveys have shown that the general public, including SNAP recipients, support program modifications to improve nutritional impact, such as increasing benefits for healthful foods and removing benefits for sugary drinks.^2,3 The timing and frequency of SNAP benefit distribution are other possible levers for improving nutritional impact. However, no previous national surveys have assessed public opinion about the frequency at which SNAP participants receive benefits (e.g., monthly, weekly) or about policy proposals recently considered by the US Department of Agriculture to restrict approved foods (e.g., Maine’s request to prohibit purchases of sugar-sweetened beverages and candy with SNAP benefits).⁴

In a recent nationally representative telephone survey (n = 1073 US adults aged 18 and years older, including 387 SNAP participants and 686 nonparticipants), we asked about views on six hypothetical SNAP policies to promote healthier diets (for additional details, see the supplemental file, available as a supplement to the online version of this article at http://www.ajph.org):

• 1.Removing sugary drinks from the allowable products for purchase with SNAP benefits,
• 2.Removing candy from the allowable products for purchase with SNAP benefits,
• 3.Providing SNAP participants with more total benefits,
• 4.Providing SNAP participants with additional benefits for the sole purchase of fruits, vegetables, or other healthful foods,
• 5.Providing SNAP participants with additional benefits on the basis of the amount of fruits and vegetables purchased (i.e., fruits and vegetables incentive), and
• 6.Increasing the frequency of benefit issuance (currently all states issue SNAP benefits once monthly).

RESTRICTIVE VS INCENTIVIZING POLICIES

We found that the majority of adults supported each of the six policy modifications, with the highest levels of support for providing additional benefits that can only be used on fruits and vegetables (83% overall; Figure 1). Support for the “restrictive policies” (removing sugary drinks, removing candy) was significantly higher among nonparticipants than SNAP participants (Figure 1) and varied by political party affiliation, with significantly higher support for restrictions among Republicans than among Democrats (e.g., sugary drinks: 71% Republicans vs 56% Democrats; P = .02). Two thirds supported removing sugary drinks (63% overall); among the 34% who opposed this restriction, approximately half (47%) said they would support a sugary drink restriction if it was paired with additional benefits for healthful foods. Every proposed policy modification had bipartisan support by a majority of Democrats and Republicans.

FIGURE 1—

Support for Supplemental Nutrition Assistance Program (SNAP) Policy Alternatives Among US Adults: May 8–31, 2018

Note. F&V = fruits and vegetables. Population size was n = 1073. Proportions are presented on the basis of weighted frequencies.

Although both the sugary drink and candy restrictions were supported overall, only 48% of SNAP participants expressed support for restrictions. Although restrictions may be cost neutral from a government affordability perspective and cost saving from a health care perspective,⁵ these may be less politically feasible options. It will be important for future research to determine whether restrictions would have the desired outcome of improving diet by reducing intake of sugary drinks and candy or whether they would merely shift purchasing of these items to SNAP participants’ limited cash resources.

By contrast, “incentivizing” policies (providing additional benefits, fruits and vegetable benefits, fruits and vegetables incentive) were viewed more favorably. Support for the incentivizing policies tended to be higher among SNAP participants (Figure 1). Incentives also had stronger support from Democrats, women, and respondents younger than 30 years. We found very strong support among SNAP participants for incentivizing fruits and vegetables purchases with additional benefits (90%). Research has already demonstrated the effectiveness of these types of incentives on increasing fruit and vegetable purchases in supermarkets.⁶ Despite a higher initial cost associated with incentivizing policies, recent models predict that fruit and vegetable subsidies (and subsidies combined with restrictions) would be cost saving once long-term health impacts are taken into account.⁵

TIMING AND FREQUENCY OF BENEFITS

Once monthly issuance of benefits may be associated with detrimental outcomes linked to insufficient benefits at the end of the benefit cycle (e.g., hunger, health, strain on retailers) as well as sugary beverage marketing timed with SNAP issuance.⁷ More frequent issuance may be favored by some participants as a budgeting tool, could help participants smooth consumption over the benefit month, and has the potential to reduce the association between the timing of SNAP benefits and retail marketing strategies or promotional pricing. However, this administrative change may not be preferred by participants who shop once monthly to save on transportation costs or to take advantage of buying in bulk.

When asked about how frequently benefits should be issued to participants, 14% preferred once monthly, 31% preferred twice monthly, 21% supported giving participants the option to choose the frequency that works best for them, and 30% reported no preference. SNAP participants and nonparticipants did not significantly differ in their issuance preferences (P = .25). There was strong support, among SNAP participants and overall, either for increasing benefit issuance to twice per month or for allowing participants the option to choose the frequency that works best for them.

Congressional action would be necessary to permit more than once monthly issuance, and states may also have logistical concerns about changing the benefit issuance schedule. Potential challenges to twice-monthly issuance may include (1) participant confusion during the transition period, (2) effectively communicating the changes, and (3) participants’ adjustment to the lag in receipt of the full monthly benefit each month. These issues are potentially compounded by administrative aspects (e.g., recertification frequency) that vary by state, so challenges would need to be considered and addressed on a state-by-state basis. Nevertheless, this type of administrative change may be more politically feasible than restrictive or incentivizing policies related to the types of foods purchased. Our findings demonstrate that there is significant public support for modifying the frequency of benefit issuance, including among current SNAP participants. Further consideration is warranted, and next steps may include funding demonstration projects to examine the feasibility of implementing these types of changes from the perspective of retailers and state administrators and studies to pilot test the impact of several issuance options.

PARTICIPANT SPENDING PATTERNS

We also asked SNAP participants about patterns in their benefit spending. A majority (61%) reported that SNAP benefits lasted two weeks or less each month, including 35% who reported one week or less. When asked to think about food purchases only (i.e., SNAP-eligible purchases), the majority (55%) reported that their SNAP benefits paid for half or less of their monthly groceries. This is likely one reason why additional benefits (rather that restrictions) were strongly supported by participants.

CONCLUSIONS

We found that a majority of Americans supported each of the six policy modifications presented. Despite recent political polarization, policy support for sugary drink restrictions, targeted fruits and vegetables benefits, and additional benefits to guarantee that SNAP participants can afford a healthy diet has strong bipartisan public support that policymakers should consider. The public overall and SNAP participants strongly favor changes to SNAP that would incentivize healthy purchases and modify the frequency with which participants receive their benefits each month. Together, these changes could improve the nutritional impact of the program and should be considered in the development of future SNAP program and policy proposals.