The Trump administration’s continued war on welfare directly targets a system that today provides crucial, if fragmented, state support for the working class in the United States. Its latest mark is the Supplemental Nutrition Assistance Program (SNAP, colloquially known as food stamps). SNAP, along with other programs, effectively holds crisis at bay for many working-class families, serving the immediate needs of some of the poorest Americans through an average monthly benefit of $127 to over 40 million people. On July 24, 2019, the USDA Food and Nutrition Service (USDA-FNS) proposed a rule that would remove 3.5 million people from food stamps entirely. In the pursuit of a multiracial, working-class movement, we must defend the health of low-income people, while opposing the erosion of essential benefits and continued use of means-testing for basic services.
The federal government already uses aggressive means-testing to determine who qualifies for SNAP. Under the new rule, that would only worsen: those with an income above 130 percent of the federal poverty line or in possession of more than $2,250 in assets would be excluded. The limit rises to $3500 for households with an elderly or disabled person. The rule would eliminate the moderate flexibility states currently have in deciding who is SNAP-eligible in each state’s specific context.
As it is, SNAP leaves substantial gaps in coverage, and its beneficiaries routinely face food shortages and rationing toward the end of the month when their allotment runs low. This can have catastrophic effects on their health. While working on a research study, one of the authors of this article met a participant who periodically stopped taking her HIV medication when she ran out of food, because the drug was meant to be taken at mealtimes. The virus made a resurgence in her blood and became resistant to this medication. She developed a dangerous form of inflammation in her brain and started experiencing a complex of symptoms known as HIV-associated neurocognitive disorder. This rule change will only exacerbate existing gaps in state support, making cases like this patient’s all the more likely to affect lower-income people.
If 3.5 million people lose SNAP benefits, the devastation to their health will be immense. Much of it will come from the progression of heart disease. Food insecurity increases the risk of having high blood pressure and high cholesterol, two of the biggest risk factors for a variety of cardiovascular diseases, including heart attack, stroke, and congestive heart failure. Heart disease is already the number-one cause of death in the United States, and it already disproportionately affects lower-income people, effectively discriminating along class lines. Eroding access to SNAP will deepen this inequality in health outcomes.
The proposed rule wages war on the poor not just by worsening the health of those who have the least access to health care and the highest burden of disease, but by entrenching poverty via a welfare paradigm premised on means-testing and work requirements. By framing the rule as a way to “close a loophole” and “ensure that SNAP benefits are targeted to the appropriate households,” the USDA-FNS implies that those who stand to lose their SNAP benefits don’t really deserve them. These recipients are portrayed as exploiting a flaw in a system explicitly dedicated, as Brian Hennigan writes, to the “paternalistic rehabilitation of one’s capacity to work.” It also seeks to undermine solidarity and class consciousness by dividing the working class into two categories: one deserving of assistance and one not.
SNAP has been in Trump’s crosshairs for years. He railed against the program on Twitter even before he became president; once in office, he considered adding drug-testing and work requirements in order to increase the administrative burden for accessing benefits.
This fits within the administration’s broader efforts to cut welfare benefits across the board. A March 2019 report from the White House Council of Economic Advisers (CEA) helps elucidate the government’s position. As Eric Levitz explains, the CEA report argues that while the War on Poverty succeeded in lifting people out of poverty, it failed to make individuals “self-sufficient.” The CEA concluded that adding work requirements was the next step forward, while a subsequent budget proposal saw assistance programs’ budgets slashed by trillions. The broader ideological project of expanding wage labor at the expense of human dignity and welfare has a robust history, and it makes standing up in this latest salvo all the more critical.
To this end, as democratic socialist medical students, we’ve been organizing people to write public comments against the proposed regulation. We urge you to write your own comment. You don’t have to be an expert, you just have to tell the USDA-FNS why cutting SNAP would be disastrous. The Public Comment Project provides excellent guidance for writing an effective comment, and ample information about the likely outcomes of the rule is available online. If you happen to be a part of the medical community, please also consider adding your name to our petition to the USDA-FNS, which has already been signed by more than 700 medical students and residents.
The rule is open for public comment until September 23, and the USDA-FNS is obligated to respond individually to each unique comment made before this deadline. Not only is the agency required to take criticism into account before finalizing the rule, but every comment made will delay its implementation. Let’s swamp the bureaucrats with paperwork while we keep fighting for a world without impediments to the basic human rights to food and health care.
To do this in a meaningful and sustainable way, however, we in the medical profession will need to transform the structures that organize medical professionals, and the way that we conceive of our place in the class struggle. While doctors have historically been prevented from unionization in the United States, other health-care workers have already aligned their labor movements with the interests of their patients.
From improving patient safety by lobbying for more reasonable nurse-to-patient ratios to advocating for the economic rights of patients, National Nurses United (NNU) has set a powerful example. This past summer, NNU published a report bringing Johns Hopkins Hospital (JHH) to task for hounding patients over medical debt. For years, JHH had seized wages and bank accounts of patients who couldn’t pay their medical bills. The median debt was a paltry $1,438. For perspective, JHH received $164 million in tax exemptions in 2017. While NNU fights for the basic human right to health care, the American Medical Association (the largest and most influential group of physicians in the country) refuses to back a single-payer system, ensuring that the sickest, poorest patients will continue to be swamped with debt.
As medical students and as socialists, we know that caring for the health and well-being of our patients means mobilizing ourselves and others in solidarity with the working class. Rather than accepting the steepening gradients of inequality that propagate disease among those who are most exploited by capital, we should fight the underlying economic system that inflicts violence on their health. Opposing Trump’s latest round of attacks on SNAP recipients is a crucial part of that fight.
Tobias Kirchwey, Pranav Sharma, Fatima Warsame & Kiara Corcoran Ruiz
The authors are students at the Alpert Medical School of Brown University.