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Abstract
Objectives. To examine whether the expansion of Medicaid under the Affordable Care
Act (ACA) decreased the prevalence of severe food insecurity. Methods. With data
on adult respondents to the Food Security Supplement to the Current Population Survey
in US states for the years 2010 to 2013 and 2015 to 2016, I used a difference-in-difference
design to compare trends in very low food security (VLFS) among low-income childless
adults in states that did and did not expand Medicaid in 2014 under the ACA. Results.
Among low-income, nonelderly childless adults, VLFS rose from 17.4% before ACA to
17.5% after ACA in nonexpansion states, and fell from 17.6% to 15.9% in expansion
states. In difference-in-difference analysis, Medicaid expansion was associated with
a significant adjusted 2.2-percentage-point decline in rates of VLFS, equivalent to
a 12.5% relative reduction. Conclusions. The improvement in food security after the
ACA’s health insurance expansion suggests that health insurance provision has spillover
effects that reduce other dimensions of poverty. Public Health Implications. Providing
free or low-cost health insurance coverage may free up household funds, reducing food
insecurity and improving this important social determinant of health.
Nearly 15% of all U.S. households and 40% of near-poor households were food insecure in 2009. The Supplemental Nutrition Assistance Program (SNAP) is the cornerstone of federal food assistance programs and serves as the first line of defense against food-related hardship. This paper measures the effectiveness of SNAP in reducing food insecurity using an instrumental variables approach to control for selection. Our results suggest that receipt of SNAP benefits reduces the likelihood of being food insecure by roughly 30% and reduces the likelihood of being very food insecure by 20%.
Food insufficiency is a significant problem in the United States, and poor African American women with children are at especially high risk. An inadequate household food supply can potentially affect the well-being of household members, but it is difficult to distinguish the effects of food insufficiency from risk factors for poor health that are also common among the food insufficient, such as poverty. We examined food insufficiency and physical and mental health among African American and white women (n = 676) who were welfare recipients in 1997. Controlling for common risk factors, women who reported food insufficiency in both 1997 and 1998 were more likely to report fair or poor health at the later date. Food insufficiency in 1998 was significantly associated with meeting the diagnostic screening criteria for recent major depression. Food insufficiency at both times and in 1998 only was related to women's sense of mastery. These findings add to growing evidence that household food insufficiency is associated with poor physical and mental health.
Current measures of access to care have intrinsic limitations and may not accurately reflect the capacity of the primary care system to absorb new patients.
[1
]Gracie Himmelstein is a PhD candidate in Demography and Social Policy in the Office
of Population Research at Princeton University, Princeton, NJ, and an MD candidate
at the Icahn School of Medicine at Mount Sinai, New York, NY.