The Wrongologist

What’s Wrong Today:

The Farm Bill expired on September 30, 2013. It happens to include the authorization for funding the Supplemental Nutrition Assistance Program (SNAP, or Food Stamps). Senate lawmakers are proposing a $4 billion cut over the course of 10 years, while the Republican-controlled House voted to slash $40 billion from the program last year. Most lawmakers think the Farm Bill will be voted on in the next few weeks.

Congress should consider the unintended consequences of cutting food stamps.

A new study from the University of California, San Francisco, (UCSF) published online in the journal Health Affairs indicates that poor people with diabetes are significantly more likely to go to the emergency room (ER) for dangerously low blood sugar at the end of the month when food budgets are tighter than they are at the beginning of the month.

The ER admissions occur because diabetics can suffer from low blood sugar (hypoglycemia), when they have not had enough to eat, but continue taking medications for the disease. The symptoms include dizziness, sweating or nausea. In rare cases, hypoglycemia can cause fainting, coma, or death.

In order to control diabetes, patients need to keep their blood sugar within a narrow band. Levels that are either too low or too high (known as hyperglycemia) can be dangerous to diabetics. About 25 million Americans, or 8% of the US population have diabetes, according to the Centers for Disease Control and Prevention. The US spends more than $100 billion a year treating people with the disease, the CDC estimates.

And the poor are disproportionately affected: In the study, UCSF researchers matched hospital discharge records from 2000 to 2008 covering more than two million people in California with the patients’ ZIP codes. People living in the poorest ZIP codes, where average annual household income was below $31,000, were counted as low income.

For each 100,000 admissions of poor people, about 270 of them were given a primary diagnosis of hypoglycemia, compared to only 200 per 100,000 among people of higher incomes. Dr. Hilary Seligman, assistant professor of medicine at UCSF, and the study’s lead author, said the difference was statistically significant.

The New York Times reported that Dr. Seligman said she and her colleagues were aware of the debate in Washington about food stamps, and sought to document whether running out of food stamps or money to buy food at the end of the month damaged people’s health. Previous research had already established that people often give a higher priority to paying monthly bills for rent or utilities, for example, than to buying food, which is managed from day to day. From Dr. Seligman:

Seligman and her coauthors posit a plausible story about the “pay cycle” that develops in households of low-income individuals. Toward the end of the month, a household’s resources—income, SNAP, Social Security, and/or other benefits—can become exhausted, ostensibly changing food consumption patterns.

From the Study’s Abstract:

The Incidental Economist blog posted this chart from the Seligman study:

The chart shows that low-income individuals are at higher risk of hypoglycemia—and the risk increases over the course of a month, consistent with a hypothesis about exhausted food budgets. Their high-income counterparts exhibit no significant trend. Appendicitis findings are offered as a comparison which shows no significant change in admissions over the course of a month.

According to the authors, “hypoglycemia is one of the most common adverse drug events leading to visits to the emergency department”, and it’s been estimated that episodes of care for hypoglycemia have an average cost of $1,186. 

For some perspective on food stamps, they are actually only about 2% of the overall federal budget. The program cost $78.4 billion in the 2012 fiscal year. The amount given to each household averages $272 per month. In the 2010 fiscal year, 40.3 million people were enrolled. Two years later, that number had jumped by 16% to nearly 47 million people. Just over 45% of those getting food stamps are children, according to the Agricultur
e Department.

In the Fox News version of America, food stamp spending is not higher than in the past because more people are poor and hungry. Rather, food stamp use is up because the Obama European Socialist Machine is deliberately trying to build a bigger, stronger, government-supporting coalition for future elections.

In reality, it’s a mirror of the social inequities that plague our nation and drive health disparities.

The poor are always first up for attacks by government. They do not make any campaign donations, and they don’t have lobbyists. Isn’t any Congressional agenda in the last 20 years simply a matter of following the money?

To Republicans, the poor are political poker chips. They are the poster children for an ever expanding government, as well as the preferred sacrifice when the time comes to “defend our principles”.

Anyone who suggests that we must care for the poor, is considered to have an ulterior motive. Give to defense contractors? That’s another story. You have to spend on defense, or the terrorists win.