KEEPING SODA IN SNAP: Understanding the Other Iron Triangle

Abstract

Participants in SNAP have always been allowed to use their taxpayer-funded benefit to purchase Sugar Sweetened Beverages (SSBs). Despite an acute public health crisis surrounding the consumption of unhealthy products including SSBs, especially among the low-income citizens who also qualify for SNAP benefits, this policy has yet to be changed. Interviews with policy participants in Washington, D.C., reveal that change is being blocked by a culture of “personal responsibility” in America, plus three specific political forces: corporate lobbying primarily by the beverage and food retail industries; a desire by liberals to defend SNAP as income support for the poor even if nutrition outcomes are sub-optimal; and institutional inertia within the Department of Agriculture and the agricultural committees of Congress. In the 2018 farm bill debate, this “iron triangle” of bipartisan resistance to change was strong enough to block even a pilot study of SSB restrictions in SNAP.

As America’s obesity crisis worsens, why does our leading federal nutrition program, the Supplemental Nutrition Assistance Program (SNAP), continue to use taxpayer money to support the purchase of sugar-sweetened beverages, products that contribute to obesity while providing no nutrient value? Among many reasons, one surprising answer is the joining of pro-poor liberal conviction and corporate lobby power, supported by institutional inertia. The result is not a coherently reasoned outcome, but for multiple reasons it will be hard to change.

The SNAP program, which used to be called Food Stamps, is America’s flagship nutrition assistance program, currently providing food purchase credits to nearly 43 million low income Americans at an annual cost of roughly $70 billion. From the beginning, certain grocery items have been disallowed for purchase with SNAP, including alcoholic drinks, tobacco products, vitamins and medicines, pre-prepared hot foods, or foods eaten in the store.¹ When Congress created the original program in 1964, severe under-nutrition was still a common problem for America’s poor, and the obesity rate stood at only 13.4%. Partly thanks to SNAP, calorie and micro-nutrient deficiencies are a far less serious problem today, but the obesity rate has soared, reaching 39.8% in 2015–16.² If current trends in childhood obesity continue, more than 57% of today’s children will be obese by age 35.³

Sugar sweetened beverages (SSBs) are a significant contributor to the obesity crisis. Per capita calorie intake from caloric soda consumption quadrupled for American adults between 1965 and 2002.⁴ Low income American adults now consume nearly two SSB servings a day,⁵ and for every one to two daily servings consumed, the lifetime risk of developing diabetes increases by 30%.⁶ Between 1958 and 2010, the number of Americans with diabetes increased 12-fold.⁷ In addition to obesity and diabetes, SSB consumption is linked to increased risks for hypertension, coronary heart disease, and tooth decay. These health risks are faced most acutely by low-income households, including those eligible for SNAP benefits.⁸ Among American adults with no college education, about 8% of all deaths due to diabetes and cardiovascular diseases are linked to SSB intake.⁹

Allowing sugar-sweetened beverages to be purchased with SNAP benefits was controversial from the start. In the original enactment process in 1964, the House of Representatives proposed disallowing SSBs, but the Senate objected partly on grounds that recipients were unlikely to use a significant part of their benefit for unnecessary items like soda.¹⁰ This might have been plausible in 1964, but quite a few federal SNAP dollars are going to purchase SSBs today. A 2016 study from USDA indicated the number one product purchased by SNAP benefits is sweetened beverages, comprising 9.3% of SNAP benefits.¹¹ And, about three-quarters of all the sugary drinks purchased by SNAP households were purchased using SNAP benefits versus out-of-pocket.¹² A 2015 USDA study also revealed that SNAP recipients, compared to other low-income non-participants in the program, drank more SSBs and were more likely to be obese. Obesity prevalence among SNAP recipients was 40%, versus 32% among low-income non-participants.¹³ Dr. David Ludwig, an advocate for improved nutrition at Boston Children’s Hospital, said in 2017,

“We have more evidence for the harms of sugary beverages than for any other category of food, and yet it tops the list of reimbursed products in SNAP. No one is suggesting poor people can’t choose what they want to eat, but we’re saying let’s not use government benefits to pay for foods that are demonstrably going to undermine public health.”¹⁴

In the work that follows we explore why removing SSBs from SNAP has remained controversial. Part of the explanation is deeply cultural, given the distinct preference of most Americans for personal responsibility versus governmental authority. In a 2011 Pew Global Attitudes survey, Americans preferred “freedom to pursue life’s goals without state interference” over “state guarantees that nobody is in need” by a margin of 58 to 35%. In Britain these preferences were roughly reversed, with only 38% opting for freedom. In Germany and France 62% opted for state guarantees over freedom.¹⁵ A second relevant trait is America’s distinctive bias in health care toward disease treatment rather than prevention. By one calculation, 70% of the illnesses being treated in the United States could have been prevented.¹⁶ Taken together, these cultural factors help to explain why U.S. food policies are often less progressive, even though obesity rates in the United States are twice as high as on the continent of Europe.¹⁷ Background factors such as these are important, but our focus here is on the behavior of institutions in the political foreground.

We begin with a summary review of failed attempts to restrict soda purchases in SNAP over the past two decades, up through the current 2018 Farm Bill debate. These failures are largely attributable to America’s culture of personal (versus governmental) responsibility in combination with a unique but persistent confluence of political forces: corporate lobby power on the right, liberal advocacy for minorities and the poor on the left, and institutional inertia. The analysis is based on the public record plus information gathered in thirty-one confidential interviews with current policy process participants conducted in 2017–18.

Past Efforts to Restrict SSB Purchases in SNAP

The eligibility of different food products for purchase in SNAP was originally set by Congress, and only Congress can make permanent changes. The legislative vehicle for doing this would be the Farm Bill, an omnibus measure renewed every 5 years (or so) that bundles together federal nutrition programs with subsidies to farmers. The Department of Agriculture (USDA) can authorize experimental rule changes in restricted locales for SNAP, but only Congress can make a permanent entitlement-wide change. In addition, individual state governments can ask permission from USDA to conduct experimental rules changes on their own, and several have done so to test soda restrictions over the past dozen years, but USDA has denied permission in each case so far.

Reasons for USDA Resistance

USDA has a long history of resisting SSB restrictions in SNAP. In 2004, the state of Minnesota asked USDA for permission to block the use of SNAP for SSBs and candy, but USDA refused, explaining that implementing such a waiver would “perpetuate the myth that participants do not make wise food purchasing decisions.”¹⁸ In 2010, the state of New York asked USDA for permission to conduct a 2-year SNAP pilot project in New York City that would exclude SSBs, but USDA turned this request down as well, for several reasons: the scale and scope of the pilot were too large, retailers might not be able to operationalize the change, there was no clear process for determining product eligibility, and the evaluation design was supposedly inadequate for measuring consumption and total calorie intake.¹⁹

The state of Maine petitioned USDA in 2015 for a waiver to ban SNAP purchases of soda and candy, but through the final months of the Obama administration this request also went unapproved. Maine’s Republican Governor Paul LePage, who had been an ardent Trump supporter, renewed the petition in 2017, but early in 2018 Trump’s USDA formally rejected the petition, explaining to the media, “When considering waiver requests, USDA focuses on moving people into self-sufficient lives, protecting the integrity of the program, and improving customer service. We don’t want to be in the business of picking winners and losers among food products in the marketplace, or in passing judgment about the relative benefits of individual food products.”²⁰

In 2007, USDA had spelled out its position at greater length, in a memorandum titled “Implications of Restricting the Use of Food Stamp Benefits.”²¹ This document asserted that there are no inherently bad foods, only bad diets resulting from bad combinations or quantities of food. For SSBs, federal dietary guidelines say, “If they are consumed, amounts should be within overall calorie limits and limits for calories from added sugars.”²²

The 2007 memo goes on to say it would be burdensome for USDA to maintain an up to date list of products such as SSBs not allowable under SNAP, since an average of 12,000 new food products are introduced into retail stores every year. The task of identifying, evaluating, and tracking the nutrition profile of so many products could require a significantly expanded federal bureaucracy, or place an unacceptable certification burden on manufacturers. In addition, ordinary SNAP recipients could not be expected to know exactly which foods were allowable and which were not, so final enforcement would rest with poorly trained check-out clerks in the 260,000 stores authorized to accept food stamps. Particularly in smaller stores or specialty stores without modern scanning and inventory control systems, confusion over allowable items would slow down checkout, and rejections at checkout might be a stigmatizing experience.

As its final argument, the 2007 USDA memo speculated that little might be gained for public health in the end, because individual food purchase patterns might not change: “There is no guarantee that restricting the use of food stamps would affect food purchases – other than substituting one form of payment (cash) for another (food stamps).”²³ The memo cites data suggesting that the average monthly food spending for SNAP eligible households exceeds the average monthly SNAP benefit by 40%, creating ample space for this kind of payment substitution.

When the Trump Administration arrived in January 2017, some Republicans hoped the department would become more welcoming toward SSB restrictions. Early in 2017, Representative Doug LaMalfa, a California Republican and member of the House agriculture committee, approached Secretary Sonny Perdue to ask for a promise that USDA would approve any state waiver request for an SSB restriction if endorsed by that state’s legislature. Five different state legislatures at the time were actively considering bills to force such a request – Arkansas, Florida, Mississippi, New Mexico, and Tennessee (all but New Mexico under full Republican control).²⁴ The LaMalfa request was refused by Secretary Perdue, who said he didn’t want USDA to become part of a “nanny state.” Perdue repeated this phrase when responding to a question at a public hearing before the House agriculture committee in May 2017.²⁵

This USDA position opposing new food restrictions in SNAP is well reasoned, but still largely speculative. The best way to learn what an SSB restriction might actually do to checkout procedures, or to overall SSB consumption patterns, would be to conduct a pilot study, yet even this modest first step has been resisted by USDA so far.

Congressional Resistance

Until now Congress has also resisted disallowing SSB purchases in SNAP. In June 2013, during an earlier Farm Bill debate, eighteen mayors including from New York, Los Angeles, and Chicago, sent congressional leaders a letter asking for a chance to “test and evaluate choices” for limiting SSBs, but to no avail. Later in September, Representative Phil Roe (R-TN), a medical doctor, introduced a Healthy Food Choices Act that would have allowed only healthful choices in SNAP, thus making it similar to the WIC program. Roe was not a member of the House Agriculture Committee, where his proposal languished with no action taken.

Moving into the current 2018 Farm Bill debate, several new efforts were made to influence Congress on SSBs in SNAP. In 2015, a National Commission on Hunger created by Congress made 20 specific recommendations, one of which was to “exclude a carefully defined class of sugar-sweetened beverages from the list of allowable purchases with SNAP benefits.”²⁶ A follow-up report, issued by the Bipartisan Policy Center in March 2018, again proposed to “eliminate sugar-sweetened beverages from the list of items that can be purchased with SNAP benefits.”²⁷ The task force that authored this report, which also backed incentives for healthy eating, was led by two former Secretaries of Agriculture (a Republican and a Democrat), plus a former Senate Majority Leader who was also a medical doctor, Republican Bill Frist from Tennessee.

Congress has remained unmoved by such recommendations. The House committee on agriculture did hold a hearing on the SSB restrictions issue in February 2017, but one committee member after another speculated about what might go wrong. A restriction might be insulting to the poor; it might result in only a small diet quality improvement; it might impose unacceptable hardships on retailers.²⁸ The best way to answer such questions is with a pilot study, but even this has been more than Congress wants to accept.

Pilot research studies have a long history in the SNAP program – in fact the original 1964 food stamp program grew out of an earlier 1961 pilot study. In the 2008 Farm Bill, Congress authorized $20 million for pilot studies to evaluate health and nutrition incentives (not restrictions) in SNAP, a so-called Health Incentives Pilot (HIP) Program. This study demonstrated that financial incentives did increase fruit and vegetable purchases, and partly as a result the 2014 farm bill authorized USDA to create a new competitive grants program named Food Insecurity Nutrition Incentives (FINI), to help eligible organizations design and implement more schemes of this kind in SNAP.²⁹

In the 2014 Farm Bill, Congress took the research pilot approach farther, authorizing up to $200 million for 10 pilot projects designed to reduce dependency and increase work effort in SNAP, with funds to be awarded as pilot grants to 10 different states through a competitive process.³⁰ The 2014 law also mandated that a pilot be conducted to test the possibility of allowing retail food stores to accept SNAP benefits through online transactions.³¹

Going into the most recent 2018 Farm Bill process, both houses of Congress (and thus both agriculture committees) were under Republican Party control, along with the White House and USDA, so Republican critics of SNAP had a new opportunity to attempt program changes. The Republican chair of the House agriculture committee, Mike Conaway from Texas, scheduled 23 separate fact-finding committee hearings on SNAP to set the stage for change, but soda restrictions were never a central focus.

In 2017, several Republican members of the committee did approach Conaway on the SSB issue, but he told them the most he might accept would be a pilot that combined restrictions with incentives for healthy food purchases. One variant his committee staff considered briefly was a “buy-in bonus” plan that would start recipients with 95% of their current SNAP entitlement and then expand the benefit to more than 100% if more healthy purchases were made, but SSBs were not singled out for cuts. At least one Republican on the Committee, Representative John Faso (R-NY), did prepare draft language on a stand-alone SSB restriction in 2017, but the American Beverage Association learned of Faso’s move and reacted with discouraging telephone calls to committee members.

Chairman Conaway did not accept Faso’s amendment into the committee’s farm bill draft, so he proposed it to the House Rules Committee as an amendment to be offered from the floor. In May 2018, this Republican dominated committee also said no.

On the Democratic side of the House Agriculture Committee, the opposition was unanimous to any disallowance of SSBs in SNAP, and even to a pilot study of such a restrictions, and even if combined with incentives for healthy foods. Representative James McGovern (D-MA), ranking member of the Nutrition Subcommittee and one of the staunchest Congressional advocates for the poor, strongly opposed the idea of a restrictions pilot in the public hearing on February 2017. McGovern called instead, tongue-in-cheek, for a pilot study to restrict unhealthy, taxpayer-funded food consumption in President Trump’s White House. McGovern’s view was that restricting choice was “something that we ought not to be doing here in Washington”.³²

Other Democrats on the agriculture committee rejected SSB restrictions in SNAP as a violation of the all-American “pursuit of happiness.” Representative Al Lawson, Jr. (D-FL), said “I am a country boy and so I couldn’t think of anything more important on a Friday than RC Cola and a moon pie.” Representative Alma Adams (D-NC), although diabetic herself, said those living with this illness might need products like SSBs or candy bars to raise their blood sugar.³³

In April 2018, when Chairman Conaway finally released his draft of a nutrition title for the new Farm Bill, it included a re-authorization of FINI grants to incentivize healthy purchases in SNAP, plus a new $120 million pilot program to reimburse participating retail stores for up to 25% of dollar bonuses offered to households purchasing fruits, vegetables, and milk, but the draft included nothing that would limit or even discourage the purchase of SSBs.³⁴

Explanations for Resistance

In addition to the background sociocultural factors mentioned earlier, federal resistance to restricting SSB purchases in SNAP comes simultaneously from at least three specific sources. The first is corporate food lobbying, influential with both parties but Republicans in particular. Second is the influence of specific anti-hunger groups on Democrats to protect SNAP as a source of income support for the poor, however sub-optimal the nutrition outcome. A third factor is institutional inertia within both Congress and USDA. These three sources of resistance reinforce each other, making policy difficult to change.

Corporate Lobby Power

For many in Congress, getting along often means listening to the American Beverage Association (ABA), a politically active trade association representing manufacturers of non-alcoholic beverages, an industry with $195 billion in domestic sales in 2016.³⁵ About $6 billion of these sales may come from SNAP, so disallowing these purchases would harm industry profits.³⁶ Just as important, the reputation of the industry would be harmed, if its products were lumped together with tobacco and alcohol as ineligible for purchase under SNAP.

America’s food retailers, as represented by the Food Marketing Institute (FMI), are equally opposed to restricting SSBs in SNAP. These retailers fear that any new food restrictions in SNAP will complicate checkout procedures at the 260,000 stores now serving SNAP recipients.³⁷ In February 2017, the CEO of FMI reminded the House committee on agriculture that, “Cashiers end up being food police at checkout time.”³⁸ Alongside the FMI stands the National Grocers Association (NGA), representing independent grocery retailers. In April 2018, FMI and NGA jointly organized a “fly in” by 200 supermarket and food industry executives to lobby Congress against any farm bill changes that might burden grocers.

Andrew Fisher has used the Senate’s lobbying disclosure database to calculate that the ABA plus individual beverage companies spent $16.2 million in SNAP-related lobbying activity in 2013, a Farm Bill year.³⁹ In 2016, Coca-Cola, Pepsi, and the ABA together spent $12.2 million lobbying the federal government including USDA, in part hoping to shape policy outcomes in SNAP.⁴⁰ In addition to lobbying, beverage industry political action committees (PACs) make campaign contributions directly to members of the House agriculture committee, totaling $225,000 since 2015 according to one account.⁴¹

When seeking to influence Congress on SNAP, the beverage industry works through Democrats as well as Republicans, particularly those representing minority districts, since roughly one third of all SNAP recipients are African Americans and an additional 14% are Hispanic.⁴² Prior to New York’s 2010 SSB restrictions request, both Coca-Cola and PepsiCo made contributions in the quarter million dollar range to the Congressional Black Caucus Foundation. Partly as a result, 18 members of the Congressional Black Caucus wrote a letter in April 2011 urging the Secretary of Agriculture to reject New York’s petition, which he did.⁴³

To spread their influence even wider, the beverage industry and food retailers also make financial contributions to anti-hunger and anti-poverty organizations, knowing that these groups also oppose SSB restrictions. Led by the Food Research and Action Center (FRAC), these organizations on the political left want an expanded SNAP budget with no new restrictions, which is exactly what the retailers and the beverage industry want. FRAC takes industry money to ease its own fundraising requirements, and to increase lobby access to Republicans in Congress.

The beverage industry first began appearing on FRAC’s list of funders in 2013, and at FRAC’s 2014 annual benefit dinner a number of industry donors were honored, including Coke, Pepsi, and the ABA.⁴⁴ FRAC’s 2017 annual benefit dinner in Washington, D.C., with 300 guests, acknowledged contributions from PepsiCo, the Coca-Cola Company, the American Beverage Association, and FMI.⁴⁵ FRAC is not shy about these industry ties; it even created a Coalition to Preserve Food Choice in SNAP whose members include anti-hunger groups plus the main trade associations: beverages, candy, baking, snack food, and dairy. Tom Farley, a New York City official who unsuccessfully petitioned USDA to test SSB restrictions in 2010, complains that anti-hunger groups like FRAC are actually “doing the bidding of the big food corporations.”⁴⁶

Income Support for the Poor

Anti-hunger groups like FRAC and some liberals in Congress have been opposed to SSB restrictions because, for them, SNAP isn’t entirely about nutrition. They value SNAP not as a tool to alter food choices but as way to increase the overall purchasing power of low income Americans. Every additional $30 in monthly SNAP benefits might raise total SNAP household food spending on average by only $19.48, so in these instances one third of the added benefit is operating like an income supplement.⁴⁷ As one pro-welfare Democrat was willing to say in private, “It’s not a health program.”⁴⁸

Ever since President Bill Clinton supported a 1996 law to “end welfare as we know it,” poor Americans have found fewer ways to qualify for cash benefits from the government. More than 13 million Americans were getting cash payments in 1995, but by 2016 that number had fallen to just 3 million.⁴⁹ The SNAP program, by giving poor households the equivalent of a cash benefit as well as a food benefit, is valued by some Democrats as a partial substitute for the traditional welfare programs no longer available. And as described above, this perspective is reinforced through lobbying from FRAC and other anti-hunger organizations.

Advocates who wish to defend SNAP as a source of income transfer may even see America’s growing obesity crisis as a political threat: rising obesity could undermine the idea that poor people are “hungry” and hence in need of food benefits. SNAP advocates usually fall back on the persistence of “food insecurity,” a condition linked to poverty that is assessed by asking households if, for example, they worry about not having enough money to buy food. Asking ten such questions, USDA concluded in a 2017 report that 41 million Americans lived in “food-insecure households.”⁵⁰ Advocates for SNAP quickly re-phrased this as evidence that 41 million Americans are still “struggling against hunger.”⁵¹

For conservative critics of SNAP, today’s growing obesity crisis can nonetheless be used as evidence that SNAP is enabling the poor to make bad food choices. The sub-text, with an unspoken racial component, is that the recipients might be unworthy of the benefit. According to Republican Representative Steven King of Iowa,

“We built the programs because — to solve the problem of malnutrition in America. Now we have a problem of obesity. When you match up the EBT card with what the scales say on some of the folks, I think it’s worth looking at.”⁵²

Supporters of SNAP know that even discussing SSB restrictions in SNAP may reinforce the conservative narrative that bad choices are being made. It also delivers to poor minorities a message that is taken as discriminatory, since plenty of middle class white citizens who don’t need SNAP are also making poor food choices. Groups representing poor minorities enjoy considerable moral authority inside the Democratic Party, so most elected Democrats defer to their sensitivity on the issue. One irony here is that actual SNAP beneficiaries are not so strongly opposed to SSB restrictions; one 2014 study suggested that a majority of program participants would support removing SSBs from purchase eligibility, especially if paired with incentives for healthier foods.⁵³

Interestingly, all other major federal food benefit programs have strong nutrition standards. This includes the Women, Infants, and Children (WIC) program and the National School Lunch Program (NSLP), which impose clear nutrition standards on the kinds of foods offered. WIC only makes available specifically listed “nutritious” foods, and NSLP lunches must meet federal nutrition standards. While these programs have differences in their origins and aims compared with SNAP, their nutrition standards and limitations are not generally considered discriminatory or insulting.

Public Health Advocacy Falls Short

A number of public health organizations have been willing to consider SSB restrictions in SNAP, but they have learned it is a divisive issue. The American Medical Association (AMA) came out for a soda ban in SNAP in 2013, the same year it decided to classify obesity as a disease; and more recently AMA has emphasized combining restrictions with healthy food incentives in SNAP.⁵⁴ Meaningful monetary incentives for healthier foods might add $4.5 billion or more to SNAP costs every year, so this approach has been fiscally hard to advance.⁵⁵ An organization named Physicians Committee for Responsible Medicine has called for outright restrictions on numerous unhealthy food categories including soda in SNAP, allowing only 28 specific healthful food categories, an approach few congressman may support.⁵⁶ The American Diabetes Association (ADA) has supported a pilot study of SSB restrictions in SNAP, while the American Cancer Society campaigns against SSB consumption and favors taxing retail sales in the marketplace, but not excluding soda from SNAP.⁵⁷

When the public health lobby in Washington tries to join forces with anti-hunger and anti-poverty groups, thoughts about SSB restrictions are often stifled. In April 2017, an alliance of 87 different groups from the National Alliance for Nutrition and Activity (NANA) and the Food Policy Working Group (FPWG) developed a set of “nutrition priorities in the 2018 Farm Bill.” These priorities included incentives in SNAP for the purchase of more fruits and vegetables, but nothing on restrictions or disincentives for SSBs.⁵⁸

One liberal advocacy organization strongly in favor of reducing SSB consumption has been the Center for Science and the Public Interest (CSPI).⁵⁹ CSPI has long depicted SSBs as “liquid candy,” and the organization made a conspicuous effort to restrict SSBs in SNAP during the 2013–14 Farm Bill Debate, when it persuaded fifty-four national and local health groups to call on the Secretary of Agriculture to approve pilot programs for SNAP that might include restrictions on SSBs.⁶⁰ Yet in the current political context, with Republicans in control, CSPI does not want to give ammunition to SNAP critics, so going into the 2018 Farm Bill debate CSPI emphasized instead new research funding ($200 million over 5 years) to support academic studies of things like healthy food discounts in the marketplace.

In 2017–18, the public health organization most clearly in support of a research pilot to test SSB restrictions in SNAP was the American Heart Association (AHA). Expecting opposition from elected Democrats to a stand-alone restriction, AHA proposed a research pilot that combined restrictions with monetary incentives for healthy purchases. There would also be a robust evaluation to measure the effects on diet quality, purchasing behavior, retailer feasibility, and stigma, among other variables.⁶¹ To make this pilot more palatable to Democrats, participation would even be voluntary. AHA worked with both Democrats and Republicans in seeking support for this approach, and some individual members expressed interest, but it was not included in the farm bill draft that emerged from the House committee.

Most recently, when the March 2018 Bipartisan Policy Center report called for SSB restrictions among other recommendations for strengthening SNAP, FRAC called these recommended restrictions “counterproductive,” saying they would bring harm to the SNAP program by “stigmatizing beneficiaries and throwing sand in the gears of this very successful program.”⁶² Two months later, when Representative Faso sought permission from the Rules Committee to offer his restrictions proposal as a floor amendment, it was not approved. The Bipartisan Policy Center continues to promote its report and recommendations to make SNAP healthier.

Institutional Inertia

A third force working to keep soda in SNAP, both in Congress and within USDA, is institutional inertia. For the agriculture committees in Congress, enacting an SSB restriction, or even authorizing a pilot study, would complicate the larger problem of reauthorizing agricultural subsidies every 4 years. Members of Congress from farm states and rural congressional districts are no longer numerous enough to ensure floor vote majorities for farm bills, forcing the agriculture committees to bundle farm subsidies together with SNAP benefits in order to get the majority votes they need.⁶³ The chairs of these committees know that cuts to SNAP, or new restrictions on beneficiaries, will threaten a farm bill by disaffecting Democrats. The House Republican leadership learned this lesson the hard way in May 2018, when Conaway’s draft farm bill containing tighter SNAP work requirements went to the floor with zero Democratic support. The measure failed when 30 Republicans who wanted instead to vote on an immigration bill defected. The problem is even more acute in the Senate where more than a majority is required for floor passage. Senate agriculture committee Chair Pat Roberts made this clear in February 2018, when dismissing any thought of making a drastic change in SNAP. “Quite frankly,” he said, “I need 60 votes.”⁶⁴

A status quo bias for SNAP also prevails within the executive branch. Enacting an SSB restriction – or even pilot restrictions – would require the Food and Nutrition Service inside USDA to classify individual beverage products in the marketplace (including hundreds of new products coming onto the market every year) as either allowable or not under SNAP. This might readily be achieved for SNAP (USDA already classifies beverages for school meals programs), yet it would complicate things at FNS, which until now has been able to classify all food products in the market as allowable. When New York petitioned USDA in 2010 for permission to conduct an SSB restriction pilot, New York officials traveled to Washington to plead their case in person at USDA. At a meeting with Undersecretary Kevin Concannon and a dozen of his staff, the petition was not welcomed. Concannon referred to New York’s request as a “momentous experiment” and then made a joking reference to how small the constituency for change was inside USDA.⁶⁵ Secretary of Agriculture Tom Vilsack eventually turned down New York’s request. USDA stated that the scale and scope of the pilot were too large, retailers might not be able to operationalize the change, there was no clear process for determining product eligibility, and the evaluation design would be inadequate for measuring consumption and total calorie intake⁶⁶; Vilsack said incentives for healthy foods would be a better approach.⁶⁷

A Republican effort to change USDA’s position was made in August 2017, when a group of state officials named the Secretaries’ Innovation Group (SIG) sent a long letter to Secretary Perdue, and also to House and Senate staff, recommending a number of changes to SNAP, including SSB restrictions. This group was made up of human services secretaries and workforce directors from 20 different states, all with Republican governors. The SIG letter to Perdue recommended allowing states to “restrict the purchase of soda, candy and other non-nutritional products.”⁶⁸ Specifically, the letter suggested establishing a pilot project in “up to 10 states” to test “nutrition controls on SNAP purchases.”⁶⁹ Despite this SIG advice, USDA went ahead early in 2018 to refuse Maine’s petition for a soda and candy waiver.⁷⁰

From USDA’s vantage point, even a pilot on SSB restrictions would bring unwanted controversy. Drawing valid conclusions from a pilot would require knowing how many SSBs had been purchased out of pocket, or taken with restaurant meals, or consumed at social events. Twenty-four hour recall surveys can be used to reconstruct this kind of consumption, yet the imprecision of this technique opens room for challenge if any of the conclusions were considered unwelcome. Instead of providing clear answers, a pilot might thus create new controversy. Conducting a restrictions pilot with actual SNAP recipients would also be legally sensitive from USDA’s perspective, since it would temporarily withdraw, from some at least, a currently entitled choice. USDA’s mantra when experimenting with SNAP is, “First, do no harm.” To protect itself, USDA would want political cover for a pilot in the form of a Congressional mandate.

A Failed Effort in California

On one occasion near the end of the Obama Administration, it appeared that a pilot study of SSB restrictions might be launched in California, but this effort also failed. USDA by then had received several state petitions for SSB pilots, so FNS saw some value in regaining control of the process by encouraging a pilot with a state-level partner it could trust, and funding for this purpose was added to the FY2017 research budget of FNS.⁷¹ The Obama White House gave USDA political clearance to go ahead with this effort, and a local pro-nutrition organization in California stood ready to conduct the pilot in several rural counties, as long as it included incentives for healthy food choices along with restrictions, and as long as the participating SNAP recipients retained an option to keep their existing benefit (opening the way for possible selection bias, of course).

The California experiment never took place in part because petitions to USDA can only come from states, not county governments, and in Sacramento California’s Department of Social Services (CDSS) was not ready to endorse a pilot, having sensed objections from the state’s private legal services lobby, which viewed itself as a defender of the poor. A final blow was Donald Trump’s November 2016 election victory, which meant the results of any California pilot would be interpreted by a Republican rather than a Democratic USDA. Pro-nutrition reformers sensed they had missed their political window, and no petition from California was ever forwarded to USDA.

Breaking the Iron Triangle

Political scientists attempting over the years to explain why federal subsidies to farmers are so durable have pointed to an “iron triangle” of institutions blocking reform: The agriculture committees in Congress, the Department of Agriculture in the executive branch, and an organized “farm lobby” from civil society.⁷² The analysis here identifies a parallel iron triangle of institutions focused on keeping soda in SNAP: the agricultural committees of Congress (needing Democratic votes to pass a farm bill); the Department of Agriculture (with a Food and Nutrition Service leery of restrictions); and civil society groups that include advocates for minorities and the poor in addition to private industry. Is there any way, in the interest of better nutrition targeting in SNAP, to break this parallel iron triangle?

As our nation’s obesity crisis continues to worsen, as the harms of SSBs are more widely understood, and as the increasing sociocultural focus on “clean” and healthy food continues to grow, we believe that resistance to conducting a range of nutrition-focused research pilots in SNAP, including SSB restrictions, will eventually resolve.

Alternatives to restrictions might also be considered. One example would be a partial financial disincentive in SNAP for SSB purchases, and perhaps for other unhealthy products as well such as junk foods and processed meats, combined with financial incentives for healthy foods such as fruits, vegetables, nuts, whole grains, fish, and plant-based oils.⁷³ This approach would avoid rejections at checkout, preserve choice, not single out SSBs alone, and combine fiscal incentives with disincentives to be cost neutral for SNAP.

What happens next will depend on what various pilots might reveal. If implementing a restriction does not disrupt retail checkout, and if significant health-improving reductions in SSB consumption can be documented, retailer objections will diminish, the beverage industry will become more isolated, public health groups will be emboldened, and pressure on Congress to enact a restriction will grow. On the other hand, a research pilot might just as well reveal SSB restrictions causing serious implementation problems at checkout, and it might fail to document significant health-improving reductions in SSB consumption, as recipients simply switch to out-of-pocket purchases. If these are the findings, restricting soda in SNAP will be made more difficult, and public health advocates may have to turn their attention to more promising venues for policy change. This supports the need to simultaneously test a range of approaches in different state SNAP pilots, including potential restrictions, incentives, and combined incentive/disincentive programs.

Biography

Robert Paarlberg is adjunct professor of public policy at the Harvard Kennedy School. From 1976 until 2015 he was professor of political science at Wellesley College. He received his B.A. from Carleton College and earned a PhD in International Relations from Harvard University. He is the author of six university press books, including most recently, The United States of Excess: Gluttony, and the Dark Side of American Exceptionalism (Oxford 2015).

Dariush Mozaffarian is Jean Mayer professor of nutrition and medicine, and dean of the Friedman School of Nutrition Science and Policy at Tufts University. He is a cardiologist who has authored more than 300 scientific publications on the dietary priorities to reduce cardiovascular disease, diabetes, and obesity in the US and globally; and on evidence-based systems, innovations, and policies to reduce effectively these burdens. Dr. Mozaffarian has served in numerous advisory roles, including for the US and Canadian governments, American Heart Association, Global Burden of Diseases study, World Health Organization, and United Nations. He is also Editor-in-Chief of the Tufts Health & Nutrition Letter.

Renata Micha is research associate professor at the Friedman School of Nutrition Science and Policy at Tufts University. She is trained as a clinical dietitian, public health nutritionist, and epidemiologist and has expertise in nutritional and chronic disease epidemiology

Carolyn Chelius is Food Literacy Project (FLP) Manager at Harvard University. She is a 2016 graduate from Wellesley College who received a dual degree in Economics and Environmental Studies. In addition to coordinating the FLP, she oversees Harvard’s Farmers’ Market and the Harvard Community Garden.