Medicare and Medicaid Look into Food Subsidies to Keep You Healthy

"Let food be thy medicine and medicine be thy food." Hippocrates may have had a point. What we put into our bodies affects our health in countless ways. Aligning with the food-as-medicine movement, states are increasing taxes on processed foods, and Medicare and Medicaid are piloting programs for food subsidies.

Nutrition and Chronic Disease

Access to food is essential for life but access to healthy quality food can also help to decrease the risk of disease. It is one of the social determinants of health.

The modern-day American diet thrives on convenience. That often means processed foods with added sugar, fat, salt, nitrites, and food additives. High salt diets can provoke hypertension, high-fat diets can be associated with heart disease, and added sugar can increase the risk for diabetes.

What we eat affects these chronic health conditions just as much as medications. Not everyone knows what foods to choose and those that do cannot always afford them. More educational and public health reforms are needed to make a difference.

Food Education

Most people need to learn more about nutrition, and that includes doctors and other medical professionals. The Food as Medicine Institute, based in Portland, Oregon, has an annual symposium on nutrition for medical professionals. The goal is to educate them so that they can better apply nutrition principles in clinical practice.

There is even a teaching kitchen at the Helfgott Research Center for doctors, chefs, and nutrition experts to get hands-on training that they can then use to show with others. The Institute offers a public track in their symposium and other community programs. Medical professionals can also take action to educate their patients.

The St. Joseph Hoag Health Alliance in Huntington Beach, California has developed a Shop with Your Doc program where a doctor meets you at the grocery store to help you make better choices at the point of care.

One of the most important aspects of food education is making sure that people do not fall into pseudoscience. With the popularity of food as medicine, there is plenty of profiteering to go around.

Many nutritional supplements and diet books do not have research or data to back up their claims. Not only could they be costly, but they could also be potentially dangerous. Buyer beware.

Food Subsidies

Whether from medications, doctor's visits, or hospitalizations, the Centers for Medicare and Medicaid Services (CMS) understands that people with chronic diseases have more healthcare expenses. With Medicare losing solvency by 2026, it has become more important than ever for the government to rein in costs. They may be turning to healthy food prescriptions to do just that.

Likewise, for those who already have chronic diseases, healthy lifestyles, including access and affordability to healthy foods, may be able to decrease the risk of flare-ups and increased spending. This is where food subsidies come into play.

A 2019 study published in PLoS Medicine (Lee et.al.) looked at two different models for food subsidies, each offering a 30% discount on healthy foods. In the first, food subsidies were provided for fruits and vegetables only. In the second, the subsidies were broader, including not only fruits and vegetables but also whole grains, nuts and seeds, seafood, and plant oils. Computer simulations were run for each model using data from Medicare and/or Medicaid beneficiaries who had participated in the three most recent National Health and Nutrition Examination Surveys (NHANES 2009-2014).

The researchers found that both food subsidies were cost-effective. In the first model, 1.93 million cardiovascular events (heart attacks and strokes) would be prevented and $39.7 billion saved. In the second model, numbers increased to 3.28 million cardiovascular events and $100.2 billion. This is not the first study to show the benefits of food subsidies on healthcare spending and health outcomes. Peñalvo et al, and Niebylski et al., have published notable studies in BMC Medicine and Nutrition, respectively.

Pilot programs for food subsidies are being pursued in the U.S. thanks to the passage of the 2018 Farm Bill. This bill reauthorized the Food Insecurity Nutrition Incentives Program, now called the Gus Schumacher Nutrition Incentive Program. The program receives $250 million over five years and includes a Produce Prescription Program.

Food Taxes

Not all states tax groceries. The idea is that it is unfair for people with lesser means to spend a larger portion of their income on essentials like food and beverages. In fact, 32 states exempt groceries from taxes altogether. Another six states (Arkansas, Illinois, Missouri, Tennessee, Utah, and Virginia) tax groceries but at a rate lower than their state's sales tax.

The question is what qualifies as "groceries?" Someone can certainly buy something at a grocery store and be taxed on it, even if they live in a tax-exempt state.

Each state has a different interpretation, and not everyone agrees if candy and soda make the list. Even when these items are known to have low nutritional value, some states tax for them and others don't. As of July 2018, 62% of the 38 states with full or partial grocery exemptions will tax their full sales tax for the purchase of candy or soda.

The disincentive to purchase these items may steer people towards healthier food choices and can lead to decreased rates of cardiovascular disease and diabetes.

Also, income generated from a candy and/or soda tax could be redirected towards public health programs that can further benefit the community. While these taxes remain controversial, more states are taking them into consideration.

A Word From Verywell

America needs to change how it eats to become a healthier nation. Food taxes on unhealthy foods like candy and soda may disincentivize people from making poor choices while food subsidies on healthy foods may improve access and affordability to quality foods like fruits and vegetables. Regardless, more public health initiatives need to be taken to improve the health of individuals and their communities.