Will We Let Our Children Go Hungry?

This past Wednesday, February 12, 2020, I had the opportunity to testify before the General Laws Committee of the Missouri House on behalf of the Missouri Chapter of the American Academy of Pediatrics (MOAAP) against HB1785, a proposed bill to tighten work requirements for recipients of SNAP, the Supplemental Nutrition Assistance Program. This is the program that many of us know as Food Stamps.

This was the fourth bill considered by the committee that afternoon. The hearing started just after 4:00 PM, and the representative who proposed this bill began testifying on it at about 6:20.

Coincidentally, that morning my colleagues at Danis Pediatrics, our primary care clinic at Saint Louis University and SSM Health Cardinal Glennon Children’s Hospital, had presented at Grand Rounds, our weekly big educational meeting, about their work to help identify and address issues of food insecurity in our patient population.

“Food insecurity” is that more scientific way of saying: My kids and I often go to bed hungry.

Over the past year we have been asking our parents at Danis Peds to fill out questionnaires when they come in for well child visits to assess food insecurity among other things (problems with housing, utilities, etc.). While the data are preliminary and depending on how we asked the question, somewhere between 10% and 40% of our families are dealing with simply not having enough food to feed their kids day to day.

From a data standpoint, this is a big spread, and there is still a lot of work to do, but even if it’s the low number — 10% — it’s a scandal that one out of ten kids in what we like to think of as the richest, most generous country in the world go to bed hungry.

And this includes families who already receive SNAP benefits. SNAP, a federally-funded program, provides the most basic nutrition to those who receive it. On average, families receive the equivalent of $1.35 per person per meal or right around $5.00 per person per day. Even at that most basic level, Missouri receives $1.2 billion per year in federal funds to support this program, and there are people in every corner of Missouri — urban, rural, and suburban — who depend on this crucial lifeline.

As for my being there to give testimony, it was really coincidental. It turns out that, months ago, the MOAAP board scheduled a board meeting in Jefferson City on Thursday, February 13. I had already planned to be there the evening before so I got on the road from St. Louis at about 1:30. I arrived just before the start of the hearing, put on my white coat, and walked to the Capitol.

A quick word about that white coat: I am not a white coat guy. I find them cumbersome and heaven knows, they are not at all slimming! Still, they seem to be catnip for legislators so doctors generally wear them whenever we go to visit federal or state lawmakers. SLUCare buys the faculty new white coats every couple of years with our names embroidered on them. This one had been hanging on the back of my office door for quite a while so I grabbed it as I headed to the car. When I got to the Capitol, as I was walking toward the building, I realized that it still had a price tag hanging from the hem. Luckily, I was able to yank that off before going through security.

When I got to the hearing room, I was the only doctor there and therefore the only one not is some form of business attire. As I sat waiting to testify, I felt like that person who goes to a costume-optional party and finds out they’re the only one who wears a costume.

Like I said, I’m not a white coat, guy. Anyway, back to business.

As I listened to testimony on the bills that were being heard before HB1785 while waiting to testify myself, I went over the statement and fact sheet that we at MOAAP had prepared to make the case that this bill would be bad for kids. It’s been estimated that the state of Missouri would lose $95,000,000 in federal funds if this bill were passed, and much worse, 45,000 Missouri kids would lose access to basic nutrition.

Contrary to what you might think, I get nervous at times like this. Testifying in front of legislators is not my sweet spot. In fact, I find it kind of terrifying. I don’t think of myself as being good at confrontation. Truth be told: I avoid it whenever I can. So here I was, hoping against hope, that I wouldn’t have to face hostile legislators while wearing a white coat that made me look, I thought, either pretentious or dorky — or both.

As afternoon slid into evening, I began to feel, after my hundredth or so review of my notes, that I might be more effective speaking off the cuff rather reading from a prepared statement.

Then the committee took up its third bill, HB1708. Among the provisions of this bill is one to restrict the ability of TANF (Temporary Assistance for Needy Families, which used to be called Welfare) or SNAP recipients from obtaining cash from their electronic benefit card to pay for purchases that cannot be made with the card. There are already restrictions on how these funds can be spent. TANF is to help with the needs of everyday living — rent, transportation, laundry, utilities, etc. SNAP is for food. Both prohibit use for the purchase of “alcoholic beverages, lottery tickets, pornography, or tobacco products,” and other adult-oriented products and services.

What struck me about the testimony by the bill’s sponsor was the stunning lack of appreciation of the realities of living in an economically-poor community. Many of these communities depend on a cash-based economy. Many landlords will only accept cash. If you go the laundromat, you need dollar bills to put in the coin-changer to work the machines. When you need a ride to the doctor for yourself and your kids, your neighbor may need $5 for gas. None of that would be possible if this bill were to become law.

I was heartened that committee members from both parties were generally skeptical about the wisdom of this bill. One Republican representative went so far as the say to the sponsor that, while they often agreed on legislation, he was going to have to push back on this one. In essence, he said that he grew up in a household with a single mom where his family relied on this form of assistance. She had problems with substance abuse. Did she sometimes use the funds from this program for purposes that were not approved? Yes. But he said, he also got the benefits, enough to get him through to be able to make a life for himself and to sit in the Missouri General Assembly. If these benefits had been cut off due to his mother’s problems, he would have suffered too.

Finally, it was time for HB1785. The sponsor used his allotted time to talk about the importance of making sure that if public funds go to “able-bodied” (not defined in the legislation, by the way) adults, they would have to meet more stringent work requirements than are already part of the current system. More concerning was the inclusion of more rigid reporting requirements for recipients. In other words, even if a person working a low-wage job (or jobs) was at a low-enough income level to qualify for SNAP, if they did not fulfill these reporting requirements for ANY reason, and here I quote from the bill:

The disqualification period shall be as follows:

(1) For the first occurrence of noncompliance, the individual shall be disqualified for three months;

(2) For the second occurrence of noncompliance, the individual shall be disqualified for six months; and

3) For the third occurrence of noncompliance, the individual shall be disqualified permanently.

If an individual who is the head of a household…becomes disqualified under this section, THE ENTIRE HOUSEHOLD [emphasis added by me] shall be ineligible to participate in the program for a period not to exceed the lesser of either the duration of the ineligibility period of the disqualified individual or one hundred eighty days. A household disqualified under this subsection may reestablish eligibility if:

(1) THE HEAD OF THE HOUSEHOLD LEAVES THE HOUSEHOLD [emphasis added by me];

(2) A new and eligible individual joins the household as the head of the household; or

(3) The head of the household becomes exempt from the program’s work requirements during the disqualification period.

This is me again. That is the pertinent language in the bill. In other words, if you do not meet the reporting requirements for any reason, you and everyone in your household loses your access to food. One way this bill would restore your family’s eligibility is if you, as the head of the household, leave and abandon your family.

I will just stop here for a minute to allow us all time to think about the ramifications of these proposals…

Now, at this point I want to make clear that I truly believe that the legislators who proposed both HB1708 and HB1785 sincerely believe that the threat of loss of benefits will be a kick in the pants to people who want a better life for themselves and for their kids.

But they are wrong. Psychologically. Socially. Economically. They are extrapolating from life experiences that give no accurate context for the lived experience of the humans for whom these policies would be devastating. Further, they are unwilling to give people the tools they would need to make the changes they would need to make — and indeed would like to make — for these policies to be anything but disastrous for tens of thousands of Missouri’s kids.

In talking about his bill the sponsor extolled the fact that these reporting requirements would give people the motivation to better themselves. “People don’t need a hand out. They need a hand up.” When questioned about where this “hand up” would come from, the sponsor talked about various jobs and transportation programs already in place. On further questioning, he acknowledged that his bill did nothing to expand these programs or to improve access to them. In fact, the only new positions that would be created by this bill would be for personnel who would track these work requirements and make the decision to terminate families from the SNAP program. Both he and the first witness speaking in support of the bill said that, while they could not dispute the projected loss of $95,000,000 to Missouri’s economy as well as 45,000 kids losing SNAP benefits, they felt that the motivation that this loss of benefits would provide to push people to find jobs that would more than offset the loss of federal dollars and that there were plenty of food banks and other sources of charitable food that would make sure that no child went hungry.

To say that I was pretty upset by this point would be a vast understatement. Two quotes swirled through my head as I listened to these witnesses:

The first from the pre-redemption Ebenezer Scrooge: “Are there no prisons? Are there no workhouses?”

The second from Marie Antoinette when informed that the people had no bread to eat: “Let them eat cake.”

When the Chair asked for those speaking in opposition to the bill, I walked up to the witness desk. I introduced myself, I said that I was a pediatrician — thus the white coat — and I was speaking in opposition to HB1785 on behalf of the 1200 members of the Missouri Chapter of the American Academy of Pediatrics. My thought of speaking off the cuff was abandoned. I was so upset that I was trembling, and it was everything I could do to sit and read from my prepared text. I finished after about 90 seconds, and said, “I would be happy to hear any questions or comments.”

To backtrack, I had been happy, relieved even, when I walked inot the hearing room at 4:00 PM and saw that Rep. Tracy McCreery and my own representative, Rep. Peter Merideth, were on this committee. I have known them and worked with them for years on issues of justice, not just in health care but in LGBTQ equality during my years on the board of PROMO. Seeing them there helped me stay grounded. As it turns out, Tracy and Peter were the only ones to ask questions. To be honest, in situations like this, I get into a flow state near-fugue zone, so here, to the best of my recollection is what I recall of what followed:

In my remarks, I had discussed how the bill makes some provision to make sure kids get some benefits, if not all, if a parent loses theirs. Still, even if a child is being fed, if their parent can’t afford food, the child is still traumatized. Tracy asked me to expand on that.

Over the past twenty years there’s ben a growing body of evidence about the devastating effects on Toxic Stress on children that can be lifelong. One of the most harmful causes of Toxic Stress is having parents who themselves are under constant stress. These parents are already constantly being bombarded by worries about keeping the lights on, a landlord who won’t get rid of black mold in your apartment, having to work three low-wage jobs and juggling bus schedules to get to them, knowing you can be fired if the bus didn’t come through no fault of your own. If they then lose their SNAP subsidy and are starving, how can a parent be emotionally available to a child under those circumstances? This deprivation turns on genes in the child for stress hormones which can be useful in the short term, like if you’re running from a saber-toothed tiger, but if it’s on constantly, it will affect that child’s health for the rest of their life, not only psychological and emotional health, but physical health. Children who grow up with Toxic Stress have higher lifelong rates of asthma, allergies, heart disease, high blood pressure, diabetes type 1 and type 2, strokes, and lots more.

Peter noted that I had worked in communities affected by poverty for my entire career.

Yes, I said. I worked in East St. Louis for 10 years, and as of last month I had been at Cardinal Glennon and SLU for 22 years.

He asked if the assertion that threatening people with loss of benefits would motivate them to get jobs and get off public assistance was accurate.

Absolutely not, I said. All it will do would be to add another stressor to caregivers who are already under tremendous stress. Imagine being in the situation I already talked about, working 2 or 3 jobs, wondering how to get your kids child care while you’re working 14 hours a day, remembering how your child got thrown off Medicaid like 100,000 other Missouri kids because the department that administers that program sent that single renewal letter to your old address which you had to move out of because there was a house fire because of a faulty space heater, and you and your kids had to move into one room at your aunt’s house, and the department didn’t bother to track you down, and your child wasn’t able to get their asthma inhaler, and you all ended up in the emergency room. You remember all that, and then you hear that if you do not accurately report how much you work, you will lose this crucial assistance to buy food? This is not a motivator. This is what drives people to despair. And please know that SNAP is barely enough to feed people. At Danis Pediatrics, where I work, we have a partnership with Operation Food Search and the St. Louis Food Bank to provide emergency food to families in need. It’s a bag with non-perishable food items like pasta and tomato sauce and canned vegetables, enough to feed a family of four for a day. Nothing special, but I can’t tell you how many times I’ve given a mom one of these bags, and she has broken down in tears because tonight, at least, she and her kids will have food on the table.

I have been doing this for over thirty years, and God help me I am now seeing people coming in with their grandkids who I saw when THEY were kids! And I can tell you, in that thirty years, I have never met anyone who wanted to stay on public assistance and who was not working as hard as they could to create a better life for their kids, often under extremely difficult circumstances. I am humbled every day by what the families I see experience. I often wonder how I would have done in those same circumstances.

So the assertion that anyone needs a kick in the pants to want a better life is simply wrong. Now if anyone here wants to talk a out creating robust jobs-training programs, improving schools and promoting small business in economically-depressed areas, this is where you can start to help people to get out of food assistance programs.

But until that happens, kids and their parents still need to be assured that there will be a next meal. That’s the least we can do.

There were no other questions. I thanked the committee and went back to my seat. Jeanette Mott-Oxford was up next and gave powerful testimony about the need for food security. I stayed for a short time but left after a few minutes. I was late for dinner with the members of the Executive Committee of MOAAP to discuss the next day’s meeting with legislators and with the full board. It was a really nice dinner, and I did have a glass of wine. Afterwards, I went to the hotel. It was nice. It was warm.

As I fell asleep, I thought about the question:

What do human beings owe to each other?

The best answer I could come up with is, always more than we can give, but that shouldn’t stop us from trying anyway.