The Impact of SNAP Work Requirements on Nutrition-Sensitive Comorbidities: Evidence from Hospital Inpatient Data

• In Event: SNAP Work Requirements and Their Impact on Health and Financial Well-Being Outcomes

Abstract

This study examines whether SNAP work requirements for Able-Bodied Adults Without Dependents (ABAWDs) affect nutrition-sensitive health outcomes in hospital inpatient settings. While prior research confirms SNAP work requirements reduce participation with minimal employment gains, evidence on health impacts is scarce and has generally not examined nutrition-sensitive clinical outcomes. Using 2003-2011 Health Care Cost and Utilization Project (HCUP) National Inpatient Sample data merged with county-level ABAWD waiver information from the Center on Budget and Policy Priorities and USDA, I investigate whether access to SNAP influences the prevalence of nutrition-sensitive comorbidities. My identification strategy leverages two forms of variation: geographic differences in waiver implementation and the age cutoff (50) that determines ABAWD status, examining the interaction between patient age (under/over 50) and county waiver status to isolate the effect of work requirement exposure. This approach employs hospital, procedure, and year-month fixed effects while controlling for county-level economic conditions associated with waiver status, including unemployment rates and median household income. To minimize utilization bias inherent in studying discharge data, I focus specifically on comorbidities—conditions not directly related to the principal diagnosis—rather than primary diagnoses, examining nutrition-relevant conditions including fluid/electrolyte disorders, deficiency anemias, weight loss, diabetes, and hypertension. I also analyze whether exposure to work requirements is associated with higher severity levels for discharges where these conditions are present. Methodological challenges including the NIS's unbalanced panel sampling design and potential endogeneity between economic factors and waiver status are addressed through hospital fixed effects and economic controls, while I conduct falsification tests using conditions less likely affected by nutritional access. I also examine heterogeneity by primary payer, with particular focus on Medicaid-covered discharges, as these patients are more likely to be affected by SNAP policy. Preliminary findings suggest that exposure to work requirements is associated with increased prevalence of certain nutrition-sensitive comorbidities, particularly among Medicaid patients—individuals under 50 in non-waiver counties (subject to work requirements) show statistically significant increases in fluid/electrolyte disorders and weight loss comorbidities compared to those not exposed to work requirements, and demonstrate higher rates of severe illness when presenting with these comorbidities. These findings contribute timely evidence on how safety net program restrictions affect health outcomes among vulnerable populations, particularly relevant as recent legislation has increased the ABAWD age threshold and USDA has signaled a more restrictive approach toward waivers, revealing concrete health implications of work requirements and informing ongoing policy debates about the broader impacts and tradeoffs of safety net program conditionality.

Author

• Mitchell McFarlane, Syracuse University
  Presenting Author