Identify a policy that is not usually intended to be a health policy but that you think may have important health implications.
Resumption of work requirement for ABAWDs (Able-Bodied Adults Without Dependents) receiving SNAP (Supplemental Nutrition Assistance Program) in the state of Alabama. An ABAWD is a person between the ages of 18 and 49 who has no dependents and is not disabled. ABAWDs can only get SNAP for 3 months in 3 years if they do not meet certain special work requirements. This is called the time limit. The time limit does not apply to people who are unable to work due to physical or mental health reasons, pregnant, care for a child or incapacitated family member, or are exempt from the general work requirements. To be eligible beyond the time limit, an ABAWD must work at least 80 hours per month, participate in qualifying education and training activities at least 80 hours per month. Due to the economic downturn, many States qualified for and chose to waive time limits in all or part of the State.
Describe why an evaluation of that policy is informative (e.g., determining effects of the policy, or primarily a test of hypothesized mediators).
The resumption of work requirement may have both positive and negative health related effects. For example, able bodied SNAP recipients may benefit from retraining, getting back to work, moving out of poverty, eligible for employer health benefits which can translate into lower morbidity and mortality. On the other hand, some recipients may lose benefits and may slid back into poverty and have worse health related outcomes.
Specify the outcomes and populations you think most affected or least affected by the policy.
Population Affected: SNAP recipients excluded from the waiver.
Outcomes: Cardiovascular Disease, Mortality
Propose a study design to evaluate the policy.
Cohort study. Cases – ABAWD SNAP recipients in the states of Alabama and Kentucky. Here the recipients in the state of Alabama will be cases (required to resume work or training) and those in the state of Kentucky will be controls (requirement is still waived).
Describe biggest challenge to implementing and drawing inferences about the impact of the policy on health.
Each state is different in terms of employment and retraining opportunities. The policy is implemented statewise; hence it is not feasible to conduct the study within a state. Thus, the conclusions may be subject to criticism due to differences in cases and controls. In addition, conclusions in a state may be unique to that state and may not be applicable to a different state. Implementing uniform changes in policies may thus be difficult.