[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]
HEARING TO REVIEW FEDERAL NUTRITION PROGRAMS
=======================================================================
HEARING
BEFORE THE
SUBCOMMITTEE ON DEPARTMENT OPERATIONS,
OVERSIGHT, NUTRITION, AND FORESTRY
OF THE
COMMITTEE ON AGRICULTURE
HOUSE OF REPRESENTATIVES
ONE HUNDRED ELEVENTH CONGRESS
SECOND SESSION
__________
JANUARY 25, 2010, COLTON, CA
__________
Serial No. 111-41
Printed for the use of the Committee on Agriculture
agriculture.house.gov
----------
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COMMITTEE ON AGRICULTURE
COLLIN C. PETERSON, Minnesota, Chairman
TIM HOLDEN, Pennsylvania, FRANK D. LUCAS, Oklahoma, Ranking
Vice Chairman Minority Member
MIKE McINTYRE, North Carolina BOB GOODLATTE, Virginia
LEONARD L. BOSWELL, Iowa JERRY MORAN, Kansas
JOE BACA, California TIMOTHY V. JOHNSON, Illinois
DENNIS A. CARDOZA, California SAM GRAVES, Missouri
DAVID SCOTT, Georgia MIKE ROGERS, Alabama
JIM MARSHALL, Georgia STEVE KING, Iowa
STEPHANIE HERSETH SANDLIN, South RANDY NEUGEBAUER, Texas
Dakota K. MICHAEL CONAWAY, Texas
HENRY CUELLAR, Texas JEFF FORTENBERRY, Nebraska
JIM COSTA, California JEAN SCHMIDT, Ohio
BRAD ELLSWORTH, Indiana ADRIAN SMITH, Nebraska
TIMOTHY J. WALZ, Minnesota ROBERT E. LATTA, Ohio
STEVE KAGEN, Wisconsin DAVID P. ROE, Tennessee
KURT SCHRADER, Oregon BLAINE LUETKEMEYER, Missouri
DEBORAH L. HALVORSON, Illinois GLENN THOMPSON, Pennsylvania
KATHLEEN A. DAHLKEMPER, BILL CASSIDY, Louisiana
Pennsylvania CYNTHIA M. LUMMIS, Wyoming
ERIC J.J. MASSA, New York
BOBBY BRIGHT, Alabama
BETSY MARKEY, Colorado
FRANK KRATOVIL, Jr., Maryland
MARK H. SCHAUER, Michigan
LARRY KISSELL, North Carolina
JOHN A. BOCCIERI, Ohio
SCOTT MURPHY, New York
EARL POMEROY, North Dakota
TRAVIS W. CHILDERS, Mississippi
WALT MINNICK, Idaho
______
Professional Staff
Robert L. Larew, Chief of Staff
Andrew W. Baker, Chief Counsel
April Slayton, Communications Director
Nicole Scott, Minority Staff Director
______
Subcommittee on Department Operations, Oversight, Nutrition, and
Forestry
JOE BACA, California, Chairman
HENRY CUELLAR, Texas JEFF FORTENBERRY, Nebraska,
STEVE KAGEN, Wisconsin Ranking Minority Member
KURT SCHRADER, Oregon STEVE KING, Iowa
KATHLEEN A. DAHLKEMPER, JEAN SCHMIDT, Ohio
Pennsylvania CYNTHIA M. LUMMIS, Wyoming
TRAVIS W. CHILDERS, Mississippi
Lisa Shelton, Subcommittee Staff Director
C O N T E N T S
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Page
Baca, Hon. Joe, a Representative in Congress from California,
opening statement.............................................. 1
Prepared statement........................................... 4
Costa, Hon. Jim, a Representative in Congress from California,
opening statement.............................................. 7
Fortenberry, Hon. Jeff, a Representative in Congress from
Nebraska, opening statement.................................... 5
Witnesses
Pino, Lisa J., Deputy Administrator, Supplemental Nutrition
Assistance Program, Food and Nutrition Service, U.S. Department
of Agriculture, Washington, D.C................................ 9
Prepared statement........................................... 11
Webb-Curtis, Christine, Chief, Food Stamp Branch, California
Department of Social Services, Sacramento, CA.................. 15
Prepared statement........................................... 17
Swanson, Nancy, Director, Department of Transitional Assistance,
San Bernardino County Human Services System, San Bernardino, CA 20
Prepared statement........................................... 22
Valenzuela, M.D., M.B.A., Guillermo J., Associate Medical
Director and Chairman, Department of Women's Health, Arrowhead
Regional Medical Center, Colton, CA............................ 33
Prepared statement........................................... 35
Wong, M.D., M.B.A., Webster A., Chief of Pediatrics, Arrowhead
Regional Medical Center, Colton, CA............................ 36
Prepared statement........................................... 37
Sharp, Matthew, Senior Advocate, California Food Policy
Advocates, Los Angeles, CA..................................... 38
Prepared statement........................................... 40
Jessup, Edith C. ``Edie'', Program Development Specialist,
Central California Regional Obesity Prevention Program,
California State University Fresno Department of Health and
Human Services, Central California Center for Health and Human
Services, Fresno, CA........................................... 43
Prepared statement........................................... 44
Marsom, Matthew, Director of Public Health Policy and Advocacy,
Public Health Institute, Oakland, CA........................... 48
Prepared statement........................................... 50
Page, Claudia, Co-Director, The Center to Promote HealthCare
Access, Oakland, CA............................................ 53
Prepared statement........................................... 54
Submitted Material
Donatone, Lorna, Chief Operating Officer and Education Market
President, Sodexo, Inc., submitted statement................... 71
Submitted questions.............................................. 74
HEARING TO REVIEW FEDERAL NUTRITION PROGRAMS
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MONDAY, JANUARY 25, 2010
House of Representatives,
Subcommittee on Department Operations, Oversight,
Nutrition, and Forestry
Committee on Agriculture,
Colton, CA.
The Subcommittee met, pursuant to call, at 10:00 a.m., at
Arrowhead Regional Medical Center, Colton, California, Hon. Joe
Baca [Chairman of the Subcommittee] presiding.
Members present: Representatives Baca, Costa, and
Fortenberry.
Staff present: Lisa Shelton, Debbie Smith, Pam Miller, and
Sangina Wright.
OPENING STATEMENT OF HON. JOE BACA, A REPRESENTATIVE IN
CONGRESS FROM CALIFORNIA
The Chairman. The hearing in the Subcommittee on Department
Operations, Oversight, Nutrition, and Forestry to review the
effectiveness of implementing Federal nutrition programs will
come to order. That sounds great, especially here in the Inland
Empire. We are making history by having a hearing in the Inland
Empire. To my knowledge, the Agriculture Committee has never
had any kind of a hearing here. All of you that are here are
witnessing history.
I really want to thank two of my colleagues that are here.
First of all, without any objections the gentleman from
California, Mr. Costa, who is not a Member of the Subcommittee
has joined us here today. I have consulted with the Ranking
Member and we are pleased to welcome him to join the
questioning of the witnesses. I would like to say welcome to
Congressman Jim Costa from the Central Valley area.
Then to my left is Congressman Jeff Fortenberry who is the
Ranking Subcommittee chair. Welcome each and every one of you.
We will officially begin the hearing by welcoming all of you to
the 43rd Congressional District. I want to give special thanks
to Arrowhead Regional Medical Center for their wonderful
hospitality including an opportunity for many of the
individuals to give additional input earlier this morning at
the reception.
I would like to personally thank some of these individuals
for their invaluable help in coordinating and making sure that
we had this hearing. I would like to start by thanking Gary
Obit, Chairman of the Board of ARMC; Josie Gonzalez who is the
Vice Chair of the Board of Supervisors; Dr. Dev, Medical
Director; Patrick Petree, CEO; George Valencia, Director of
Business Development and Marketing; Susan Maruna who is the
Administrative Assistant. Finally, my good friend Frank Reyes
whom I have known for a long time and who is a resident of the
Inland Empire and quite active. I want to thank all of them for
being here.
By the way, there is no applause in a Congressional
hearing, so please hold your applause. We do not want to show
favoritism towards one individual or the other, we are just
addressing the issues. I want to set the rules. If anybody ends
up speaking out of turn or are disruptive, you will be escorted
out of the hearing just as we would do in Washington, D.C.
With that, I want to thank all of you and I appreciate your
patience. I appreciate all of you coming together for the
historic hearing that we are having this morning. I say
historic because, as I stated before, the House Agriculture
Committee has never held a hearing in the 43rd Congressional
District in San Bernardino County.
As we get started I want to thank the leadership for all of
their help. I especially want to thank the individuals that are
here. I want to thank my two colleagues that are here,
Congressman Jim Costa. I saved the Ranking Member from
Nebraska, Jeff Fortenberry, for last, to thank him especially
because it is coincidental, as you heard me say this morning,
is that I happened to watch a movie yesterday, Extraordinary
Measures.
I do not know if any of you have seen the movie, but it is
about a Dr. Stonehill who was from University of Nebraska. I
was in Nebraska at a hearing and Congressman Fortenberry
happened to take me to the university. As you drove up it says,
``University of Nebraska.''
There I met my good friend Tom Osborne whom I worked with
in the past, an excellent football coach and now the Athletic
Director for Nebraska.
Congressman Fortenberry set a high bar for us to follow
with his hearing in Lincoln, Nebraska because we actually held
the hearing in a health facility.
I figured, ``Well, Jeff, you really had it at a nice health
facility.'' Then I said, ``We have to have it at a hospital
because if you have physical activities you have to tie in
hospitals that provide assistance to a lot of our patients.'' I
want to thank Congressman Jeff Fortenberry, for his hospitality
in Lincoln, Nebraska and having the hearing there.
I look forward to working with him, not only now, but on a
bipartisan basis along with my colleague Jim Costa in trying to
make sure that we have related hearings. We not only want to
have them in Washington, D.C. but throughout the United States.
I would just like to say that some may have difficulty in
seeing the connection between the Federal nutrition program and
hospital settings. In fact, there is a very close and important
connection. Over the past 4 years the Subcommittee, and the
House Agriculture Committee as a whole, has built a record that
links the importance of nutrition and health. They go hand in
hand.
In 2007, we held a hearing that demonstrated the importance
of the food stamp program, called SNAP. We have to get used to
the new name of the food stamp program called SNAP. There is
the connotation that people do not want to be identified with
food stamps, but would rather be identified with SNAP.
We have a long ways to go to educate our communities about
the change. By the way, I was the one that came up with the
slogan SNAP to take the stigma away from the name ``food
stamp.'' One of the reasons I did that in the farm bill is
because I was actually on food stamps. I received food stamps
when I was young. It was at a time my wife and I had a child
and it was very difficult.
During that period of time I did receive assistance and got
food stamps. You know how embarrassing it is for those of us
who have received food stamps? It is something you do not want
to be dependent upon, but it was something that I needed during
that period of time.
I remember going to the grocery stores and people were
looking at you as you are counting your food stamps and
everybody says, ``Well, look at this guy and his wife. They are
out here.'' But I did not look at it from that point of view.
I looked at it as the inability to feed my family, at that
time I was a college student who could not afford it and did
not have a good job, so I needed assistance. I know what it is
like in terms of the stigma and being in line and being there.
Now we have the debit card which looks like an American Express
card or a Visa, which is nice that we have gotten away from
coupons. That is why it is important that we have these kinds
of hearings and look at what needs to be done.
In 2008, the farm bill provided a record level of funding
for nutrition and safety net programs like SNAP and food banks.
We made important changes to promote healthy eating by funding
vital programs that encourage consumption of more fruits and
vegetables. We expanded the Fresh Fruits and Vegetables Snack
Program to the entire nation providing children with access to
education about healthy and fresh produce.
In July of 2008, the Subcommittee heard testimony on the
economic cost of hunger and nutrition in the United States, and
that is one of the areas that we really want to address as we
look at the actual cost of nutrition. I do appreciate today's
Sun Telegram's story. ``Many ignore food stamps or SNAP.'' But,
it is more than just this. I think California has got to look
at it from the point of economics.
There is $7 billion in revenue that could come back to this
state. I think the paper missed one concept. It is good that we
look at half of the people in the United States, or in
California, that are not utilizing the SNAP Program. Yet, that
means in revenue that would come back to the State of
California it is approximately $7 billion, and we are at a $20
billion deficit in the State of California.
We just met with the Governor last week and Jim and I were
there from the California Delegation in a bipartisan meeting,
and he indicated that he needs $6 billion. Well, if we can get
the $7 billion by making sure that we educate individuals about
SNAP, it is not only about feeding them but it is also about
the revenue that would come back to the State of California.
Also at a Subcommittee hearing the testimony from
California advocates demonstrated how the lack of participation
in Federal nutrition programs means loss of revenue to
California, as I stated before. In 2009 California's poor
participation in the SNAP Program lost $7 billion for the
state.
In March the Subcommittee took up the topic of obesity in
the U.S.
Experts from the Centers for Disease Control and Prevention
testified that both nutrition education, and lack of access to
healthy food contributes to obesity costing our nation between
$80 to $120 billion.
We have established clear evidence of the link many tie
between nutrition and health. Today we will take that
conversation one step further. For some years I have wanted to
hold a hearing in San Bernardino County and I am glad that we
are able to do that now. I appreciate the bipartisan support
that we received.
[The prepared statement of Mr. Baca follows:]
Prepared Statement of Hon. Joe Baca, a Representative in Congress from
California
Good morning and thank you all for being here today in my favorite
place, California's 43rd Congressional District.
Special thanks to our hosts today, Arrowhead Regional Medical
Center, for their wonderful hospitality. I want to read the names of
some of those who have been invaluable:
Gary Obitt, Chairman of the Board of ARMC;
Josie Gonzales, Vice Chair of the Board;
Dr. Dev Gnanadeb, Medical Director;
Patrick Petree, CEO;
George Valencia, Director of Business Development and
Marketing;
Susan Maruna, Administrative Assistant;
And finally, Frank Reyes, who is a long time friend and
resident of this area.
I appreciate the effort and patience they have shown in working
with the Committee to organize this historic hearing.
I say historic hearing because as far as I know--this is the first
House Committee hearing ever to be held here in the 43rd Congressional
District and in San Bernardino County.
Before we get started, I want to thank all the great leadership we
have here at the local level.
I especially want to recognize the work of the Rialto City Council,
Mayor Grace Vargas, and Mayor Pro-Tem Joe Baca, Jr.
I also want to say a special thank you to Congressmen Jeff
Fortenberry of Nebraska; and Jim Costa from the Central Valley of
California--for their willingness to be here.
Jeff, Jim, and I share a strong interest in the connection between
nutrition and health.
In fact, it was my pleasure to chair a subcommittee hearing in
Jeff's hometown of Lincoln, Nebraska this past August.
That hearing examined the innovative ways and economic benefits to
communities and businesses in promoting healthful lifestyles.
Congressman, I appreciate your continued interest in this important
topic, and thank you again for your tremendous hospitality in Lincoln.
I hope you enjoy your visit to California's 43rd District as much
as I enjoyed being in Nebraska's First District.
Mr. Fortenberry set the bar high for his hearing by holding it in
the gymnasium of a beautiful health facility.
So, we have followed his lead by holding this hearing in a health
related location.
Some may have difficulty seeing the connection between Federal
nutrition programs and a hospital setting.
But in fact, there is a very close and important connection.
Over the past 4 years, this Subcommittee, and the House Agriculture
Committee as a whole, has built a record that links the importance of
nutrition and health.
In 2007, we held a hearing that demonstrated the importance of the
food stamp program (now called SNAP) to the overall health and long
term success of children.
Then, in the 2008 Farm Bill, we provided record levels of funding
for nutrition for safety net programs like SNAP and food banks.
We also made important changes that promote healthy eating, by
funding pilot programs that encourage the consumption of more fruits
and vegetables.
And, we expanded the Fresh Fruit and Vegetable Snack program to the
entire nation, providing children access to and education about healthy
and fresh produce.
In July of 2008, this Subcommittee heard testimony on the economic
costs of poor nutrition in the United States.
Researchers detailed that hunger costs our country $90 billion per
year in lost work productivity, the need for special education, and
other factors.
Also, at that hearing, testimony from California advocates
demonstrated how a lack of participation in Federal nutrition programs
means lost revenues to California counties, compounding the costs of
hunger and poor nutrition to communities.
In 2009--California's poor participation in the SNAP program was
estimated to cost our state $3.7 billion in additional Federal funding.
These funds would have led to an additional $6.9 billion in
statewide economic activity.
In March of 2009, the Subcommittee took on the topic of obesity in
the U.S.
Experts from the Centers for Disease Control and Prevention
testified that both nutrition education and a lack of access to healthy
foods contribute to the obesity epidemic--which costs our nation
anywhere from $80 to $120 billion ever year.
So, we have established a clear body of evidence linking the many
ties between nutrition and health.
Today, we take that conversation one step further.
For some years, I have wanted to hold a hearing in San Bernardino
County to point out the unique problems of our state's cultural and
economic diversity in improving health and nutrition.
Sadly, the recession has only emphasized the problems that we have
faced for many years.
So we hold this hearing at one of the most critical times for
California and its people.
Why does California struggle with low participation rates in
Federal nutrition programs?
What does this mean for the physical and economic health of our
communities--especially as it pertains to the obesity epidemic?
We will be looking for the answers to these and other questions
from our outstanding witnesses today.
This is a topic of great interest to me as a legislator, of
course--but also as a husband, father, grandfather, and community
member.
Again--I want to thank everyone at Arrowhead Regional; and thank
our witnesses for taking time from their busy schedules to be with us
today.
I now yield to our Subcommittee's Ranking Member--my friend, Rep.
Fortenberry.
The Chairman. With that, I would like to welcome and ask
the Ranking Member Jeff Fortenberry for his opening statement,
then I will call on Congressman Jim Costa for his opening
statement.
Congressman Fortenberry.
OPENING STATEMENT OF HON. JEFF FORTENBERRY, A REPRESENTATIVE IN
CONGRESS FROM NEBRASKA
Mr. Fortenberry. Thank you, Mr. Chairman, for holding this
hearing today and for honoring me with the invitation to
attend, in your home State of California. Welcome to you all. I
must say, coming from Nebraska, I am absolutely fascinated by
the fact of seeing palm trees nestled against the backdrop of
snow-covered mountains. That is very unique for me. I have, of
course, been in California but not in this particular area.
You have a lovely home here and I congratulate all of you
for your attentiveness to community life here. It is very clear
from our earlier meeting the level of commitment to public
service and community input from a variety of areas, not only
from the medical community but other leaders out there who are
very interested in these questions: how nutrition relates to
families, how nutrition relates to healthcare outcome, so thank
you very much.
I would like to let you all know it is a pleasure and an
honor to serve alongside with Congressman Baca in the halls of
Congress. As I mentioned earlier there can be quite a bit of
rancor and divisiveness. There are strong philosophical divides
in Washington, but the Agriculture Committee tends to pride
itself on attempting to transcend those differences in creating
a safe affordable food supply that helps feed this nation and
the world.
As you all know, Chairman Baca has served you in Congress
since 1999. He is, of course, Chairman of this Committee. I am
what is called the Ranking Member. I have admired Chairman
Baca, as well, for his service in the U.S. Army, many of you
may not know that, as a paratrooper from 1966 to 1968.
Following his military service he came back to California and
earned a degree in sociology. I understand you served both in
the State Assembly as well as the State Senate so, again, thank
you for hosting, Mr. Chairman.
As you all are very much aware, we have been engaged in
this very important debate about the future of our healthcare
system in this country. The debate has been critical to the
well being of families and small businesses and all of us
throughout our great nation. My priority has been to focus on
two essential questions. How do we actually improve healthcare
outcomes and reduce cost while protecting vulnerable persons.
I believe one important piece of this solution has been to
understand the integral role that nutrition plays in the well
being of our children and families. This is because a major
driver of our ever-increasing healthcare cost has been the rise
of chronic diseases. Many of you are very aware of this and
many of which are nutrition related.
For instance, the average American is 23lb overweight.
Obesity among young people has tripled since 1980. Obesity is a
major factor that leads to the onset of chronic diseases like
diabetes, heart disease, some cancers and even strokes. Chronic
diseases are driving 75 percent of every healthcare dollar
according to some studies.
Consequently it is imperative to me that our healthcare
system promote and incentivize healthy nutrition practices and
wellness. We must all foster a culture of wellness and reward
behaviors that reduce the onset of these diseases. I believe we
could potentially save hundreds of billions of dollars if we
could delay or reduce the onset of these chronic diseases. As
responsible individuals and citizens I hope that we will
personally implement wellness and preventative measures so that
we all can thereby reduce our risk factors for these
conditions.
The food that individuals have access to and select often
determines the quality of their overall health. The SNAP
Program, the topic of our hearing today, enables persons in
vulnerable circumstances to have access to a wide variety of
nutrition selections. As we carefully allocate these resources
an important topic of consideration should be the quality and
health-promoting choices at the dinner table for families.
This principle of healthy food combined with wide
stewardship and personal responsibility should guide the goals
of this program. I look forward to learning how these
principles are currently being implemented and what
recommendations our experts may propose to further this agenda.
Again, Mr. Chairman, it is a great privilege to be here
with you in the great State of California. Thank you.
The Chairman. Welcome to the 43rd Congressional District. I
would like to call Congressman Jim Costa.
OPENING STATEMENT OF HON. JIM COSTA, A REPRESENTATIVE IN
CONGRESS FROM CALIFORNIA
Mr. Costa. Thank you very much, Chairman Baca, and all of
those who are here this morning, the witnesses on the first
panel and the second panel. We applaud and commend your hard
work and efforts and we look forward to hearing your testimony.
Chairman Baca, I want to thank you for allowing me to be
part of the Subcommittee hearing this morning, but I also want
to convey to the constituents of the Inland Empire the
tremendous work you do on their behalf in Washington. I know
this to be a fact. I have had the honor and privilege to serve
with Congressman Baca both in the State Legislature before I
had this arctic blond and now in Congress.
I want you to know he is a tenacious advocate on behalf of
the people, not only in his Congressional district, but the
people of California. He is always passionate and his tireless
energy are hallmarks of his leadership. In the 2008 Farm Bill
he truly wanted to ensure that the nutrition program was
improved. As a result of his hard work and others in the
Subcommittee, Congressman Fortenberry and others, I think we
made progress in the food stamp program that Joe spoke of.
It is important to note, as Congressman Fortenberry
indicated, that the House Agriculture Committee is truly one of
the more bipartisan committees that we have in Congress. I
wished it were not the exception but the rule.
The 2008 Farm Bill was, I believe, the only major piece of
legislation that went through the entire hearing process. It
had regular order. Went through the House and the Senate. Went
to the Conference Committee. Had bipartisan support in both
Houses. Actually was vetoed by the President and we overrode
the veto, which really reflects the effort and the way all of
you believe that we as your representatives ought to be acting
to solve problems in this country.
I think the 2008 Farm Bill, under the leadership of the
Members of the Committee, both of them here--of course, I am on
the Committee as well. Congressman Fortenberry and I are on the
class of 2004. He does a great job on behalf of his
constituencies throughout Nebraska. We are pleased that you
have come all the way out here, Jeff, to participate in this
hearing.
Mr. Chairman, let me give a brief statement about what we
are dealing with here because your review of the Federal
nutrition programs is timely. It is timely because we enacted
the 2008 Farm Bill. It is timely because what has been part of
the big discussion and debate over this last year, healthcare.
We all know as children our parents taught us a long time ago
that an ounce of prevention is worth a pound of cure. A lot of
the focus in the healthcare bill has been on preventive
healthcare. It is that ounce of prevention that is worth that
pound of cure.
Early childhood eating habits, good eating habits, are a
key to ensuring and fostering that we live and eat healthy our
entire lives. The nutrition program is an important component
of that effort. It ties in the best aspects of America;
reaching out to those who are less fortunate, but also taking
advantage of our agricultural productivity which is second to
none anywhere in the world.
We all know that hunger and food insecurity in parts of our
country, and in parts of our state unfortunately, continues to
be a problem. One of the most devastating impacts of this
economic recession that we have been in is that an increasing
number of mothers and fathers find themselves no longer able to
put dinner on their family's table.
My district has been especially hard hit. The recession
coupled with four horrific droughts and a regulatory water
crisis have left many of the hardest working people in this
nation, who would normally be working to put food on America's
dinner table, in food lines. It is unacceptable in the richest
nation in the world.
How ironic it is that the most fertile agricultural regions
of the country were forced to rely on food banks and the SNAP
Program to feed these families. In my district we grow over 300
crops of which primarily are fruits and vegetable, that good
nutrition we are talking about. Still many Valley residents
rely on high-calorie fast foods and nutritionally deficient
low-cost options because the healthy options are either
unavailable or too costly to purchase on a family's meager
budget.
Near Bakersfield, in the southern end of my district, we
have what we call food deserts. They are not real deserts
because we grow all this food, but what I mean is they are only
occupied by fast food chains and convenience stores for miles.
Almost 60 percent of my population is overweight. Nearly 30
percent of the population in each of these counties is
considered obese. That is unconscionable. Nearly 30 percent of
the population in some of the major cities I represent like
Fresno are at the poverty level. Similarly these statistics are
hardly a coincidence.
I want to thank the Chairman. We have made great strides in
providing more healthy options for needy families in the 2008
Farm Bill and the SNAP Program that he spoke of. We need to
expand the use of farmer's markets, the expansion of Fresh
Fruits and Vegetables Snack Program to make a concerted effort
to provide more healthy options for our food banks, which is
important and through the TEFAP Program. We can and should do
better. Mr. Chairman, I am looking forward to the testimony by
our first and second panel to figure out how we can do a better
job at the local, state, and Federal level. Thank you.
The Chairman. Thank you very much, Congressman Costa and
Congressman Fortenberry for your opening statements. As we
indicated before, it is also about not only nutrition but
prevention and intervention, as well. We need to look at the
overall cost and the ability not only to use nutrition programs
but as a cost to the state as well.
I will just mention this because I mentioned the revenue is
in terms of what we could potentially get to the State of
California. In San Bernardino alone there is revenue that could
be $508,960,781 and that is the amount that we are losing in
terms of revenue because of people here in this county that are
under-utilizing the nutrition program as well.
That means that people are not putting food on their table
and feeding their families, which means additional revenue that
could come to this county alone. Then if you take LA County it
is about $2 million that they are losing in revenue just in LA
County, which is the surrounding county to that.
With that we would like to begin with the panelists to
begin to give us their testimony. Each of the panelists will
have 5 minutes. There is a light in front of you so those of
you who are new to this and have not seen this in Washington,
D.C. there is a light that comes on. At first the green light
will be on and then the yellow light tells you that you had
better cut your statement off or the gavel is going to go off.
The red means you are supposed to be done and your
testimony will be heard during that period of time and then
also we will take the written testimony. We would like to begin
with our first panelist and that is Lisa Pino who is the Deputy
Administrator for Food and Nutrition Service, U.S. Department
of Agriculture in Washington, D.C.
Ms. Pino.
STATEMENT OF LISA J. PINO, DEPUTY ADMINISTRATOR,
SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM, FOOD AND NUTRITION
SERVICE, U.S. DEPARTMENT OF
AGRICULTURE, WASHINGTON, D.C.
Ms. Pino. Good morning, Chairman Baca and distinguished
Members of the Committee. I am Lisa Pino, Deputy Administrator
of the U.S. Department of Agriculture's Food and Nutrition
Service.
I am pleased and honored to join you here today to discuss
the SNAP and how we can improve participation rates in SNAP,
especially among difficult-to-reach groups and in California.
The Federal food programs are critical components of our
nation's safety net for families in need. Our programs promote
healthier food choices among the children and families they
serve as crucial prevention components of our national public
health strategy.
The USDA is committed to making these programs as effective
as possible in addressing our top priorities--ending childhood
hunger and addressing the obesity epidemic. The setting for
this hearing on hospital grounds is historic and reminds us of
the vital connection between healthy eating and disease
prevention.
While SNAP is the largest food assistance program that FNS
administers, it is still only one of our 15 nutrition
assistance programs. They are all designed to combat hunger and
promote nutrition. Congress is poised to reauthorize the Child
Nutrition programs this year and the Obama Administration is
committed to supporting ground-breaking improvements in these
programs which includes school meals and WIC, a nutrition
program especially for women, infants, and children.
During this recession, SNAP proves its inherent value as
the nutrition safety net for America each and every day. More
than four million people have joined SNAP in the past 6 months
alone. Nearly 38 million Americans receive SNAP benefits, which
is a 22 percent increase over just 1 year ago.
While record-high caseloads are an unfortunate indicator of
the difficult times and the daily struggles of families across
our nation, they are also clear evidence that SNAP is
responding effectively, as it was designed to do during the
economic downturn.
In the past year, California has experienced a 25 percent
increase in caseload from just 1 year ago consistent with
national trends. Nearly three million Californians received
SNAP benefits as of October 2009. The average California SNAP
household received a monthly benefit of $325 or $137 per person
in Fiscal Year 2009. Still, California has a low participation
rate relative to most states. According to the USDA's annual
report on state SNAP participation, California ranks 50 out of
51 state agencies including all states and the District of
Columbia.
In 2007, the most recent data available, California served
48 percent of those eligible to participate in SNAP, while the
national average is 66 percent. Clearly a low participation
rate means less healthy food at home for households in need,
especially during such a tough economic time.
But beyond SNAP's nutritional benefit to households, SNAP
is an effective economic stimulus. Every $5 in new SNAP
benefits generate approximately $9.20 in total economic
activity. That is almost double the benefit.
If California were to increase its participation rate by
just five percent, from 48 percent to 53 percent, participants
would have more than $117 million in benefits to spend on
healthy food generating more than $200 million in total
economic activity. This is money left on the table that can
flow into the state's economy to help California get back on
its feet with an influx of additional spending.
We are working with the state to improve participation
through three methods: better policies, better practices, and
better outreach. We suggest such policies as simplifying client
reporting, expanding broad-based categorical eligibility, and
eliminating finger-imaging to prevent dual participation.
USDA also offers states an array of policy waivers to
increase participation in SNAP while reducing cost and
administrative burden. As for better practices, we encourage
all states, including California, to consider business process
re-engineering, an approach to allow states to more effectively
manage increasing caseload.
In the area of better outreach one advantage is crystal
clear. Good outreach increases participation in SNAP which
brings even more Federal funding to the state and its
residents. Currently California is reaching out to new
participants through partnerships with food banks and we are
working with all states, including California, to improve
outreach to the under-served such as Latinos, legal immigrants,
seniors, the newly unemployed, and the working poor or the
under-employed.
In closing, let me re-emphasize the Administration's
commitment to fighting hunger and improving the Federal
nutrition programs. FNS has elevated nutrition and nutrition
education as a top priority in all its programs. In addition to
providing access to nutritious food, FNS also works to empower
program participants with knowledge of the link between diet
and health.
With our state partners, we look forward to working
together to help bring more nutritious meals to those in need.
I look forward to answering any questions you have and I thank
you for your attention.
[The prepared statement of Ms. Pino follows:]
Prepared Statement of Lisa J. Pino, Deputy Administrator, Supplemental
Nutrition Assistance Program, Food and Nutrition Service, U.S.
Department of Agriculture, Washington, D.C.
Good morning, Mr. Chairman. I am Lisa Pino, Deputy Administrator of
the U.S. Department of Agriculture's Food and Nutrition Service (FNS).
I am pleased to join you today to discuss the Supplemental
Nutrition Assistance Program (SNAP) and how we can improve
participation rates in SNAP especially among difficult to reach groups
and in California. Before I get into those details, however, I want to
step back and outline the U.S. Department of Agriculture's priorities
for the Federal nutrition assistance programs managed by FNS.
These programs are critical components of our nation's safety net
for families in need. They currently touch more than one out of five
Americans each year. Using their breadth and scope to promote healthier
food choices among the children and families they serve is a critical
prevention component of our national public health strategy. The U.S.
Department of Agriculture is committed to making these programs as
effective as possible in addressing our top priorities--ending
childhood hunger and addressing the obesity epidemic. In support of
these big picture outcomes, we are pursuing an ambitious agenda to
strengthen program access, modernize operations, improve the
effectiveness of nutrition education, and strengthen program integrity.
We know that there are great challenges ahead of us, but with the aid
of our state and local partners, we are determined to achieve these
goals. We can achieve success in ending childhood hunger and improving
the nutritional status of participants.
This year Congress will reauthorize the Child Nutrition Programs.
The Administration is committed to supporting ground-breaking
improvements in these programs, including the school meals programs. In
its Fiscal Year 2010 Budget, the Administration proposed a billion
dollars each year in new funding for Child Nutrition, focused on
priorities in reducing barriers and improving access; and enhancing
nutritional quality and the health of the school environment.
One important connection between SNAP and school meals is Direct
Certification. This system enables states to utilize data from the SNAP
certification process and directly enroll students in SNAP households
for free school meals, eliminating the need for application paperwork.
This is an excellent way to simplify the administrative costs while
improving access to our hunger-fighting programs. A recent report shows
that while schools have increased their use of direct certification,
some direct certification systems are more effective than others. We
will be working to promote and expand best practices in this area.
During this recession, SNAP proves its inherent value as the
nutrition safety net for America each and every day. More than four
million people have joined SNAP in the past 6 months. Nearly 38 million
Americans receive SNAP benefits, which is a 22 percent increase over
just 1 year ago. In each month of Fiscal Year 2008, SNAP served
approximately 6.3 million households with children, representing just
over half (51 percent) of all SNAP households.
While record-high caseloads are an unfortunate indicator of the
difficult times and the daily struggles of families across our nation,
they are also clear evidence that SNAP is responding effectively, as it
was designed to do, to the economic downturn. SNAP participation
increases when the need is greater and contracts in better times. While
SNAP has been responsive in these difficult times, many eligible
individuals remain unserved.
FNS takes seriously its stewardship responsibilities for tax payer
dollars through the quality control system and support for payment
accuracy initiatives. Even as participation in SNAP continues to grow
and benefits increase, FNS remains committed to program integrity, and
the results are clear: In Fiscal Year 2008, SNAP achieved a record high
payment accuracy rate. It is possible to achieve both high
participation and high payment accuracy simultaneously.
In the past year, California has experienced a twenty-five percent
increase in caseload from just 1 year ago, consistent with national
trends. Nearly three million (2,998,851) Californians received SNAP
benefits in October 2009. The average California SNAP household
received a monthly benefit of $325, or $137 per person in Fiscal Year
2009. This is up from $259 per household and $105 per people in Fiscal
Year 2007.
Still, California has a low participation rate relative to many
other states. According to the USDA's annual report on state SNAP
participation rates, California's participation rate ranked 50 out of
51 including all the states and the District of Columbia. In 2007, the
most recent data available, California served only 48 percent of those
eligible to participate in the program. The national average was 66
percent.
California's low participation rate is a serious concern for many
reasons.
First, plain and simple, the low participation rate means less
healthy food at home for households in need. It means that families
lose the ability to stretch their food budgets to purchase more and
healthier food. It means they go hungry instead of receiving nutrition
benefits to which they are entitled.
Second, SNAP is an effective economic stimulus. Every $5 in new
SNAP benefits, if funded through emergency spending, has been estimated
to generate as much as $9.20 in total economic activity.\1\ If
California were to increase its participation rate among those eligible
for benefits by just five percentage points, participants would have
more than $117 million in benefits to spend on healthy food generating
more than $200 million in total economic activity. This is money ``left
on the table'' that could flow into the state's economy and help the
economy get back on its feet with an influx of additional spending.
Almost all (97%) SNAP benefits are spent for food within 30 days.
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\1\ Increases in food stamp (now named SNAP) benefits can
stimulate additional economic activity. An increase in benefits raises
spending by recipient households, which then stimulates production.
Higher production boosts labor demand and household income. Increased
household income triggers additional spending. Hanson and Golan (2002)
estimate that an additional $500 in food stamp expenditures triggers an
increase in total economic activity of $920. See the Economic Research
Service website at http://www.ers.usda.gov/publications/fanrr26/
fanrr26-6/fanrr26-6.pdf (See p. 2.)
---------------------------------------------------------------------------
Because SNAP is an effective economic stimulus, Congress and the
Administration worked together to build on the program's strengths
through the American Recovery and Reinvestment Act. The Recovery Act
provided additional benefits for SNAP recipients nationwide, $80 for a
household of four per month, starting in April 2009. These additional
benefits have been very effective in getting food resources to families
facing increased need as a result of the slow economy. In conjunction
with the Mid-Session update to the President's Fiscal Year 2010 budget,
we estimate that over time, the increased benefits will total $48
billion. This figure will be re-estimated with the President's Fiscal
Year 2011 budget request and is likely to increase. The increased SNAP
benefits were some of the first Recovery Act dollars to reach the
wallets of needy people and the neighbors and businesses in their
communities and made an immediate impact on the national economic
situation.
We recognize the extraordinary budget difficulties states,
including California, face in this current economic crisis. To help
address the growing strain on existing resources, the Recovery Act
provided nearly $300 million in new administrative funds to states--
funds that will not require a match--to help them serve the growing
number of families seeking assistance. California's share of these
funds is $21.7 million. The Defense Appropriations Act recently
provided another $400 million to states for this purpose.
USDA has offered all states an array of policy waivers to increase
participation in SNAP while reducing cost and administrative burden and
helping to more effectively manage the increasing workload.
California has already made some steps in the right direction. For
example, California has established broad-based categorical eligibility
for families with children. They are doing telephone interviews at
certification and recertification in some regions. There are online
applications with electronic signature capability in some regions as
well as change processing call centers in some regions. One important
waiver that California is already using restores eligibility to
households terminated for failure to provide reports if those reports
are received within 30 days. These efforts represent a significant
start towards improving participation.
We are working with California to improve participation through
three methods--better policies, better practices and better outreach to
those eligible for SNAP.
First, better policies. There are several policies that California
can implement to achieve significant savings and help to address its
$20 billion budget deficit, while also improving access and service for
clients.
Specifically, we recommend the following approaches for California:
First, simplify client reporting. FNS has asked the state to
submit a plan by February 2010 to convert from the current
quarterly reporting system to a simplified reporting system.
Simplified reporting will require less frequent submission of
report forms from clients, lead to longer certification periods
for some households, and reduce the time and expense of acting
on changes.
Second, expand eligibility and reduce workload through
broad-based categorical eligibility: Other states have
eliminated asset requirements and are making use of higher
income limits (up to 200 percent of the Federal poverty line)
for all eligible households, not just those with children under
18 as in California. Broad-based categorical eligibility is an
effective workload management tool for overburdened states
workers and simplifies the application process for clients.
Third, consistently offer telephone interviews in lieu of
face-to-face interviews. Many California counties have chosen
not to use telephone interviews consistently or limit the
criteria for waiving the face-to-face interview. Use of
telephone interviews and tailoring interview length and
questions to the specific circumstance of the case make the
process more efficient and reduce as many burdens possible.
Failure to fully utilize these telephone interviews to their
fullest extent can make it more difficult for households to
navigate the certification process, thereby discouraging
participation.
Fourth, eliminate finger imaging: While there is no hard
data to establish that finger imaging prevents participation of
eligible households, community-based groups have consistently
reported that low-income groups (especially low-income legal
immigrants) are often fearful of applying for SNAP because of
the finger imaging requirement. As states look for ways to
provide services in difficult fiscal times, the cost associated
with finger imaging should be reconsidered. Most states satisfy
the requirement to establish a system to prevent duplicate
participation by matching names with Social Security Numbers,
which is less costly than finger imaging and is also an
effective deterrent. We need to make every dollar count by
managing resources in the most efficient and effective manner
possible. USDA is in the process of evaluating how finger
imaging systems may impact cost and client participation.
Fifth, expand call center change reporting and electronic
applications. While these approaches are being used in some
regions, participation and access could be enhanced if they
were used statewide.
In the area of better practices, we stress the importance of
customer service and better business processes. The more user friendly
the application and related processes are, the more likely it is that
access to the program will improve. We will continue to work further
with the state to see where the application process can be improved or
``reengineered'' and whether there are waivers or other assistance we
can provide to help counties move towards more efficient application
processes. FNS encourages states to learn from each other and implement
models that work.
One critical customer service that must be addressed is application
processing timeliness. Timeliness standards are set by law.
Applications must be processed within 30 days or within 7 days for
expedited cases where applicants have very low income. Despite current
challenges, these standards must be met. People have a critical need
for timely assistance. Every day matters when you're hungry.
Some states have persistent difficulty with timeliness with little
improvement. California has experienced decreasing timeliness rates
over the past 2 years. In 2008, 79.6 percent of applications were
processed in a timely manner in California. The national average is
85.6 percent. Record caseloads are challenging even those states with
historically good timeliness rates. Yet there are states successfully
maintaining timeliness rates despite rising caseloads. We encourage
California to talk with such states and learn more about their business
practices.
The negative error rate, which is the rate of incorrect denials,
suspensions or termination of benefits, is another critical customer
service issue. California has a very high negative error rate. When
negative errors occur, access is hampered and households face
unnecessary hardship because households are removed from the program
unnecessarily. Over the past several months, FNS has done in-depth
reviews in the five largest states, including California, to learn why
the negative error rate is going up and what we can do to help states
reverse the trend. Results of this analysis are expected later this
year.
Like all states, California must promote accountability and make
improved negative error performance as a priority. Policy, Quality
Control (QC), and Corrective Action staff must work closely together on
provided resources and tools to local county staff to promote improved
performance in this measure.
In the area of better outreach, the advantages are crystal-clear:
due to economic multiplier effect I described earlier, increasing the
number of eligible individuals participating in SNAP would bring
additional Federal funding support to the state and its citizens.
California is to be recognized for its statewide outreach plan that
includes partnerships with food banks. We are working with many states,
including California, to improve access and participation through
innovative outreach and community partnerships, especially those
designed to reach underserved populations, such as Latinos, the
elderly, and the unemployed and under-employed.
Nationwide, more than five million U.S. Latinos participated in
SNAP in 2006, but nearly as many were eligible yet did not participate.
SNAP served nearly 1.1 million Latinos in California in an average
month in 2006 (the latest year with data on race and ethnicity). The
participation rate of eligible Latinos is just 56 percent nationwide,
and in California is it just 43 percent. This means California is
losing millions in federally-funded SNAP benefits to which their
residents are entitled.
Latino families are much more likely to live in poverty and
experience food insecurity than white non-Latino households. More than
\1/4\ of all people eligible for SNAP benefits but not receiving them
are Latino. According to USDA's Economic Research Service, while
fifteen percent of households in the U.S. are food insecure in 2008,
the rate of food insecurity among Latino families was over 25 percent.
This is not just a food security issue--it is a question of equitable
program access across USDA's diverse customer base. The Department is
making a concerted effort to overcome barriers to program participation
in a wide range of programs among Latinos and other traditionally
under-served communities. We continue to seek ways to help all states
develop strategies that increase participation among such target
populations.
Factors impeding Latino SNAP participation include confusion and
misinformation about the issue of whether someone is considered a
``public charge''. In fact, receipt of SNAP benefits does not make one
a public charge. Other factors impeding participation are the lack of
awareness and understanding of the program and eligibility
requirements, and limited delivery of that information in cultural and
linguistically appropriate ways.
For many years, the Food and Nutrition Service has worked to
eliminate these barriers and reach out to underserved groups to raise
awareness of the nutrition benefits of SNAP, including significant
efforts to reach the Latino population. Our efforts include:
Outreach to make sure that eligible clients, outreach
providers, and other stakeholders are aware of Department of
Homeland Security policy that clearly indicates that
participation in SNAP does not make one a public charge.
Radio advertisements in English and Spanish to promote the
nutrition benefits of SNAP and educate non-participating
eligible people have aired in multiple states for 6 years. We
are in the planning stages for the seventh year. Radio
advertisements have aired in California during each year to
date.
A web-based pre-screening tool in English and Spanish.
Individuals using the prescreening tool receive estimates of
their eligibility and benefit amounts. This tool is online at
http://www.snap-step1.usda.gov.
A national toll free number, 1-800-221-5689, provides
information about the program in Spanish or English and
includes the option to receive a packet of information by mail.
Educational posters and flyers in English and Spanish which
may be ordered for use in local outreach campaigns that can be
used in promotional and informational materials. These
resources are available at http://foodstamp.ntis.gov/
A comprehensive Latino strategy outreach plan, now under
development, to better reach and educate the Latino audience
about the nutrition benefits of SNAP.
A national SNAP Outreach Coalition to bring together
national and local organizations working with low-income
audiences. Coalition members share effective outreach
strategies to educate eligible, non-participating, low-income
Latino people about the benefits of SNAP.
Participation grants for projects that look at ways that
state partnerships can improve access, and make the application
and intake process more user-friendly. Three of these grants
have been awarded to organizations in California during the
past 7 years.
Outreach grants for small organizations to study the
effectiveness of strategies to inform eligible low-income
people about the program. Neighborhood and faith-based
organizations in California have received nine outreach grants
since 2001.
Now, I would like to turn my attention for a moment to the role
that SNAP plays in promoting healthy eating. Through the nutrition
education component called SNAP-Ed, SNAP plays a critical role in
helping recipients obtain a healthy diet, engage in physical activity
and pursue healthy lifestyles within limited resources. SNAP-Ed
nutrition education resources in English and Spanish such as Loving
Your Family, Feeding Their Future can reach low-income mothers and
motivate them to improve their families' eating and physical activity
behaviors. While SNAP-Ed can certainly be improved, it does play a key
role in efforts to improve participants' food choices.
The Food Conservation and Energy Act of 2008--the 2008 Farm Bill--
authorized $20 million for pilot projects to evaluate health and
nutrition promotion in SNAP to determine if incentives provided to SNAP
recipients at the point-of-sale increase the purchase of fruits,
vegetables or other healthful foods. FNS refers to this effort as the
Healthy Incentives Pilot. Through this recently launched pilot program,
we released a competitive solicitation to encourage state applicants to
test innovative ideas to improve the nutritional choices of SNAP
participants. The Healthy Incentive Pilot is only one example of the
agency's efforts to provide grants and other incentives in the programs
to advance nutrition.
Increasing the number of farmers' market authorized by SNAP is
another priority. This effort not only creates access to healthy
produce for our clients but it expands the customer base for local
farmers. The number of farmers markets in SNAP increased 25 percent in
Fiscal Year 2009 over the prior year.
Know Your Farmer, Know Your Food is a new initiative launched by
Secretary Vilsack and Deputy Secretary Merrigan to enhance the link
between consumers and local producers. By successfully improving the
link between consumers and local producers there can be new income
opportunities for farmers and wealth can be generated that will stay in
rural communities. There also can be a greater focus on sustainable
agricultural practices and families can better access healthy, fresh,
locally grown food.
In closing, let me reemphasize the Administration's commitment to
fighting hunger and improving the Federal nutrition programs. I would
like to thank the Committee for the opportunity to join you here to
raise awareness, focus attention and motivate action to improve the
effectiveness of SNAP and all Federal nutrition programs, both here and
across the nation. Working together, we can strengthen our ability to
ensure that, no matter what other hardships they experience in the face
of economic disruption, low-income people need not experience food
insecurity and hunger. I look forward to answering any questions that
you may have.
The Chairman. Thank you very much, Ms. Pino. Thank you very
much for sticking within the time limits because your light
just went on. Just at the nick of time so thank you very much.
I am glad you did not pick any of our habits--Members' habits--
I should say.
Next I would like to have Christine Webb-Curtis who is the
Chief, Food Stamp Branch for California Department of Social
Services out of Sacramento.
STATEMENT OF CHRISTINE WEBB-CURTIS, CHIEF, FOOD STAMP BRANCH,
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES, SACRAMENTO, CA
Ms. Webb-Curtis. Thank you, Chairman Baca and Committee
Members. My name is Christine Webb-Curtis and I am the Chief of
the Food Stamp Branch--we are saying Food Stamps in California
still--at the California Department of Social Services.
Currently we have oversight of the Food Stamp Program and the
Emergency Food Assistance Program.
California's Food Stamp Program is the second largest in
the country, serving about three million persons with about $3
billion in food benefits each year. The most recent USDA report
on participation, as Lisa mentioned, for 2007 indicates that we
rank among those states with low rates.
Although we have much work to do to increase participation,
the data is 2 years old and doesn't reflect the many state and
county efforts to improve program access that have occurred
over the past few years. Additionally, California's ``cash-
out'' of approximately 1.2 million persons receiving SSI/SSP is
a significant factor in our participation rate, as these
families are not included in the calculation.
Well before the recent economic slowdown, we had undertaken
steps to increase public awareness about the program and
improve access to these benefits. Along with our county parties
we also pursued policy and operational changes to simplify and
streamline the application process and the administration of
the program. I would like to highlight some of those.
The expansion of categorical eligibility makes households
with minor children no longer subject to the resource test.
Full implementation was completed the first of this month. The
Governor's budget includes funding to expand this policy to
apply to all Food Stamp households, not just families which
would add about 45,000 households.
In 2008 we received a Federal waiver to exempt most Food
Stamp households from the face-to-face interview requirement.
In 2009 we received another waiver to exempt all households
from the face-to-face requirement. This was recently
implemented and is available at county option. In waiver
counties fingerprint imaging can also be postponed for up to 1
year.
Last year we provided instructions to counties to develop a
simplified process that ensures that emancipating foster youth,
about 4,000 a year, will be given the opportunity to apply for
this critical benefit prior to aging out of the Foster Care
system.
We are one of only four states to provide Restaurant Meal
Allowance Program for homeless, elderly, and disabled Food
Stamp recipients who may not have easy access to cooking
facilities. This allows access to hot cooked meals at approved
locations throughout the five counties which have implemented
this option.
A federally-approved restoration of eligibility waiver is
about to be implemented to allow discontinued households to
have benefits restored easily without the need for a new
application if the reason is ``cured'' in the month following
termination.
Finally, we are working with our stakeholders including the
California Food Policy Advocates to develop a new program name.
We hope that the new name will go a long way toward eliminating
some of the stigma associated with the Food Stamp Program, and
provide an opportunity to outreach to potentially eligible
families through the marketing of the new name.
These efforts have played an important role in increasing
participation in California from 2007 to 2009. We saw an
increase of 31 percent.
We continue to explore ways to streamline the application
process and enhance access to the program. Our phase two with
Foster Youth would provide emancipated foster youth with the
maximum benefits for their initial certification period. We are
currently drafting a demonstration project proposal to be
submitted in March to USDA.
We are exploring a pilot for leveraging DMV information to
assist in establishing identity, which may help decrease
administrative costs and provide a more public-friendly
mechanism for detecting duplicate aid. We are one of five
states with a biometric system for duplicate aid detection.
States with a single automated eligibility system can more
easily identify duplicate aid fraud. We have four systems, soon
to be three. The Statewide Fingerprint Imaging System is the
only statewide system, and having a statewide duplicate aid
detection and prevention system is a Federal mandate.
We received more than $22 million under the economic
stimulus package and the Governor's budget contains
modernization proposals for additional administrative
efficiencies and enhancements, including expansion of online
applications in all three automation systems. These
enhancements will benefit recipients and county welfare
departments by expediting the application process and providing
quicker handling of the cases.
In 2009 we and the Department of Health Care Services were
directed to develop a comprehensive plan for a single
eligibility system for our programs. The work of this
stakeholder group only recently began. The first meeting was
January 21. We have greatly expanded our outreach efforts. For
2010 the outreach project doubled to 82 subcontractors
operating in 43 counties with a budget of over $13 million.
I will leave you to read our comments on the Emergency Food
Assistance Program and just thank you for the opportunity to be
here. California has more to do, but we have a solid basis for
moving forward on increasing participation. We welcome ideas
and opportunities and we will continue to do what we can.
[The prepared statement of Ms. Webb-Curtis follows:]
Prepared Statement of Christine Webb-Curtis, Chief, Food Stamp Branch,
California Department of Social Services, Sacramento, CA
Chairman Baca and Committee Members,
Thank you for bringing together this panel to discuss Federal
nutrition programs in California. My name is Christine Webb-Curtis and
I am the Chief of the Food Stamp Branch in the California Department of
Social Services (CDSS.)
I will briefly summarize for the Committee, the programs and some
of the initiatives undertaken by my department and our county and
stakeholder partners to address the food needs of low-income
individuals and families in California. Currently, the Federal
nutrition programs for which CDSS has oversight responsibilities are
the Food Stamp Program (FSP) and the Emergency Food Assistance Program
(EFAP).
Food Stamp Program:
The FSP is a Federal entitlement program that provides monthly
benefits to assist low-income households in purchasing the food they
need to maintain adequate nutritional levels. The California Food Stamp
program is the second largest in the country, serving approximately
three million persons and providing about $3 billion in food benefits
over the course of a year.
The most recent report on FSP participation, for Federal Fiscal
Year 2007, released in November of 2009, by the United States
Department of Agriculture, Food and Nutrition Service (FNS) indicates
that based on Federal methodology, California still ranks among those
states with low program participation rates at 48 percent. Although we
acknowledge that we have much work to do to increase participation, the
data is 2 years old and doesn't reflect the many state and county
efforts to improve program access that have occurred over the past
couple of years. Additionally, California's ``cash-out'' of
approximately 1.2 million persons receiving SSI/SSP is a significant
factor in our low program participation rate as we are the only such
``cash-out'' state and these families are not included in the
participation rate calculation.
Well before the recent rise in food prices and the economic
slowdown, CDSS and the California Office of Systems integration had
undertaken steps to increase public awareness about the FSP and improve
the access of eligible individuals and families to these benefits. CDSS
and the County Welfare Directors Association (CWDA) also pursued policy
and operational changes to simplify and streamline the application
process and the administration of the FSP. Recently, CDSS has pursued
several changes to enhance access to and participation in this
important program with the assistance of our many partners. I'd like to
highlight some of these changes.
The expansion of categorical eligibility, pursuant to AB 433
in 2008, makes households with minor children no longer subject
to the resource test for purposes of determining FSP
eligibility. This option ensures that low-income families are
not denied critical food benefits simply because they may have
too many assets. Implementation was completed by January 1,
2010, for applicant households. The Governor's Budget proposal,
released on January 8, includes funding to expand this policy
so it will apply to all Food Stamp households, not just
families. This proposal would add an estimated 45,000
households to California's Food Stamp Program.
In 2008, CDSS received a Federal waiver to exempt most Food
Stamp households from the face-to-face interview requirement at
recertification, and for elderly and disabled households at
both intake and recertification. These interviews will be
conducted by telephone.
In 2009, just this past year, we received a Federal waiver
to exempt all households from the face-to-face interview
requirement. This waiver was recently implemented and is
available at county option. In counties where face-to-face
waivers are implemented, counties can also postpone the
fingerprint imaging requirement for up to 1 year.
CDSS provided instructions to counties this past year to
develop a simplified process that ensures that emancipating
foster youth will be given the opportunity to apply for the FSP
prior to ``aging out'' of the Foster Care system. Food stamps
at exit from Foster Care provide a critical benefit that helps
stabilize foster youth at this critical juncture in their
lives. Annually, about 4,000 foster youth statewide go through
the emancipation process.
California is one of only four states in the nation that
provides counties the option to operate a Food Stamp Restaurant
Meal Allowance Program for homeless, elderly, and disabled food
stamp recipients who may not have easy access to cooking
facilities. This option allows these household to have access
to hot cooked meals at approved locations throughout the
county. Five counties, accounting for 42 percent of caseload,
have implemented this option.
A federally-approved restoration of eligibility waiver is in
the process of being implemented to allow discontinued
households to have benefits restored quickly and easily without
the need for a new application and interview if the reason for
discontinuance is ``cured'' at any time in the month following
termination.
The Department collaborates with U.S. Department of
Agriculture (USDA) on a regular basis across the spectrum of
Food Stamp activities. As an example, CDSS partnered with the
USDA Western Region Office and four counties (Los Angeles, San
Diego, Fresno, and Tulare Counties) to implement a strategic
planning process to increase Food Stamp participation. This
plan utilizes a partnership with these counties, local
community-based organizations, along with CDSS and USDA, to
increase public awareness of the FSP and encourage eligible
low-income working families to access FSP benefits.
Finally, we are working with critical stakeholders,
including California Food Policy Advocates (CFPA), the
California Department of Public Health, and the counties, to
develop a new name for California's FSP. We are very
appreciative that CFPA was able to secure funding through The
California Endowment to employ research and marketing
specialists to assist with development of the new name for the
FSP. It is our hope that the new name will go a long way toward
eliminating some of the stigma associated with the FSP and will
provide a great opportunity to outreach to potentially eligible
families through the marketing campaign that will support the
launching of the new name.
All these efforts have played an important role in increasing
California's Food Stamp participation over the past few years. From
Federal Fiscal Year 2007 to 2009, California's program participation
has increased 31 percent or four (4) percent higher than the increase
nationally.
Future Policy Efforts
In addition to the above efforts, CDSS continues to explore ways to
streamline the Food Stamp application process and also enhance access
to the program.
Our phase two with Foster Youth would provide emancipated
foster youth with FSP eligibility without regard to income or
resources for a defined period of time to ensure their
stability. Individuals eligible for this program will receive
the maximum benefits for their initial certification period (up
to 12 months). As a result of enacted state legislation (AB
719), CDSS is currently in the process of drafting a
demonstration project proposal to be submitted to FNS no later
than March of this year to put this proposal in place.
CDSS is exploring options through a pilot for leveraging
Department of Motor Vehicle information to assist in
establishing identity for individuals in the food stamp
program. This partnership may help to decrease administrative
costs with counties and may provide a more public-friendly
mechanism for detecting duplicate aid. Most states have a
single automated eligibility determination system and can more
easily identify duplicate aid fraud. However in California,
there are four (soon to be three) automated welfare systems
that do not talk to each other. California is one of five
states that have a biometric system for duplicate aid
detection. While there are several statewide automated systems
that support our welfare programs, the Statewide Fingerprint
Imaging System (SFIS) is the only statewide system that detects
and prevents duplicate aid within our multiple eligibility
systems; and having a statewide duplicate aid detection and
prevention system is a Federal mandate. The only other state
that has multiple automated welfare systems is New York. New
York City requires fingerprint imaging and is on a different
automated welfare system from the rest of the state.
California received more than $22 million in administrative
funding for the Food Stamp Program from the Federal FNS under
the Economic Stimulus package. The Governor's Budget contains
modernization proposals for additional administrative
efficiencies and enhancements, including an expansion/creation
of online applications in all three automation systems as well
as installation of document imaging capability in one
automation system and Interactive Voice Response systems in the
other two automation systems. These automation enhancements
will benefit recipients and county welfare departments by
expediting the application process and providing quicker
handling on Food Stamp cases.
Recent legislation in 2009, AB X4 7, directed the Department
and the Department of Health Care Services (DHCS) to develop a
comprehensive plan for a single eligibility process for the
departments' programs--Food Stamps, Medi-Cal, and CalWORKs
which is California's Temporary Aid for Needy Families (TANF)
program. The stakeholder workgroup includes representatives of
advocacy organizations, county employees, county human services
agencies, the California State Association of Counties, and
legislative staff. The work of the stakeholder group has only
recently begun, holding its first full meeting on last
Thursday, January 21.
Additionally, over the last 2 years, we have greatly
expanded our outreach efforts in the Food Stamp Program. The
Food Stamp Outreach Project involves partnering with the
California Association of Food Banks, the Central Valley Health
Network and other community-based organizations. These
organizations are much closer to those families who are
potentially eligible for the Food Stamp Program. They are able
to reach out to them, explain the benefits of the program and
assist them to apply.
For 2010, the FS Outreach Project doubled and includes
82 subcontractors operating in 43 counties with a total
budget of over $13 million.
The Emergency Food Assistance Program (EFAP):
The second food-related program administered by CDSS is the
Emergency Food Assistance Program, or EFAP. In FFY 2009, EFAP
provided 109.5 million pounds of donated food to 49 local
county food banks and over 2,300 distribution sites. The
program serves approximately one million needy individuals
monthly in low-income households. EFAP also provides a portion
of the food used in soup kitchens throughout the state that
daily serve thousands of homeless individuals. The food comes
from two sources:
(1) USDA provides the bulk of the food distributed by EFAP. In
FFY 2009, USDA allocated $27.7 million in ``entitlement''
commodities to California (45.8 million pounds). In the
same year, USDA also provided California with free bonus
food comprised of surplus agricultural commodities valued
at approximately $40 million and weighing 49.6 million
pounds.
(2) In addition to these Federal commodities, the California
Donate/Don't Dump Program was established in 1995 to
salvage fresh fruit and vegetables from farmers and growers
throughout California and distribute them to needy
Californians. EFAP collects and distributes to local county
food banks over 14 million pounds of fresh fruits and
vegetables annually.
Over the past several years, food banks have been reporting
a steady increase in participation.
Food banks are reporting an increase of more than 20
percent in participation rates. The food banks report that
many of the new participants have lost their jobs and do
not have enough money for food in addition to their bills.
Soup kitchens that provide hot meals to the homeless
have also cited a 12 percent increase in meals served.
Fortunately the 2007 Farm Bill increased funding for the
EFAP Program. In FFY 2007 EFAP was provided $15.6 million for
the purchase of food. In FFY 2009, this was increased to $27.7
million. In addition, that same year, bonus commodities
increased from less than $6 million to over $40 million.
EFAP_American Recovery and Reinvestment Act:
In FFY 2009, the American Recovery and Reinvestment Act, or
ARRA, provided approximately $12 million to EFAP for the
purchase of food. In addition, ARRA provided approximately $3.1
million for administrative funds in FFY 2009 for California
food banks, and California will receive an additional $3.1
million in FFY 2010.
Fresno Drought Disaster Relief:
During 2009, Governor Schwarzenegger provided approximately
$7.8 million to purchase and distribute food to provide relief
to victims of the drought disaster in Fresno County.
Distribution began in August 2009 and to date EFAP has provided
food assistance to over 150,000 individuals and families.
Disaster food commodities will continue through February 2010.
Thank you for the opportunity to share some of the many positive
things that are happening in California to enhance access to this vital
food and nutrition assistance program. California is moving in the
right direction and many of the reforms and initiatives I have
highlighted today will go a long way toward improving California's Food
Stamp participation. We have more to do, but we have a solid basis for
moving forward. We are open to other ideas and opportunities, and will
continue to do everything possible to ensure California's needy
households have access to these critical programs.
Thank you.
The Chairman. Thank you very much, Ms. Webb-Curtis, for
your testimony.
At this time I would like to call on Nancy Swanson, the
Director of the Department of Transitional Assistance from San
Bernardino.
Nancy.
STATEMENT OF NANCY SWANSON, DIRECTOR, DEPARTMENT OF
TRANSITIONAL ASSISTANCE, SAN BERNARDINO COUNTY HUMAN SERVICES
SYSTEM, SAN BERNARDINO, CA
Ms. Swanson. Good morning, Mr. Chairman, and Members of the
Committee. Thank you for having me here today. My name is Nancy
Swanson and I am the Director of the Transitional Assistance
Department for San Bernardino County. Our department
administers all the Public Assistance Programs including the
Food Stamp Program for the residents of San Bernardino County.
Today I would like to share some important information on San
Bernardino County's continued efforts to increase public
awareness and participation in the Food Stamp Program.
I will be providing some statistical data on our Food Stamp
caseload including recent growth and possible contributing
factors; how we have worked with many agencies to assist the
public with accessing the Food Stamp Program; different
constraints the county faces; and what counties need to
increase Food Stamp participation rates.
In 2009 San Bernardino County received 152,624 Food Stamp
applications which is an average of 12,719 applications per
month. Currently we have 105,044 active Food Stamp cases with a
total of 270,468 individuals participating. Of those
individuals participating, approximately 58 percent of them are
18 years old or younger. Approximately $38.2 million of
benefits were issued per month.
From January 2009 to December 2009 the Food Stamp caseload
increased 46.1 percent, which is an average monthly change of
about 3.5 percent. The economy is clearly driving the demand
for services. A changing applicant is also being noted. Our
two-parent family caseload has increased by 67.5 percent.
County residents receiving public assistance increased from one
in every five residents to one in every four residents.
Recession has forced many working families to apply for
government help who have never done so in the past.
One avenue used to increase public awareness and streamline
program access was to create an online application. This allows
customers the flexibility to apply at anytime. In August of
2009, in conjunction with our County's Consortia, C4Yourself
was launched. Since inception we have received over 17,000 Food
Stamp applications through our website www.c4yourself.com.
San Bernardino County continues to reach out to provide
important information on Food Stamps and eligibility
requirements to community and faith-based organizations, the
public, family agencies, and other county departments. We
participate in many different outreach efforts including Inland
Empire Economic Recovery Corporation Home Foreclosure
Prevention Seminars, job fairs, senior events, veteran affairs
events, and other health events.
Our participants receive literature on the Food Stamp
Program including general eligibility requirements, as well as
nutritious food choices; how to choose an active lifestyle; and
recipe cards to create healthy meals. At some of these events
we have even been able to have staff on-site to take Food Stamp
applications.
We recognize our county's geographic area as large and
customers living below the Federal poverty level reside in all
areas. To assist with program accessibility we continue to
collaborate with the community-based organizations. To assist
our customers living in remote mountain areas we recently
relocated eligibility staff to an out-station office in the Big
Bear area. In addition, we have eligibility staff located on-
site at several schools to accept program applications and
provide customer service.
Last year in conjunction with Congressman Baca's office we
provided training to 224 participants from community-based
organizations, county departments, and school districts. This
training covered general program and eligibility requirements
for Food Stamps, the C4Yourself website and how to access it,
the online application. Participants were given user guides to
assist them when they are helping members of the community.
Many families and individuals do not apply for Food Stamp
benefits due to the social stigma associated with receiving
assistance. The public has a perception that benefits are too
small to make a difference and the program is not easily
accessible. A recent survey completed by the USDA indicates the
most common reasons why a person does not apply for Food Stamps
is perceiving oneself to be ineligible, avoiding dependency on
government assistance, and difficulty of applying for benefits.
I will let you read my further testimony. I would just like
to conclude with saying that we continue to think of
possibilities and ways of improving access such as improving
online application processes, kiosks that could be put in
schools and libraries and stores and hospitals so people would
have the ability to go into their communities and apply for
assistance.
Call centers where people can call in to get general
information, not only about the Food Stamp Program but if they
are already receiving assistance, to get information about
their case. I think that if we continue to work together with
our Federal and state partners that we should be able to make
some of these changes and streamline the technology with some
eligibility processes to improve access to Food Stamps. Thank
you.
[The prepared statement of Ms. Swanson follows:]
Prepared Statement of Nancy Swanson, Director, Department of
Transitional Assistance, San Bernardino County Human Services System,
San Bernardino, CA
Good morning, Mr. Chairman, Members of the Committee. I am Nancy
Swanson, Director of the Transitional Assistance Department for San
Bernardino County. The Transitional Assistance Department administers
Public Assistance programs, including the Food Stamp Program, for the
residents of San Bernardino County.
Today I would like to share some important information on San
Bernardino County's continued efforts to increase public awareness and
participation in the Food Stamp program.
I'll be providing statistical data on San Bernardino County's Food
Stamp caseload, including recent growth and possible contributing
factors, how we've worked with many agencies to assist the public with
accessing the Food Stamp program, different constraints the county
faces, and what counties need to increase the Food Stamp participation
rate.
Last year (2009) San Bernardino County received 152,624 Food Stamp
applications, which is an average of 12,719 applications per month.
Currently we have 105,044 active Food Stamp cases with a total of
274,468 individuals participating. Approximately $38.2 million of
benefits were issued per month.
From January 2009 to December 2009 the Food Stamp caseload
increased 46.1% (The average monthly change for this period is 3.5%).
The Economy is clearly driving the demand for services. A changing
applicant is also being noted.
Two-parent family caseload increased by 67.5%.
County residents receiving public assistance increased from
one in every five residents to one in every four residents.
Recession has forced many working families to apply for
government help who have never done so before.
Online Application--``C4Yourself''
One avenue used to increase public awareness and program access was
to create an online application. This allows customers the flexibility
to apply at anytime. In August 2007, in conjunction with the County's
Consortia, C4Yourself was launched. Since inception, we have received
over 17,000 Food Stamp applications through www.c4yourself.com.
Outreach
San Bernardino County continues to reach out to provide important
information on Food Stamps and eligibility requirements to community
and faith based organizations, the public, family agencies, and other
County departments. We participate in many different outreach efforts
including Inland Empire Economic Recovery Corporation Home Foreclosure
Prevention Seminars, job fairs, senior events, and health events. Our
participants receive literature on the Food Stamp Program, including
general eligibility requirements, as well as nutritious food choices,
how to choose an active lifestyle, and recipe cards to create healthy
meals.
We recognize our county's geographic area is large and customers
living below the Federal poverty level reside in all areas. To assist
with program accessibility we continue to collaborate with many
community-based organizations. To assist our customers living in the
remote mountain areas we recently relocated eligibility staff to an
outstation office in Big Bear. In addition we have eligibility staff
located on-site at schools to accept program applications and provide
customer service.
Last year training was provided to 224 participants from community
based organizations, county departments, and schools. This training
covered general program and eligibility requirements, the C4Yourself
website and how to access. the online application. Participants were
given user guides to assist them in helping members of the community.
Many families/individuals do not apply for Food Stamp benefits due
to the social stigma associated with receiving assistance from the
government. The public has a perception benefits are too small to make
a difference and the program is not easily accessible.
A recent survey completed by the USDA Food and Nutrition Services
(FNS) indicates the most common reasons why a person does not apply for
Food Stamps is perceiving oneself to be ineligible, avoiding dependence
on government assistance, and difficulty of applying for benefits.
Changes to the process to make applying for the program less
intrusive and simplification of requirements would help to overcome
some of these perceived barriers. We believe that our online
application process, as well as our outreach efforts, is a step in the
right direction in helping to reduce these barriers, as well as
streamlining the application process.
With the increasing caseloads salary and benefits costs have
increased dramatically. The average employee cost increased by 68% from
FY 2001-2002 to 2008-2009. Program Administration funding has stayed
relatively flat for the same period. As a result, staffing levels have
dropped significantly.
Additional funding is needed to serve our increasing caseloads and
assist the families within our communities.
It is important that we continue to collaborate with our state and
Federal partners to ensure adequate funding--not only for the
administration of the program but also to educate the public and reach
out to those that may qualify.
The Transitional Assistance Department is committed to increasing
public awareness, accessibility and participation in the Food Stamp
program. Working collaboratively with government and community
partners, this goal is achievable.
The Chairman. Thank you very much, Ms. Swanson, for your
testimony. I know that it is intimidating to pick up the gavel
when someone says, ``I've got to finish my statement.'' We go
through that when we are giving the 1 minute spiels on the
floor back in Washington, D.C. and sometimes they cut us off
immediately when we go beyond our 1 minute. I want to thank
each of you for your testimony.
We will begin with questions. I will begin with myself with
some questions, I will then call on Congressman Fortenberry,
and then I will call on Congressman Costa for questions.
I will start my first question addressed to Lisa Pino, the
Deputy Administrator. Ms. Pino, thank you for your testimony
and for traveling here to Southern California on a beautiful
day that we are now going to remark that you are in Switzerland
as Mr. Fortenberry indicated out here.
Mr. Costa. Jeff, everyday is like that.
The Chairman. During the summers it is like this. You just
have to look beyond the smog. Thank you very much for coming
here.
Ms. Pino, given the audit in Texas, New York, and
California casting doubt on the cost effectiveness of
fingerprinting for food stamp applications to deter and detect
fraud, given significant evidence that fingerprinting deters
and discourages eligible applicants, why does the USDA permit
states to use Federal food stamp funds to operate
fingerprinting imaging systems?
Ms. Pino. We are currently evaluating the efficacy of
finger-imaging, and actually states have the flexibility of
choosing the structure of that option. That is why there are
four localities in the country that do institute finger-
imaging. However, we do take a strong stand and believe that
finger-imaging is not the most cost-effective means for
detecting dual participation. It is very expensive to operate.
We also have heard from many constituent groups and
community-based organizations that it does act as a deterrent
from participation among Hispanics, especially in immigrant
communities. We think that there are alternative fashions of
just doing a simple data match of name and Social Security
Number. Finger-imaging isn't very effective in terms of the
cost and the investment needed, so we encourage California to
consider suspending finger-imaging, possibly eliminating it
altogether.
The Chairman. The next question I have is: Can you explain
to the Subcommittee USDA's current plan for marketing and
outreach for Federal nutrition programs like SNAP.
Ms. Pino. Absolutely. I would be delighted to answer that
question for you, Mr. Chairman. First, a little bit about
marketing and outreach just to explain how it works for the
benefit of all at the hearing. We do a 50/50 match with
outreach initiatives, so whatever the state invests up front,
we provide a 50/50 match. At this time, we have about 40 state
outreach plans all together. States aren't obligated to conduct
outreach, but most of them do.
In addition to state-level outreach, we also have national
campaigns. We have a campaign of media involving radio and
television. We have public service announcements. We do see a
spike of activity and calls when those announcements are
played. We have an 800 number and a call center. We also have
an 800 number available to Spanish speakers. We have a lot of
information in the form of educational materials that are
available for download on the website in both English and
Spanish.
We also have an extensive national partnership network.
Organizations such as the Catholic Charities are one among many
of our partners. This is an area that we have dedicated serious
attention to. With the new Administration, we are also working
very hard to take the marketing and outreach plans that we do
have, and more effectively coordinate a bigger more strategic
plan so that we can better identify issues. One of the issues,
as you have noted, Mr. Chairman, is that while caseload is
increasing so quickly, we will need to bridge the gap with
certain under-served communities such as Latinos, such as
seniors, and most notably with the recession, the working poor.
That involves an additional level of strategy and we look
forward to working with California, as we look forward to
working with many states during this time of crisis.
I have also brought for your benefit some materials today.
I have an oven mitt for you, Chairman Baca, for the next time
you make a casserole at home.
The Chairman. My wife would love that. She would love to
get me to cook.
Ms. Pino. Let give you one little example of how we are
working hard to help states spread the good word of SNAP
because, again, we cannot emphasize enough the economic value
of this program. Traditionally, our retailers used to have a
sign saying, ``We accept SNAP benefits.'' We are now
encouraging them to advertise, ``We welcome SNAP benefits.''
That might seem like one little change, but to us and to
retailers, it is paramount because it is taking SNAP out of the
old perception, the old stigma and stereotype, and positioning
it as nutrition assistance and inviting a new, fresh attitude
that shows that SNAP is something that is a benefit to help
people at a time of need. It is not anything that they should
be ashamed of.
The Chairman. Thank you. I know that my time is past. What
we are going to do is we are going to have another go-around,
but I am going to ask one final question.
I think all of us agree that better education and
nutritious foods and healthy lifestyles are essential to fight
obesity. I understand that the SNAP-Ed Program plays a critical
role in education. What does USDA plan to do in moving forward
to improve the SNAP-Ed Program? You talked a little bit about
that. Does the Department have any current plans to expand the
program's outreach?
Someone mentioned that we used to have homemaking classes.
Is that what needs to be done in terms of curriculum and our
educational system so that our children understand the value of
healthy food and living longer? We have cut back a lot of the
physical education programs. Could you elaborate a little bit
on that? Then I will turn it over to Mr. Fortenberry to ask the
next question.
Ms. Pino. Absolutely. My pleasure. First, let me say that
we view the role of SNAP-Ed, not only in the context of SNAP,
but also in the context of all of our 15 food programs. What is
amazing about our programs is that they literally can span a
person's lifetime from birth to senior age. In the context of
SNAP-Ed, we have legislation that authorizes us to use those
funds for what is termed as ``SNAP-eligible communities.'' We
understand that SNAP-Ed has to have somewhat of a focus in
terms of targeting those who could be eligible for the program
who are not aware of the program and who can benefit from
learning about healthy eating and other good eating behaviors.
Now, what is tricky about this question, and we are
currently evaluating how we can expand SNAP-Ed, is that the
more that you broaden the scope of that initiative, the more
difficult it becomes to account for how you are going to track
the outcome. How do you know that a specific initiative
actually led to someone either enrolling in the program or
changing their behavior? So, it's not to say that we aren't
considering it. We are, but we are just currently evaluating it
because it is very challenging.
As you know, SNAP-Ed involves about $300 million.
California is by far the largest player and has over $118
million, so we want to very carefully weigh the balance between
using it as an effective tool and engaging education, promoting
these early eating behaviors, while at the same time, trying to
be very committed to the fiscal responsibility of ensuring that
those monies are also leading to direct results.
The Chairman. Thank you.
Now I recognize the gentleman from Nebraska, Mr.
Fortenberry, for 5 minutes. Please stay to 5 minutes.
Mr. Fortenberry. With flexibility determined by the
Chairman. Thank you, Mr. Chairman.
Again, thank you all for your insightful testimony. I want
to turn to you first, Ms. Pino, as well. You stated that low
participation rates means less healthy food at home. I assume
you mean that there is evidence that those who are benefiting
from the SNAP Program are selecting healthy choices at the
grocery store.
Now, it is also my understanding that there is no evidence
to suggest that obesity rates among children in the SNAP
Program are lower than the population at large. Can you unpack
what seems to be a conflict there.
Ms. Pino. SNAP is termed the Supplemental Nutrition
Assistance Program because, as you noted, it is a supplement.
It is not meant to account for a household's entire food
budget. We do not see any link between SNAP participants and a
higher rate or incidence of obesity. We are often asked why
doesn't SNAP restrict food purchases? How do you account for
that these dollars are spent for healthy eating?
The way we approach this conundrum is that we don't view
obesity or the lack of healthy eating at home as just an issue
that pertains to low-income households. We see this as a broad
cultural epidemic affecting the entire country, and we see it
as something that is pretty analogous to smoking. It took
decades of repeated messages and repeated work for smoking to
become a rare instance, as it is today, and that really is a
generational change.
However, we very much believe in vehicles like SNAP-Ed to
teach households not only about making healthy purchases but
also about engaging physical in activity, about making
purchases that are affordable. We want to use this vehicle in a
constructive, positive light. We are very excited about our
Healthy Incentives Pilot Program. We received $20 million,
authorized by Congress, for this pilot which is to launch this
year. We are in the request-for-proposal mode right now.
The Healthy Incentives Pilot Program is to examine whether
you can incentivize healthy purchases at the point of sale--if
people buy more fruits and vegetables and if they receive a
greater economic benefit for doing so, if incentives are going
to change behavior because that really becomes the hardest
connection to make. It is one thing to provide that education
and to provide that option, but actually tracking whether it
has really made a long-lasting impact in changing behavior is
the most difficult obstacle to prove. But, it is one way of
looking at it from a more constructive incentive than going
down the road of restricting behavior and making people feel
isolated for their purchases.
Mr. Fortenberry. One of the inherent conflicts here is, and
Chairman Baca alluded to this earlier, that in the initial
formative stages of these programs the intent was to increase
caloric intake. So, what we are all trying to do is change that
culture. The difficulty of that, though, is foods high in
caloric intake are less expensive, potentially, than the foods
that would necessarily improve health outcomes. This is the
tradeoff and dilemma.
Ms. Pino. Just to add to that, Mr. Congressman, that is one
reason why we are expanding our farmer's markets and we are so
excited about it, especially here in California. We want to
also incentivize people to buy fresh fruits and vegetables. We
also have other initiatives like Know Your Farmer, Know Your
Food that talks about the important economic and health
connection of buying locally.
You are right that hunger and obesity do coexist. It is a
paradox, but that is why we are more committed than ever to
looking at how we can improve healthy eating patterns for
families in all our programs.
Mr. Fortenberry. Let me segue from what you said. This may
be a little bit beyond your realm of expertise but if you and
the panel want to comment on this as well. The Fresh Fruits and
Vegetables Snack program was greatly expanded in the last farm
bill to provide more low-income students with access. Can you
comment as to how this program is working in California?
Ms. Pino. I will just say very quickly, and I will let my
colleagues answer, that the Fresh Fruits and Vegetables Snack
program did begin in California as I understand it. We have
about $5 million apportioned for that. It has been, from my
knowledge, very successful. What is great is that about 90
percent of the schools in the program are those that offer free
and reduced-price meals, so that is very exciting to us.
Ms. Webb-Curtis. I would not want to pretend that I can
speak to it but I would be glad to get you information about it
however.
Mr. Fortenberry. Thank you.
Ms. Swanson. In San Bernardino County, it has just recently
started up in the desert at a few local farmer's markets.
Mr. Fortenberry. I am finished for now.
The Chairman. Thank you very much. It is a good question
and one that we need to address. I know that we have school
board members here changing their philosophy and looking at
policies in using fresh fruits and vegetables.
Now I would like to turn to the gentleman from the Central
Valley, Congressman Jim Costa.
Mr. Costa. Thank you very much, Mr. Chairman. To both the
Federal and state witnesses, I spoke of the challenges this
last summer with the large unemployment and the food lines that
I witnessed and participated in to help provide food in the
areas where the droughts occurred.
Since we have both the USDA and state witnesses here I
would like to talk about the coordination of food banks. The
food banks in a number of our areas indicated that they had
come close, and we tried to be helpful, to the end of their
food and administrating fund supply. During that period last
fall we inquired to the USDA whether or not they were following
up on this. They indicated they had purchased more than
adequate supplies of food and supplied the state with
administrative funds.
Our food banks at the time were unclear and very fearful
that there was going to be an end of that availability. Could
you talk about how the USDA and State Department of Social
Services determines what and when and how much food and
administrative funds are provided? If you cannot provide the
answers, I would like you to get back to me on those points.
Ms. Pino. I do have some specific information about the
amounts. I don't know if you want me to actually go through all
of the fiscal amounts right now. I can.
Mr. Costa. For the sake of brevity why don't you provide
that in a written statement because I have some other questions
I want to ask.
Ms. Pino. I will provide that later. Okay.
Mr. Costa. Ms. Webb-Curtis, you care to add anything to
that?
Ms. Webb-Curtis. I also have information about amounts but
I can't speak to that.
Mr. Costa. Also, because I worked with the Schwarzenegger
Administration and folks, in some of these food lines, sadly in
the most productive agricultural region in the world, I noticed
that there were canned vegetables that were purchased from
China. I mean, talk about nonsensical. While you have the
option the preference is to buy American food products and they
said they were going to correct that. Would you please let us
know about that?
Ms. Webb-Curtis. I will look into that.
Mr. Costa. Number two, it was spoken earlier by Congressman
Fortenberry about the importance of fruits and vegetables and
obviously we want to encourage that. We know they are more
costly under the SNAP program than, say, potato chips. Do you
believe it is worthwhile providing additional incentives to
purchase more healthy food options like fruits and vegetables?
You talked about some of the things that you were doing when he
asked you the question earlier. What are some of the logistical
barriers to providing the system? Like Safeway provides bonuses
in their purchasing. Can you comment, please?
Ms. Pino. Well, I think that overall, and I would like to
actually make a quick note about food banks as well, but
overall the tricky part is the coordination from the local
level, the state level, and the Federal level. At the same
time, more than ever, we need to be engaging partners whether
they are community-based organizations, faith-based
organizations. We are here at a hospital today. We have to more
effectively engage the health and medical community because
they really serve as vital links to that coordination.
Mr. Costa. I want to get to that point but if you could----
Ms. Pino. I would just say, for instance, food banks serve
as a front line.
Mr. Costa. Right.
Ms. Pino. The more that we can have those front lines
distributing information, building awareness, engaging
partners. For instance, with our farmer's markets and some
localities there are additional incentives so that when people
buy fruits and vegetables, they also can receive an additional
incentive so those fruits and vegetables become more
affordable.
Mr. Costa. Some of our areas have been innovative, and it
gets back to the point that the Chairman was raising a moment
ago in terms of access and taking advantage of all those who
potentially can qualify. Some of our areas have been innovative
and they have one-stop-shops that include nutrition assistance
for health, where health clinics also provide funding for WIC,
Women and Infant Children, as well as SNAP depots. What are you
folks doing to further incentivize or encourage that
collaboration, one-stop shopping?
Ms. Webb-Curtis. I am not sure whether you are directing
that at me.
Mr. Costa. To you, please, Ms. Webb-Curtis.
Ms. Webb-Curtis. I cannot speak to the one-stop shopping. I
can tell you that there is a lot of enthusiasm in California
for the incentive program. We don't have it up and running but
there are people----
Mr. Costa. Is the state providing any funding for clinics
to co-locate some of the sign-up process?
Ms. Webb-Curtis. Not to my knowledge but that may be the
case and certainly I will find out.
Mr. Costa. Why don't we look at that? It seems to be that
would be helpful because I have one county, Kern County, that
does that, it is very innovative. I have another county, Fresno
County, that doesn't. The differential between those that sign
up and those that don't in the two counties is distinct.
My time has expired. Thank you very much.
Ms. Swanson. Congressman Costa, could I just share with you
that in San Bernardino County we are working on an integrated
health initiative that includes our Behavioral Health
Department, our Public Health Department. I also have
eligibility staff that will work at these clinics to ensure
that Medi-Cal applications and Food Stamp applications are
taken at the time people come in for services. We are really
very excited about it. I think it is going to be a very
promising venture.
Mr. Costa. Good for you. Congratulations.
Ms. Webb-Curtis, that other aspect with regards to where
you are purchasing your food from, I do want to stay on top of
that.
Ms. Webb-Curtis. Oh, yes. I have made a note.
Mr. Costa. That is an embarrassment. Thank you.
The Chairman. Thank you very much, Mr. Costa, for your
statement and your question, especially as it pertains to the
one area. I think both the Minority Ranking Member and I are
very much interested in looking at what we might do from a
national perspective in terms of policy to make sure that we do
buy products that are made right here in the United States for
a multitude of different reasons. A lot of the products that
come from another country do not have the food safety
requirements that are required here in the State of California,
especially as it pertains to pesticides, and the impact it
could have on children, and other individuals.
We will begin a second round of questions and I will begin
the first one. I will ask Ms. Webb-Curtis first. The Committee
recognizes that California has increased enrollment in Food
Stamps for SNAP in recent years. As we all know the current
economic downturn is the primary reason for this. What efforts
has CDSS undertaken to identify the level of needs in our
states, Number one? Number two, how does CDSS adjust policies
and practices to respond to the increased need during difficult
times like these?
Ms. Webb-Curtis. I think I will answer your second question
first and that has to do with adjusting policies. We have
worked very closely with many of the partners in this room
including the counties, California Food Policy Advocates, and
other community-based organizations to look at how we can do
things better to address the needs of those whose nutrition
needs to be improved.
In addition, we work with our partners in public health to
manage the outreach program and the nutrition education
programs. I think I might have explained our increase in
outreach efforts over the last year which were considerable. I
have tried to communicate that we have really done a lot of
work in areas that I think you and your Committee Members would
be happy about, in terms of our modified category for
eligibility. For example, to allow individuals to apply and not
be subject to the resource test. It is something that we work
at all the time. We are bound by certain state statutory
requirements, and we work with our legislative partners as
well, to make changes that are beneficial to this population.
The Chairman. Thank you. The next question I have is how
much does finger imaging cost the state? Do you believe this is
cost effective? In today's article there is a constituent in
the area that says finger imaging has deterred a lot of
individuals from even going and applying.
Also, what type of information is gathered. I stated at the
beginning that we had problems in privatizing collection of
some information in Texas and in Indiana. A lot of people are
very much concerned when you look at all of the data and
information, especially now, as you look at identity theft.
Or individuals may say in filling out the application,
``They are asking for too much information and a lot of that is
available. I don't want the IRS to find out I didn't pay my $10
payment at Target.'' I was going to mention another store but I
better not mention that one. This presents a problem. Can you
elaborate on that, please?
Ms. Webb-Curtis. Well, first, let me tell you that I cannot
tell you how much the fingerprint imaging cost the state, but I
can certainly provide that information to you.
The Chairman. Thank you.
Ms. Webb-Curtis. As Ms. Pino mentioned, the information
that we have available to us through a study indicated that one
of the most important reasons that individuals do not apply for
the program is that they don't know that they qualify, and that
they are afraid of the administrative burdens. The fingerprint
imaging didn't appear to be an issue in that particular study.
Be that as it may, California does have a system of
determining eligibility that is done through four automation
systems, soon to be three, that essentially don't talk to each
other at the moment. In other states that have a single
eligibility system, of course there are other ways of detecting
duplicate aid that would be simpler. In California it is not so
simple. That is where we are on the fingerprint imaging.
The Chairman. Okay. Ms. Swanson, given your experience,
what are the most serious barriers to better SNAP participation
that we face here in San Bernardino County?
Ms. Swanson. I think a lot of those barrier are things that
we talked about, the perceptions or misperceptions people have
about the program. People don't necessarily want to go to the
Welfare Department. They don't necessarily see Food Stamps as a
nutrition program. They kind of lump it in as an entitlement
program with the CalWORKs benefits.
I also think from comments that we have heard from our
community, members that come in and do apply, that the finger
imaging is indeed a concern for many of them. At times that is
one of the first questions that they do ask. Sometimes we take
an initial application and then when we explain they are going
to have to wait to be finger imaged they leave our offices.
That is why I really think that our online application process
and going to the phone interviews is really going to improve
access in San Bernardino County.
The Chairman. Thank you.
Mr. Fortenberry.
Mr. Fortenberry. Yes, Mr. Chairman. I do want to return to
my earlier question and further unpack this issue as to seeing
if there is any evidence of a change of buying patterns yet. As
you know, the farm bill provides significant resources and is
attempting to institutionalize cultural changes towards more
healthy choices in this program, as well as your outreach
efforts.
The stimulus program dumped huge amounts of new resources
into the SNAP program. Has that provided evidence of any change
of buying patterns toward more healthy food selections?
Ms. Pino. I think the Healthy Incentives Pilot really will
serve as the first paramount in-depth examination of that
query. It will probably take a couple of years to really
accumulate all that information, which doesn't seem like too
long of a time--in the world of research that is a pretty
reasonable time.
It cost $20 million which sounds like a lot of money, but
because we are going to do such in-depth research and comparing
shopping patterns ``before'' versus ``after,'' I think that
examination will really give some specific information about
what the potential impact is, the connection between changing
food pattern consumption, how that links to better health, how
that can also lead to increased physical activity and promote
better health in the realm of disease prevention and promotion.
I think the HIP Pilot really will serve to do this.
Mr. Fortenberry. I think you understand what I am driving
at given my earlier testimony in the opening statement as is
related to healthcare outcomes, as well as prudence around
governmental budgeting. Because, we will pay to fix or cut or
prescribe in the healthcare system but not incentivize
prevention and wellness and this is one of the cost drivers in
our system that is leading to chronic diseases. There is
linkage between nutritional outcomes.
In that regard I appreciate your commentary on local
farmer's markets, Know Your Farmer, Know Your Food.
Reconnecting the urban and the rural, the farmer to the family
is not only a growing trend because, given the fragmentation in
our society, people are looking for that sense of connectedness
from a sociological perspective but it has real potential power
to improve healthcare outcomes as we move better nutritional
selections directly to the table. But, it also creates local
economies, the revival of local economies.
There are a multitude of opportunities here. It is a bit
ironic that this is the way we used to do things. This is not
new. We are returning to something traditional. My family was
engaged heavily in the Cooperative Extension Service. My
grandfather was a county agent, my mother an extension
educator, 4-H agents they used to be called. I loved looking at
the old pamphlets that aren't that old. Many of you may
remember growing up with them. Congressman Costa had mentioned
he was in 4-H and so was I. Were you in 4-H? You missed that
chapter of life.
This was a part of the USDA's effort to acculturate through
the land-grant system in the classrooms directly, as well as in
family education, this common sense essential aspect of
balancing healthy lifestyles by focusing primarily on
nutrition. We are trying to recapture something that is old. I
would go dust off all of those old extension pamphlets if I was
you that are a bit anachronistic.
Ms. Pino. No, it's funny that you say that because actually
my colleagues and I----
Mr. Fortenberry. They are very interesting.
Ms. Pino. Yes, absolutely. We were recently at the
Smithsonian in Washington. They just opened a gallery of food
stamp artifacts and we were looking at the old food stamp
coupon books. The back of those books, even if they were 10 or
20 or 30 years old, they still had the same information that we
are preaching today, like portion size and fruits and
vegetables and take 15 minutes to exercise. It really is
nothing new.
On your point, Mr. Congressman, about the connection of
localism, as you noted aside from the amazing economic impact,
because when you purchase something that has been grown locally
it has such a higher magnitude of economic stimulus. What is
really exciting in the Know Your Farmer, Know Your Food
initiative is to see the impact on children. Today, children
think food comes from the supermarket.
When you ask them where does food come from, they think it
comes from plastic-wrapped containers. They really don't know
enough about how food is grown. It is exciting to encourage
that respect and understanding because the more that you do
that, what is amazing is you will see how children will start
changing their behavior and then they act as ambassadors at
home. I visited a school in Vermont not that long ago and it
was amazing to see that the food prepared and distributed at
the school was grown in a garden that used to be a desolate
lot. How the kids loved going to the garden.
They are so excited to eat fruits and vegetables now
because they have met the farmer who grew them. They have seen
how they are grown. They have nurtured those plants. Having
that emotional connection, especially with children at such a
young age, we think that is a very significant and empowering
means of helping to develop adults with good eating behaviors
for life.
The Chairman. Thank you. I would like to thank each of the
panelists for being here. I would like to call the next panel,
panel two, to the table. I would like to just state that
originally when the farm bill was done there were 38 million
people who were going hungry and that is before we went into
the big depression that we are in, so it is even higher than
that in terms of hunger in the United States.
We still have a lot of work ahead of us in marketing and
reaching out to assure that not only do we reach needy
individuals, but at the same time look at it from a cost
effectiveness view. With that we would like to thank each of
the panelists for being here. We would like to call our next
panelists to the table. While they are coming up, I will have
at the very beginning Congressman Jim Costa introduce a
constituent, an individual from his area, and then I will
introduce the other panelists.
We will begin if we can have your attention, please. If you
would be silent so we can begin the second panel. I would like
to welcome the panel up here. I will introduce a couple of the
individuals right now. Dr. Guillermo Valenzuela who is one of
our panelists. We have Dr. Webster Wong from Arrowhead Medical
Center here in Colton, California. We have Matthew Sharp,
Senior Advocate, California Food Policy Advocates from
California. We have Matthew Marsom, Director of Public Health
Policy and Advocacy from Public Health Institute in Oakland,
California. Then we have Ms. Claudia Page, Co-Director of The
Center to Promote HealthCare Access to Oakland, California.
I will let the gentleman from Central Valley, Mr. Costa,
introduce one of his constituents.
Mr. Costa. Thank you very much, Mr. Chairman, and thank all
of you. This second panel is very exciting and I appreciate the
expertise that all of you provide for us. Unfortunately the
Chairman has been very kind to me. Not that that is
unfortunate. I appreciate that but unfortunately I have to
leave. I won't be able to stay for the entirety of the second
panel because I have another hearing at 1:00 in downtown Los
Angeles.
Edie Jessup is the Central Valley Regional Obesity
Prevention Program Director. She has a wealth of experience.
She is a pistol as you will find out in her testimony. She grew
up in Porterville in Tulare County and has been working in a
host of efforts in advocacy and direct service work with
neighbors that happen to be poor and, thereby, hungry, homeless
and some without access to healthcare.
She has focused on advocating there with the State
University of Fresno. Go Bull Dogs. Go Dogs. We appreciate her
good work with Fresno Metro Ministry, Girl Scouts, the youth
county homeless shelters and the Sanford Public Library for
Adult Literacy Programs. Mr. Chairman, you have a good panel
here, the second panel, and I am really pleased to hear. I
won't be able to hear all of you but I have your statements and
I have read them and I will have some questions if I am not
able to remain and submit them after the testimony.
The Chairman. Thank you very much, Mr. Costa, for the
introduction.
At this time we would like to begin with Dr. Valenzuela.
Please begin. You have 5 minutes.
STATEMENT OF GUILLERMO J. VALENZUELA, M.D., M.B.A.,
ASSOCIATE MEDICAL DIRECTOR AND CHAIRMAN,
DEPARTMENT OF WOMEN'S HEALTH, ARROWHEAD
REGIONAL MEDICAL CENTER, COLTON, CA
Dr. Valenzuela. Mr. Chairman, thank you for inviting me to
talk. Since you have my statement I will just talk a little bit
about what I consider important in this area of obesity in
general. You know, if you have ever seen a Chihuahua date a
German Shepherd you realize that if the female is a Chihuahua
that she cannot use the gene that come from the German Shepherd
or huge dogs. The mother controls the size of the baby in utero
and in that way she is able to have puppies. They will grow
really rapidly thereafter using the genes of the father. The
important part of this is that in utero we determine a lot of
what will happen given the rest of our life.
For instance, if the mother is overweight and eats a lot,
or the mother is underweight and the baby weighs very little,
50 years later or way before we have myocardial infarction,
diabetes, hypertension. Because of the mother's environment
regardless of your genes it can make things a lot worse.
I think that in order for us to deal with the problem of
obesity or undernutrition we are going to have to look at a lot
of other factors, not just telling children to eat this or eat
that. I think this is great what you guys are doing with the
SNAP program and so on. However, I personally feel that many
times a child is told at school to do this or do that. They go
home and they get Cheetos and they get cheese and they get a
big hamburger or whatever depending on the socioeconomic
factors and that is what they will eat.
So recently here we started a program trying to intensively
teach pregnant women how to eat right apart from what the state
is doing and to see how big the problem is. For instance, we
have 80 women that we were trying to do intensive counseling, a
group of 40 and another we work with. We do so much counseling.
The BMI of these pregnant women was 40 or there about. We had a
pregnant woman who weighed 680lb. We had multiple pregnant
women with severe problems.
If you think of those children, they are condemned for life
because it is already going to start with insulin resistance at
birth. They will have a much higher chance of being obese. If
the parents are obese, there is a much higher chance for them
to be obese. The problem I think that we are going to have, and
we are trying, is to face it from a cultural point of view.
For instance, here in the capital Mr. Petree have set up
Find the Feet that people come and walk around, go up and down
stairs. They have a running competition.
Dr. Wong is working in another area with children. What we
are trying to do in pregnancy is try to get these women support
during pregnancy, and when they go back to their community to
try to work with community-based organizations so we can
provide support. Diet and exercise program success is very
limited, for 2 years.
In every place that they have done any studies they have
shown that after 2 years everything goes back to normal, it is
only when you change the whole culture of a group. Right now
there are studies showing that children are watching 7 hours a
day between video games, the TV or whatever. You have any type
of food, even a pretty healthy food, and you eat a lot of
pretty healthy food and you don't do anything you are going to
get fat anyway.
Personally I like the theory of pregnancy because I blame
my parents on my 23 pounds that I am overweight. But the point
is that I think the city needs to design places where children
can safely run and play and teach the parents the same thing.
This is what we are starting to do here.
First we start with the pregnant women and then we are
trying to get back into the community with the help of
Supervisor Gonzalez to try to see if we can interact with
community-based organizations in order to provide support to
these women and trying also with the schools and children in
other areas. This is what we are trying to do here. I think it
is important that we take this program to multiple places from
exercise and education, not only to the children but the
parents and affecting the expecting mother. That is what I
would like to say.
[The prepared statement of Dr. Valenzuela follows:]
Prepared Statement of Guillermo J. Valenzuela, M.D., M.B.A., Associate
Medical Director and Chairman, Department of Women's Health,
Arrowhead Regional Medical Center, Colton, CA
The relevance of addressing obesity as a major health problem is
the projected $147 billion in costs related to healthcare.
The causes for obesity are multi-factorial. The process begins in
utero. We know that if a baby is born whom weighs less or more than he
should for the gestational age he is born at, a higher rate of insulin
resistance is more likely. Barker in England demonstrated the
relationship between birthweight and diabetes, heart disease, insulin
resistance and obesity. Later, other investigators have added the
metabolic syndrome. If the mother undergoes gastric bypass surgery,
children born after the surgery tend to have a lower prevalence of
obesity.
Animal studies show that a mother's weight and health influence her
child's birthweight and size. Generally, if one of the parents in the
household is obese, the child is two to three times more likely to
become so.
Evidence also points to ethnicity as a factor. For example,
childhood obesity is more common amongst American Indians, non-Hispanic
blacks and Mexican Americans than in non-Hispanic whites. Clearly,
there are socioeconomic factors as obesity is more common amongst low-
income populations.
Public perception of criminality, drugs, urban violence, etc. in
residential areas are a factor. They have made neighborhoods unsafe for
children to play and traverse (walking, running, bicycle); therefore,
decreasing considerable ``public space'' and limiting outdoor physical
activities.
Gender also affects obesity. 80% of teenage girls that were obese
as children, remain obese, versus only 30% of males under the same
circumstances. Furthermore, in recent years there is a decrease in
physical activities both at home and at school, increase in usage of
video games, increase in time spend watching TV (up to 7 hours/day),
high-caloric snacks (very popular with younger teen); all of these
factors are associated with increase incidence in obesity.
Complicating the solution, is that choices confronting care-givers,
schools, etc. are defined also by cost-effectiveness in the food
selection. The cost of food with good nutritional value is higher,
while food with high-calorie and fat content is subsidized and thus
cheaper and very abundant.
Many studies examine obesity in adults and children and evaluate
the treatments of diet, exercise and use of medication and surgery.
This research shows that treatment of obesity successes are very
limited in the long-term (2 years), except for surgery. As for the last
option, even though the risks of surgery have been decreasing
significantly with time, there are still major obstacles. These include
financial cost and the risk of morbidity/mortality to treat a
significant portion of the society.
Any solution will require an integrated system, utilizing portions
of prenatal care, to be sure that women gain a healthy amount of weight
during pregnancy. It will require a community effort to address
multiple causes such as awareness of the impact of a mother's weight on
her child's, opportunity and encouragement for exercise for children
and adults and access to adequate nutrition at schools. The bottom line
is to positively influence a change in obesity trends and work together
on multiple levels to address the problem.
The Chairman. Thank you very much, Dr. Valenzuela.
Next we have Dr. Wong.
STATEMENT OF WEBSTER A. WONG, M.D., M.B.A., CHIEF OF
PEDIATRICS, ARROWHEAD REGIONAL MEDICAL CENTER, COLTON, CA
Dr. Wong. Thank you very much, Congressman Baca,
distinguished guests, Congressmen. My name is Dr. Webster Wong.
I am Pediatric Chair of Arrowhead Regional Medical Center. What
we are looking at is calculated by some experts to be a $147
billion price tag per year that America spends on obesity and
obesity-related illnesses. Some experts will also say that
price tag will go up to $1 trillion by 2030.
For kids, Medicaid kids who are obese cost at least $6,700
per year for obesity-related issues and across the nation, even
here in San Bernardino, upwards of 18 to 25 percent of all
adolescents and children are obese or are overweight. Seventy
percent of those kids will be obese adults.
Not only are issues of obesity-related diseases affecting
kids but also other issues such as school performance. Upwards
of four times the number of school problems occur in obese kids
and upwards of 30 percent of kids will have more thoughts of
suicide, depression, and feelings of hopelessness. There are
many reasons for issues of obesity, namely socioeconomic
problems, the urbanization of America. Kids are more concerned
about safety rather than going to their playgrounds or their
local parks.
The technology factor that Dr. Valenzuela alluded to: there
is more TV time. There are more computers and more video games
to deflect and defray the kids away from physical activity.
Also, the family unit is a bit affected. There are more single-
parent families. Also there is a de-emphasis on family
mealtime, too.
Obesity disease states, when it comes to pediatrics,
include many things and with long-standing consequences.
Namely, type 2 diabetes. Back 20 years ago this was named adult
onset diabetes, but we are seeing patients who are 7, 8, 9
years of age who qualify for diabetes. That along the lines
will contribute to issues of heart disease, atherosclerosis,
stroke, and also asthma and certain cancers. Depression is also
an issue with regards to these obese kids.
Certainly this affects their productivity not only from a
school standpoint but from a worker standpoint as they get into
the workforce. Obesity has caused some issues with
discrimination. Obese people earn less and undergo a lot of
discriminatory actions against them.
The SNAP program is a valuable program, as we all know.
However, studies show that moms who are primary food buyers and
food preparers really don't like to engage in certain behaviors
that increase cleanup time. Certainly they are not always
around their kids when mealtime occurs. So, therefore, kids
have poor role models. Many families are struck with obesity
not only with their kids but with parents, too.
Serving-size issues and, again, no family mealtime leading
to increased TV time all contribute to obesity.
Studies also show that lower-income families, kids, 70
percent eat less grains, 50 percent eat less fruit and there is
certainly a lower amount of vitamin E, zinc, and calcium levels
in those diets, too. Everyone has a face to obesity. My face is
a 14 year-old Hispanic female by the name of Gabriella, one of
the 24,000 visits that we see here at Arrowhead Regional
Medical Center Pediatric Clinic per year.
She is 300 pounds and 54" and she has a debilitating hip
issue called SCFE, slipped capital femoral epiphysis, which
limits her ability to move and that increases her downward
spiral of hypertension, of obesity, of depression. She really
doesn't have the ability to get herself out of this spiral
affect.
Her mother is obese and both of them, although they
understand the message, lack the motivation to be able to get
her to lose weight. As a provider we are all overwhelmed with
access issues, and we all have issues in trying to get a
concerted message out to try to fight obesity through adequate
nutrition.
At Arrowhead, we are poised to deliver that concerted
message. We have three mobile clinics. We already have existing
relationships with schools and we are able to see patients
right there in schools. We have our FHCs, our family health
clinics, and pediatric specialists. Ultimately we look forward
to being part of the solution and we look to our leaders to
show us the way so that we can address this pervasive problem.
Thank you very much.
[The prepared statement of Dr. Wong follows:]
Prepared Statement of Webster A. Wong, M.D., M.B.A., Chief of
Pediatrics, Arrowhead Regional Medical Center, Colton, CA
Pediatric obesity and its related conditions are serious
consequences to an increasingly unhealthy lifestyle in the United
States. Poor awareness, cultural and socioeconomic factors, genetic
predisposition and educational deficiencies contribute to this
widespread problem.
Obesity is measured by a Body Mass Index (BMI) of over the 95th
percentile. Overweight children are defined by a BMI between the 85th
and 95th percentile.
Obesity in children has a direct causal effect on the development
of various disease states: diabetes, cardiovascular compromise,
hypertension, musculoskeletal ailments and cancer. Recent studies show
that American children are fatter, more sedentary and prone to lifelong
illnesses than international children. Statistics bear out these
observations: The percentage of overweight and obese children has
tripled since the 1975. More than 10% of infants and toddlers and
nearly 18% of adolescents are obese.\1\ More than 70% of them will be
obese adults. Furthermore, \1/3\ of U.S. children eat fast food every
day. Those that do stand to gain about 6 pounds each year. In addition,
Hispanic and African American teens are more at risk than other
ethnicities.
---------------------------------------------------------------------------
\1\ Cynthia L. Ogden; Margaret D. Carroll; Lester R. Curtin; Molly
M. Lamb; Katherine M. Flegal. Prevalence of High Body Mass Index in
U.S. Children and Adolescents, 2007-2008. JAMA, 2010; 0 (2010): 2009.
2012.
---------------------------------------------------------------------------
The annual cost of obesity related problems has been estimated at
$147 billion. If unchecked, experts calculate that the yearly
expenditures will top $1 trillion by 2030.\2\ The cost for healthcare
for an obese child is three times that of an average child. Mean annual
healthcare costs for an obese child are $3,700 for insured and $6,700
for Medicaid plans.\3\ More than 300,000 deaths each year are
attributed to obesity.\4\
---------------------------------------------------------------------------
\2\ Benchener M. Obamacare's Impact On Obesity, Liberty, And Cost.
2009. The Philadelphia Bulletin. Available at: http://
www.thebulletin.us/articles/2009/08/10/commentary/op-eds/
doc4a8064c80fd5f937691673.txt. Accessed August 2009.
\3\ Ibid.
\4\ American Academy of Child and Adolescent Psychiatry, May 2008,
Number 79.
---------------------------------------------------------------------------
Psychosocial issues as a result of obesity influence mental health,
employment, and school performance. Obese children and adolescents plan
or contemplate suicide 32% more often and are 20% more likely to have
thoughts of hopelessness than healthy adolescents. Roehling described
that overweight workers were stereotyped with negative traits and as
socially/emotionally handicapped, which resulted in lower wages and
benefits. School performance is negatively affected four times greater
than healthy-weight students.\5\
---------------------------------------------------------------------------
\5\ Schwimmer, Jeffrey B., Tasha M. Murminkle and James W. Varni,
``Health-Related Quality of Life in Severely Obese Children and
Adolescents,'' Journal of the American Medical Association, vol. 298,
No. 14, April 9, 2003.
---------------------------------------------------------------------------
Culturally, widespread obesity can be linked to America's societal
evolution over the past 3 decades. As a whole, Americans have embraced
a culture of fast, poorly nutritious food, increasing divorce rates,
urbanization, sedentary activities, and skyrocketing medical costs.
Fast food is more accessible and easier to prepare compared to cooking
at home. The rates of children raised in broken and dysfunctional homes
are steadily rising, leading to a de-emphasis on healthy eating. More
children are unable to exercise in cities where parks and playgrounds
are unsafe or unavailable. In exchange, kids are adopting non-active
lifestyles filled with video games, television and computers.
These factors are felt no more acutely than in poor, working class
communities. Parents struggle with maintaining income causing their
parenting skills to suffer. Nutrition education seems to be a distant
priority and obesity envelopes the family unit. Medical costs are too
high and access is too limited to halt the long term consequences of
obesity. The downward spiral of these communities continues.
Many possible solutions are being considered to reverse these
staggering statistics. Successful programs must rely on changing the
culture of obesity by involving the family unit, community resources,
education, healthcare and government. Children and their families
should benefit from a comprehensive effort to guide and to re-educate
dietary and exercise choices, with continued contact with healthcare
providers.
By combining a comprehensive medical program utilizing measurable
outcomes and a socioeconomic, culturally based educational component to
drive home specific methods to combat obesity, a program can answer
many questions. ``How can we facilitate better recognition of obesity
before problems arise?'' ``What is needed for a basic pediatric obesity
work-up that will demonstrate health improvements over time?'' ``How
can we involve the whole family unit to combat this pervasive
problem?'' With specific answers to these complex issues, a recipe for
dealing with one of the most dangerous epidemics of our time can be
created.
As stated, the road to obesity is multi-factorial. Aside from
genetic proclivities, many of the key elements to develop an obese
child can be addressed effectively, yielding to a suspension and
perhaps reversal of the devastating results from obesity.
The Chairman. Thank you very much, Dr. Wong.
Mr. Sharp.
STATEMENT OF MATTHEW SHARP, SENIOR ADVOCATE, CALIFORNIA FOOD
POLICY ADVOCATES, LOS ANGELES, CA
Mr. Sharp. Good morning, Chairman Baca, Ranking Member
Fortenberry, Representative Costa. My name is Matthew Sharp. I
work with California Food Policy Advocates. We are a statewide
nonprofit organization whose mission is to improve the health
and well being of low-income Californians by increasing their
access to nutritious and affordable food.
Since the mid-1990s I have had the privilege of working
with this organization to try and make various changes in both
policies and programs in California communities, I work in Los
Angeles primarily, to improve health and well being.
We are focused on the Federal food programs, both food
stamps as a recession fighter and an anti-hunger tool, and the
broad range of Federal food programs as tools to help prevent
childhood obesity.
I'll talk extensively about some of the strategies that
might assist with reducing the obesity epidemic, but today I
was invited to present just a few brief remarks on steps that
might improve participation in the food stamp program.
First a few numbers to help set the context. Unemployment
in California has increased over 140 percent in the last 24
months. That is an astronomical increase in need among
households, among families. Here in San Bernardino County
nearly 14 percent is the official unemployment rate.
According to UCLA there are possibly 3.1 million California
adults that are suffering food insecurity and several million
additional children in those households. The suffering is real.
The increase in households seeking emergency food assistance
and help from a variety of charitable sources has skyrocketed
remarkably during the course of the recession.
As you've just heard from the two distinguished doctors
here at the hospital, the rate of childhood obesity has
increased dramatically. We do a lot of work in the school
setting. Forty percent of the 9th graders in the low-income
schools are overweight and unfit, so we have an enormous and
complex problem to solve.
What I wanted to do was to highlight for you a couple
numbers about food stamps and a couple of things that you might
do about it. From this report that Chairman Baca quoted
earlier; Lost Dollars, Empty Plates we analyze a number of data
sources and estimate that nearly 2.9 million Californians are
likely eligible for food stamps but not participating. Today
that has translated to about $3.5 million of lost Federal
benefits.
As the Chairman pointed out, this is nearly $7 billion in
lost economic activity but the number you haven't heard yet is
that it is also analyzed that there is $150 million in lost
state and local sales tax revenue due to the lost economic
activity that might be in these communities if benefits were
more fully utilized. So, there are a number of ways that food
stamps will contribute to a recovery from the recession, and to
mitigate the nutrition and food insecurity problems that too
many households face.
A few quick highlights of some changes that will make a
difference. First of all, Congress and USDA should ensure
adequate funding for benefits preserving the increase in the
amount of food stamps allotted that was enacted as part of the
Recovery Act in the winter. There needs to be an increase, a
better formula for the administration of the program because of
the local hiring freezes at the state level in the other
states. In California it is a county-level problem.
There is a difficulty in ensuring the local governments can
respond to the increased demand in terms of resources.
Additionally, of significant concern this winter is the
Governor's proposal for the 2010 budget which proposes to
eliminate 35,000 persons who are legal permanent residents paid
for by the state. Illegal immigrants are supposed to be cut off
from the program. Certainly we are talking about various forms
of Federal fiscal relief and this would be a population that
would be reasonable for USDA and Congress to take on to the
Federal roles in light of the state budget crisis.
A couple more: California ought to move quickly to 6 month
reporting which is basically the way of keeping people on the
program by obligating them to send in fewer forms to the county
to retain their benefits. All the other states have moved to
this system. California has been asked by USDA to do so and
ought to be expected to move very quickly to 6 month reporting.
Couple of other ones that I think you will find intriguing.
California and USDA could do a better job of connecting health
insurance to Food Stamps by combining the application processes
and the reporting processes. There are one million children in
California that receive public health insurance but do not
receive Food Stamps. Their households were willing to fill out
forms, fill out paperwork, go through the system but they have
not been imported into the Food Stamp Program despite their
probable eligibility for nutrition benefits, which is obviously
a key way to integrate the nutrition message into the delivery
of healthcare.
The states and the counties need to work together much
better to ensure that local operations are similar in all 58
counties. The way the system works today there are a number of
different operations, different computer systems. Options have
been made available to do fewer in-person interviews. There are
options to do activities online to optimize customer services
practices. All this ought to be the same for applicants in each
county and to establish those will improve participation.
Last, it is important that you get more data. As
Representative Fortenberry asked earlier about what do we know
about food stamps and nutrition. It is a good question. We
ought to talk a little more about it. We have very little
information about those who applied for benefits and have not
succeeded in the application process. We need more data about
your customer population. Thank you.
[The prepared statement of Mr. Sharp follows:]
Prepared Statement of Matthew Sharp, Senior Advocate, California Food
Policy Advocates, Los Angeles, CA
Introduction. Good morning. My name is Matthew Sharp. I work for
California Food Policy Advocates, in the Los Angeles Office. CFPA is a
statewide nonprofit organization whose mission is to increase low-
income Californians' access to nutritious, affordable food. Since the
1990s, I have worked with CFPA to increase the use of Federal nutrition
programs, particularly food stamps given its tremendous potential, by
pursuing state and Federal legislation, as well as local policy
changes. I've also coordinated food stamps advocacy and outreach with a
dozen Los Angeles-area community partners to increase awareness and
ease accessibility to these valuable nutrition benefits. This winter we
are focused on blunting the impact of the severe state budget crisis on
low-income Californians and on ensuring Congress invests new resources
for Child Nutrition and WIC Reauthorization.
This morning I will share with you the progress we've made in
California to strengthen food stamps policy and accessibility. I will
identify the key data points indicating that more changes are needed to
expand participation further and I will provide a few recommendations
for action.
Background. Food stamps and the child nutrition programs have
offered a nutrition safety net for millions of needy families and
children since the day they started. The nation's deep recession makes
these programs more important than ever. With childhood food insecurity
and obesity escalating at rates that reflect steeply increased
unemployment and poverty, the healthy meals and snacks that the
programs provide, the measurable gain in students' academic
performance, and the savings that strapped families can realize with
five less breakfasts and lunches to supply each school week are among
the many extremely valuable benefits that the child nutrition programs
can deliver.
The food stamp program, the nation's most important anti-hunger
program, helps very low-income Americans to afford a nutritionally
adequate diet. Unlike most means-tested benefit programs, which are
restricted to particular categories of low-income individuals, the food
stamp program is broadly available to almost all households with very
low incomes, making it an important resource for families with limited
income. More than 75 percent of all food stamp participants are in
families with children; nearly \1/3\ of participants are elderly people
or people with disabilities. The Federal Government pays the full cost
of food stamp benefits and splits the cost of administering the program
with the states, which operate the program. Food stamp eligibility
rules and benefit levels are, for the most part, uniform across the
nation, but states have flexibility in the procedures and requirements
that low-income families face for application and ongoing receipt of
benefits, as long as states meet certain Federal service-delivery
standards.
Food stamp households receive their benefits on electronic benefit
transfer (EBT) cards, which can be used only to purchase food. The
average household received about $133 a month (or $4 a day) for each
household member in the second half of Fiscal Year 2009. The food stamp
benefit formula targets benefits according to need. Very poor
households receive more food stamps than households closer to the
poverty line since they need more help affording an adequate diet. In
Fiscal Year 2008, ninety-five percent of food stamp benefits went to
households with income below the Federal poverty level, and more than
half went to households with income below half of the Federal poverty
level.
The share of households that receive food stamps and have no other
income is on the rise, from about eight percent in 2000 to almost 16
percent in 2008, and likely a higher level currently because of the
economic downturn.\1\ This trend is the result of two factors: first,
many low-wage unemployed workers cannot qualify for Unemployment
Insurance, and second, the cash assistance available to unemployed
workers through TANF and state general assistance programs has eroded
over time. As a result, food stamps may be the only federally funded
safety net program available to many families who have lost jobs during
this recession.
---------------------------------------------------------------------------
\1\ Based on CBPP analysis of food stamp quality control
administrative data, available at: http://www.fns.usda.gov/ora/menu/
Published/SNAP/SNAPPartHH.htm.
---------------------------------------------------------------------------
Current Data. Unfortunately, despite increased enrollment in recent
years, the Food Stamp Program misses an unsettling number of eligible,
needy Californians. This underutilization is neither acceptable nor
necessary. The numbers are sobering. Three million Californians
received food stamp benefits worth $5.4 billion during 2009--only half
those who are eligible. While this reflects an increase of 35% more
persons receiving benefits since 2007, the increase in need has been
far greater.
Unemployment in California has increased by 140% since 2007,
reaching nearly 13% statewide.
Demand at food banks and emergency shelters has increased
46%
According UCLA's Center for Health Policy Research (http://
www.healthpolicy.ucla.edu/pubs/Publication.aspx?pubID=225),
among the 3.1 m adults struggling with food insecurity, 77% do
not receive food stamps.
According to USDA's Program Access Index (http://
www.fns.usda.gov/OANE/menu/Published/SNAP/FILES/Participation/
Reaching2007Summary.pdf), only 46% of eligible Californians
participated in 2007.
Low participation means lost dollars (http://cfpa.net/ldep/
ldep2009.pdf) for all. Because, as USDA says, each dollar of food stamp
benefits generate $1.84 in economic activity, low participation
adversely impacts not only hungry families but a variety of sectors of
the California business community. If all eligible Californians
participated, California would receive $3.7 billion in additional
nutrition benefits, generating $6.9 billion in statewide economic
activity and $153 million in state and local sales tax revenue.
Increasing food stamps participation will help California families put
food on their table--and it also will help California rebound from the
recession.
Improvements. A few recent changes represent significant progress
since the 2008 Farm Bill reauthorized (and re-named) the food stamp
program.
More money. As part of the American Recovery and
Reinvestment Act, Congress provided a 13.6 percent temporary
boost in the maximum food stamp benefit in Federal Fiscal Year
2009. This provision was included as a fast and effective
economic stimulus measure that could help to push against the
tide of economic hardship that low-income individuals are
facing. Additionally, ARRA provided $300 million in additional
administrative funds to states to handle larger caseloads. The
2010 appropriations bill provided an additional $400 million
for food stamps administration.Q02
More application options. Through local partnerships with
community organizations, health clinics and WIC centers, as
well as recent state policy changes to eliminate in-person
interview requirements (and, hopefully, office visits),
Californians will have more convenient opportunities to apply
for food stamps closer to their home or workplace or to manage
their benefits by phone--and maybe even someday, online.
More flexible rules. State legislation eliminated the asset
test. When fully implemented in 2010, this will allow families
to seek nutrition help before spending down their entire
savings.
Rebranding. State legislation triggered a market research
project to gather information from non-participants about
potential names and logos that might re-position food stamps as
an attractive program. Terms like ``fresh'' and ``modern'' will
be considered as the state selects a new name this winter.
Action Steps. While numerous changes are needed at a Federal,
state, county and community level to respond to the myriad reasons why
hungry families do not receive food stamp benefits, I wanted to draw
your attention to the top policy changes that may make the most
difference to non-participants. You will hear today about technological
innovations, outreach initiatives and important connections between
food stamps and healthier eating. We support all those endeavors. Here
are our recommended priorities:
Ensure adequate funding for nutrition benefits and administration.
Congress should ensure sufficient funding for food stamps by
preserving the 13.6% increase in benefits enacted in the
American Recovery and Reinvestment Act of 2009 and establish a
mechanism to increase administrative funding more nimbly to
respond to the state and local budget cuts and hiring freezes.
Modernize the program by moving to simplified (6 month) reporting.
USDA denied California's request (http://www.cfpa.net/
USDAltr6month.pdf) to continue quarterly reporting for 4 more years,
but the state and counties have not yet implemented this important
change.
California should quickly transition to simplified
reporting.
Provide benefits to needy Californians who are fully eligible but
for the repressive welfare restrictions enacted in the 1990s. Many
legal immigrants do not receive Federal food stamp benefits, many
unemployed adults without children are subject to outdated work
requirements and SSI recipients are not eligible to participate in
California. Federal legislative changes are needed to provide benefits
to each of these populations (USDA and Department of Homeland Security
changes are needed to enroll immigrants), with state changes needed to
carve out SSI recipients that would benefit from food stamps. In order
to close the state's budget deficit for 2010-2011, the Governor
proposes to eliminate the California Food Assistance Program, which
provides food stamp benefits to legal immigrants with state funds--a
good example of where Federal fiscal relief is needed, since these are
immigrants who were once eligible for Federal food stamps.
Congress and USDA should pursue legislative changes to
ensure all needy populations are eligible for valuable food
stamp benefits. Congress should expand the pool of legal
permanent residents eligible for food stamp benefits.
Connect food stamps and health insurance. Approximately one million
MediCAL recipients--already means-tested and certified eligible for
Federal health benefits--do not participate in food stamps.
California should implement policy and technological changes
to ensure that low-income households receive nutrition
insurance alongside health insurance.
Eliminate fingerprinting. Nine years since California implemented
its biometric system to detect multiple-aid fraud, two state audits
(http://www.bsa.ca.gov/reports/summary/2001-015) and the fraud
detection systems of 46 other states have demonstrated that the system
is not cost-effective for the state and counties--and that it is
ineffective at detecting multiple benefits, the system's supposed
purpose. Fingerprinting also discourages applicants by adding stigma
and an obligatory trip to the welfare office--undermining out-of-the-
office enrollment efforts.
USDA should prevent states from using fingerprinting systems
as a condition of eligibility or issuance of benefits. USDA
should cease co-funding California's fingerprint imaging
system.
Strengthen local operations. With 58 counties administering food
stamps across California, applicants in some counties benefit from the
availability of office visit waivers (http://www.cfpa.net/
PhoneInterviewsCalifornia.html), speedy processing of benefits and
limited paperwork requirements. However, other applicants in other
counties are not as fortunate, as demonstrated by several pending
lawsuits regarding failure to provide timely benefits and excessive
requests for verification of application documents, as well as wide
variations in enrollment rates.
USDA and California should improve monitoring of local
customer service practices and timely issuance of benefits to
ensure best practices become the norm.
Significantly more resources are available at www.cfpa.net.
I am happy to answer any questions you might have.
The Chairman. Thank you very much, Mr. Sharp.
STATEMENT OF EDITH C. ``EDIE'' JESSUP, PROGRAM
DEVELOPMENT SPECIALIST, CENTRAL CALIFORNIA
REGIONAL OBESITY PREVENTION PROGRAM, CALIFORNIA STATE
UNIVERSITY FRESNO DEPARTMENT OF HEALTH AND HUMAN SERVICES,
CENTRAL CALIFORNIA CENTER FOR HEALTH AND HUMAN SERVICES,
FRESNO, CA
Ms. Jessup. Thank you for this opportunity to speak to you.
My name is Edie Jessup. For the last 10 years I worked with a
nonprofit agency on a hunger and nutrition project in Fresno,
California. That included monthly meetings with the county Food
Stamp Director and staff and over 25 community-based
organizations who work with low-income residents needing food.
I now work regionally with the Central California Regional
Obesity Prevention Program on food access and policy issues. I
am also co-chair of the Roots of Change working on a
sustainable food system for California by 2030.
I see the Federal nutrition programs as health programs, as
violence prevention programs, and I see food as a human right.
There is no scarcity of food. However, there is a political
decision not to feed people in the United States. I am
witnessing the great unraveling in my fragile community. The
nation expects affordable fruits and vegetables from the Valley
where people are hungry and food giveaways run out of food.
In any other day or time these people in line would be
considered good hardworking people. The number one agriculture
producing county in the United States, Fresno, is also the
Congressional district with the highest poverty in the United
States.
Full Food Stamp enrollments by eligible families linked to
other U.S. nutrition programs is the quickest program and
economic stimulus for my community. Food stamp enrollment would
solve institutionalized poor diet for poor people that has
created racist outcomes in poor health by diet. Prior to 1996
there was enough food on the shelf in the United States to feed
our country for a year. We have disinvested in Federal purchase
of surplus food and the consequences are seen in the emergency
nature of incompetent food provision and disasters.
Charity is not sufficient to supply and distribute food to
the increasing poor and under-employed. This leads to the ever-
unmentionable food system issue of what the Federal Government
subsidizes. The USDA needs to subsidize food and farming that
is healthy for all people. You must lead states and local
governments, from the health and environmental perspective, in
making healthy food access a high priority through integrated
and linked Federal programs.
Full Food Stamp enrollment by all eligible would benefit my
neighbors so hungry families could purchase food, but it is not
happening. The fed, states, and counties blame each other and
in 10 years of my community identifying major barriers to Food
Stamp enrollment again and again leadership to solve the issue
has not happened.
In addition to the recommendations of my colleagues, I
advise the following to overcome the 50 percent under-
enrollment in Food Stamps in California and nationally. Number
one, on the issue of immigration and fair public charge: I call
on your to request ICE and USDA to jointly sign a clarifying
directive to states, counties, and the public that immigrant
families will not be denied a change in their legal status
because of accessing food programs for which they are eligible.
Number two, customer service. Simplify enrollment and link
Federal food programs. I have to report that the county's
cultural competence is poor. People are treated poorly and do
not feel welcome at Food Stamp offices. People I have surveyed
feel their treatment is racially and class motivated. The USDA
and Congress must require better service practices.
Number three, privatization and inefficiencies. Each state
should engage one computer system for food stamps, not the four
nonintegrated systems as allowed in California. The
administrative reimbursement for counties should be based on
caseload to encourage enrollment. USDA should monitor, track,
and publicly report the cost of having banks run the Food Stamp
system compared to federally run programs.
EBT help centers should be located in the state
administering food stamps, not overseas.
What if we fed people? The Federal nutrition programs can
and should be made available to all who qualify. There is
plenty of food and we can assure through food stamps and other
programs that all those eligible are enrolled. Thank you.
[The prepared statement of Ms. Jessup follows:]
Prepared Statement of Edith C. ``Edie'' Jessup, Program Development
Specialist, Central California Regional Obesity Prevention Program,
California State University Fresno Department of Health and Human
Services, Central California Center for Health and Human Services,
Fresno, CA
Food Stamp Participation and Outreach in the Central Valley of
California
Thank you for the opportunity to testify on the condition in the
San Joaquin Valley of California, and the need for full enrollment in
the Federal nutrition programs by more than a majority of residents, in
a dignified, equitable, and sustainable way--very quickly. I see this
as urgent, not something that we need to analyze more. If Food Stamps
are to fulfill their intended outcome of a healthy population ready to
work and learn, you need to make Food Stamps work at once.
I will set the stage, with short comments on need for Federal
nutrition programs, and then provide you with seven specific issues
that the Federal Government can and should address to assure full Food
Stamp/SNAP participation from constituents in the Valley.
My name is Edie Jessup. For the last 10 years I worked with a
nonprofit agency on a Hunger and Nutrition Project in Fresno, Ca. I am
now working regionally with the Central California Regional Obesity
Prevention Program as a Program Development Specialist. I am also co-
chair of Roots of Change, working on a sustainable food system for
California by 2030.
I see the Federal nutrition programs as health programs, as
violence prevention programs, and I see food as a human right. There is
no scarcity of food. I also appreciate that agriculture is the meeting
point tying health outcomes, access to healthy food, and, a revived
agricultural economy in the Central Valley.
However, there is a political decision not to feed people in the
United States.
I negotiated a meeting where the state and Federal Partnership on
the San Joaquin Valley were willing to make Food Stamps their priority
last year, and encourage businesses and other state and Federal
agencies to promote and support enrollment in Food Stamps. The county,
state, and Federal offices started squabbling, and the offer to work to
increase enrollment by the business community was taken off the table.
The Chair said ``Clearly you people (county, state, Federal) do not
want people eligible to be enrolled in food stamps for the betterment
of their health, and the health of our local economy. There is no point
in my sitting through any more of this, and wasting my time.''
Advocates tried to link up rural municipalities in places like
Tranquility, and San Joaquin with the county Food Stamp office, to take
applications at the city offices via computer. The County would not
accommodate that because of fear they could not manage new cases of
food stamp applicants if people were not in their office in Fresno, 80
miles away, in person. People do not have transportation, nor can they
take a day off work to come into the county center. But they are
hungry, and do qualify for food stamps.
I understand that prior to 1996; there was enough food `on the
shelf' in the U.S. to feed our country for a year. We have disinvested
in storing for hard times and emergencies, and the consequence is seen
in obesity and malnutrition in the Central Valley, and is seen in the
`emergency' nature of incompetent food provision in disasters (Katrina,
the California Central Valley drought, or Hati). Charity is not
sufficient to supply the need for food by the chronically under wage
households in California. It is apparent in the Central Valley the poor
quality and safety of food provided for our school food programs, the
fact that accessing the Child Care Food Program is nearly impossible
for child care providers, and is inadequate.
I am witnessing the `great unraveling' in my community. For the
last 10 years I have worked with Ca. Food Policy Advocates statewide,
and with my county Department of Employment and Temporary Assistance,
and the local school district to raise SNAP enrollment from the 50 %
eligible but not enrolled low income families and individuals. The
story in the Valley is the same. Low income wages at best, agricultural
seasonal work, immigration raids and splitting families by deportation
of our labor force. We know the eligibility is there because in the
Fresno School District 83% of all children are eligible for free lunch,
and most rural towns have Provision two schools--where all children are
at least getting lunch. They report school lunch as the one meal daily
they can count on during the week. Breakfast needs to be the first
lesson of the day for every child in every school, and School Districts
should be required to do this so that that Breakfast is truly
accessible to kids. Their learning will improve. And Summer Lunch, a
righteous program to provide food during time off from school, needs to
be required by all school districts who serve over 50% free/reduced
during the school year. The problems of summer lunch need to be solved
by funding community based organizations to serve summer lunch, and
schools should be required to provide and transport summer lunches to
where kids are--whether neighborhood schools, or parks, or apartment
building complexes, or churches in neighborhoods.
The population in the San Joaquin Valley is fragile. The
conservative power structure's ``blame the victim'' mentality results
in institutionalized racism that determines who eats, and results in
poor health outcomes.
That attitude of scarcity preserve the poverty and ill health of
the very people assuring the rest of the nation access to healthy food.
I currently work with the Central Valley Regional Obesity Prevention
Program, directly working on environmental change and policy change to
give people access to healthier food and safe physical activity. In
Mendota, where so much public attention has been drawn to the drought's
impact on a town, nearly completely unemployed, 37 of 80 Head Start
children are obese as a direct result of diet. The local store carries
junk food and poor parents take food bank commodities or donated top-
ramen as the primary food on their table. Their health will be on our
Hospital doorstep, and the chronic treatment for diabetes in these
children will lead to impaired lives, and is now creating poor learning
in our schools. We have created this monster of a human problem. Our
Public Health Officer in Fresno County says that he can tell how many
generations an individual has been here by the decline in health
status; the biggest public health issues in Fresno County are asthma,
obesity, and diabetes. Chronic disease by diet, and our food system
practices.
Federal nutrition programs would bring in over $170 million yearly
in Food Stamp benefits to my county if all were enrolled. That is to
purchase food, our number one business in Fresno and the Valley. But it
is not happening. The feds blame the state, the state blames the feds,
and in 10 years of the major barriers to enrollment being identified
again and again, no one cares to do anything. The USDA Western Regional
Office wants to assist, the state would like to turn this around, the
counties in the Valley, because of reimbursement formulas that do not
support the administration of food stamps try to do what they can,
while struggling with caseloads of 500 families/worker, and feel under
the gun by USDA for sanctions if they make an error.
Most concerning to me is the institutionalization of poor diet, the
lack of fresh, healthy food in neighborhoods, and because of deep
poverty, and the fact that unhealthy food is the cheapest, large
numbers of folks truly have no access to healthy food. Taking on the
industry of food has to happen, and the Federal Government must engage
(from the health and environmental perspective) states and local
governments in making food access a high priority in zoning,
ordinances, and assuring equitable access to affordable food. Grocery
Stores decide to pull out of low income neighborhoods, leaving food
deserts, and populations at risk in ill health.
This leads to the ever unmentionable issue of who and what the
Federal Government subsidies in the food system. It is your watch.
Painfully we need to subsidize food that is healthy for all people. We
must cease subsidizing farmers not to farm. We must undergird small
farmers who are raising our food in sustainable ways.
We must subsidize and favor food that is not polluted with corn
syrup, fat, and salt, because we are producing unhealthy generations
who will not be able to live without extreme and long term medical
support. Or, they will die from diet that leads to diabetes, heart
disease, cancer.
Meanwhile, the economy has created devastation in towns throughout
the Valley, and drought that has displaced farm workers, and local
businesses.
The nation expects fruits and vegetables to feed the nation from
this very place where people are hungry. It is a fragile place at best,
filled with what in any other day or time would be considered good,
hardworking people.
These are the seven recommendations that would create increased
enrollment in Food Stamps.
1. In the Valley, families need linked enrollment, without repeated
applications for Food Stamps, WIC, School and Child Care food
programs, and USDA Commodities. If poor families cobble
together all these programs they might have enough to eat for a
month. The programs could be linked and tiered so when times
were better, or income improved, individual programs could be
dropped as a benefit. None of these Federal food programs, by
themselves, is adequate for hungry families.
2. I call on you to require ICE and USDA to jointly sign a
clarifying letter that acknowledges that immigrant families
will not be denied a change in their legal status because of
accessing food programs for which they are eligible.
We have mixed immigrant families from all over the world in Fresno,
over 100 languages spoken in our school district, afraid to apply for
Food Stamps, and afraid that if they allow their children to eat school
lunch or summer lunch, for which their citizen children are eligible,
their family will be split by deportation, or, that they will be
ineligible for legal status or citizenship. Both Immigration and
Customs Enforcement (ICE) and USDA say that there is no Public Charge
issue, but they refuse to sign a joint letter and directive that
clarifies this.
3. Families are definitely afraid to apply for food stamps given
that even though parts of their family are eligible because all
adults have to be fingerprinted and photographed to apply for
EBT by California rules.
I would ask that in order to enroll all eligible people in the
Federal food stamp program, you create Federal legislation that
bans using finger-imaging in connection with food stamps. The
purpose of the move to EBT was to eliminate any fraud by Food
Stamp clients. It has worked, and redundant, pejorative
continuance of photography and finger imaging as if applicant
families were terrorists is untenable and costly in California.
Prohibit California from requiring fingerprinting as, it costs over
$11 million, is revealing no fraud, and blocks families from
Food Stamp participation.
4. If we are providing fresh, safe affordable produce for the rest
of the nation, it seems that the purpose of Federal agriculture
programs should accrue to those in need, who are providing the
labor for feeding America, other than by standing in lines and
convincing people how poor they really are for a hand out of
food that is making them ill with diabetes and obesity. My
recommendation is to provide a Federal waiver and enroll in
Food Stamps everyone standing in too infrequent commodity
distributions in food stamps, and sort out eligibility later,
within the first 6 months. And if they really do not qualify,
drop their enrollment.
5. I have to report that though the counties try pretty hard, their
cultural competence is poor, and people are treated poorly, do
not feel welcome in Food Stamp offices. People I have surveyed
feel their treatment is racially and class motivated. Food
Stamp workers feel overworked. The USDA and Congress could
address the public sense that Food Stamps are for people who do
not deserve food.
6. Some of the reasons for low enrollment are the facts of poverty,
and the complexity of rules, difficulty in enrolling, multiple
trips to the County office to qualify, county refusal to take
options like face-to-face waivers that are allowed, etc.
Clearly, a simple sheet of paper or online version of the
application is preferable to the complex, nearly impossible to
translate into 100 languages that we now have. Honestly, Hmong
neighbors have told me that my County calls in the Janitor to
interpret for applicants, or the 10 year old children are the
family representatives. This is truly crazy. Increase the
administrative Federal share, so that services offered can be
rendered to eligible families.
7. Last, require California to enroll elders in Food Stamps. The
irony is that some 40 years ago, California took some `options'
offered by USDA and they are still in place, although most all
other states have rejected and reformulated their Food Stamp/
SNAP rules. Federal Legislation calls out that California SSI/
SSD recipients cannot receive food stamps, even though they
qualify by income. So, we have elders (about to grow into a
larger poorer group because of the Baby Boomers) not eating in
order to keep their home, or pay for medications and
transportation, or because they are feeding their
grandchildren, and becoming ill. I request that you see that
the Federal exception for California is taken out of the
Federal register, and require the State of California to
directly enroll all SSI/SSDI recipients automatically, now.
What if we fed people? What if we saw to it that the bounty of what
we produce gets eaten, through normal channels, like purchasing at the
store? The clear distance between producer and consumer has become
larger, more bloated, and the in-between distribution and processing is
taking the money and seeing to it that the farmer does not get enough
to farm, and the consumer pays too high a price for unhealthy, over
processed food. The Federal nutrition programs can and should be made
available to all who qualify. If people are fed reliably and healthily
they can pay their rent, and begin to address work and education, and
be contributing citizens. There is plenty of food, and we can assure
through Food Stamps and other programs that all those eligible are
enrolled. Thank you.
Additional Federal Nutrition Issues
Breakfast, lunch, summer lunch: School districts need adequate
Federal reimbursement.
Quality of food in school programs must be improved and funded
adequately, and incentivize local purchase.
In California, Counties are allowed one of four computer systems
that do not communicate with each other. Each state should engage one
computer system for Food Stamps.
Elevate Federal nutrition programs to the status of Health Care,
because Federal nutrition programs are Health Programs. Perhaps, a
joint initiative with HHS? Or National Institute of Health?
Incentivize EBT purchase of fruits and vegetables with bonus added
to EBT for such purchases.
Sustainable food system: Local and regional distribution should be
priority, and replace current commodity structures in the USDA. This
will re-create vibrant farm to table and institution results, and
economic viability in the agricultural areas of the country.
Require Farmers to overtly support all USDA programs, including
SNAP as part of their subsidy acceptance.
The Chairman. Thank you very much. At this time I am going
to let Congressman Jim Costa make a quick comment because he
has to leave to attend another hearing in LA.
Mr. Costa. Yes. I want to thank all the witnesses and I
want to thank you, Mr. Chairman and Congressman Fortenberry for
bringing this very important hearing to California. Edie, I
want to take up your challenge so let us set up some time back
in Fresno, let us bring the people together. Let us see if we
can make progress in stopping the finger pointing and maybe
take advantage of some of your suggestions and see if we can
implement them.
Ms. Jessup. Thank you.
Mr. Costa. Thank you very much, Mr. Chairman.
The Chairman. Thank you.
At this time we will continue with Mr. Marsom.
STATEMENT OF MATTHEW MARSOM, DIRECTOR OF PUBLIC HEALTH POLICY
AND ADVOCACY, PUBLIC HEALTH
INSTITUTE, OAKLAND, CA
Mr. Marsom. Good morning. My name is Matthew Marsom,
Director of Public Health Policy with the Public Health
Institute. PHI is an independent, nonprofit organization
dedicated to promoting health, well being and quality of life
for people across the nation and around the globe.
I want to thank Chairman Baca and the Members of the
Committee for providing PHI with the opportunity to testify
today regarding the Federal nutrition programs. For more than
20 years PHI has partnered with the California Department of
Public Health to implement a series of programs and initiatives
focused on nutrition education and obesity prevention. This
includes the state SNAP-Ed Program. Recently we were successful
in securing funding from the Kaiser Permanente Foundation to
help the state get ready for its Healthy Incentive application
to USDA.
In the time I have this morning I would like to focus my
remarks on SNAP-Ed, a Federal-state partnership that provides
matching reimbursement funds to support nutrition education for
low-income persons currently and potentially eligible for SNAP.
In California SNAP-Ed is overseen by the California Department
of Social Services and delivered through an inter-agency
agreement with the Department of Public Health and the
University of California. The state's largest SNAP-Ed
initiative, the Network for a Healthy California, targets an
estimated seven million SNAP-Ed eligible children and parents
in this state alone.
I would like to outline some specific steps that we believe
would help position SNAP-Ed as a central pillar in our effort
to confront the twin threat of obesity and hunger that
threatens the health of our children. We have already heard
today about the impact of obesity in the United States. I won't
dwell on that again other than to say that Food Stamp
recipients live in the most under-served communities where
environments make healthy choices challenging if not
impossible.
In the context of these environments SNAP-Ed programs work
to improve the likelihood that program participants will make
healthy choices. It is important to say that throughout the
United States SNAP-Ed programs are doing tremendous work to
promote healthy behaviors and help families make a healthy
choice. However, the program can do so much more than that.
SNAP-Ed programs can be a lynchpin linking together other
Federal nutrition programs and initiatives to address access to
healthy food while addressing hunger and obesity.
Unfortunately, however, current USDA program guidance
restricts allowable SNAP-Ed activities to focus primarily on
traditional educational approaches, which when used alone are
often inefficient, outdated, and a poor use of limited
resources.
The program rules established during the prior
Administration significantly limit the use of effective and
proven environmental and system change approaches and social
marketing approaches learned from business and the private
sector. This is despite a wide body of research that
illustrates the power of these methods to deliver sustainable
improvements in eating habits and other lifestyle changes.
Quite simply, the present program guidance makes it
cumbersome, costly, or impossible to successfully execute state
and local programs.
USDA can take immediate and no-cost steps to unlock the
potential of these programs and allow them to play a greater
role in helping to address childhood hunger. Specific actions
are as follows:
First, SNAP-Ed programs should be encouraged to use their
existing Federal share to support population-based, evidence-
driven targeted interventions including social marketing, mass
communications, and environmental and policy change approaches
that reach the audience where they live, where they work, where
they go to school, where they pray, and where they make their
food and physical activity choices
Second, state and local programs must be able to take
advantage of techniques that support healthy behavior change at
the individual level by addressing social, environmental and
community factors that currently limit their healthy choices.
Third, USDA should allow state and local agencies to use
SNAP-Ed reimbursement funding to conduct marketing campaigns
that increase participation in the Federal nutrition programs,
especially in SNAP, but also school breakfast, summer meals,
after-school snack, and the Child and Adult Care Food Program.
Finally, Congress and USDA should allow SNAP providers to
conduct counter-marketing campaigns that address the marketing
of unhealthy foods and beverages, particularly marketing to
children, learning a lesson from the strategies and innovations
that work so well for tobacco control here in California and
elsewhere.
These efforts should be accompanied by education and
promotion to increase demand for healthier food including fresh
fruits and vegetables.
By empowering parents and their children to make healthy
choices, SNAP-Ed can and must play a greater role in improving
dietary and physical activity practices, while helping to
increase community food security, prevent obesity and reduce
the risk of chronic disease for low-income Americans.
We have welcomed the willingness of the new leadership at
USDA under the direction of Secretary Vilsack and Under
Secretary Concannon to engage with those of us who are seeking
these changes. However, to date we have yet to see any specific
proposals to undo the harmful and costly rules that were
instituted during the prior Administration. Thank you very much
for the time. I can answer any questions.
[The prepared statement of Mr. Marsom follows:]
Prepared Statement of Matthew Marsom, Director of Public Health Policy
and Advocacy, Public Health Institute, Oakland, CA
Introduction: Good morning. My name is Matthew Marsom, Director of
Public Health Policy with the Public Health Institute (PHI). PHI is an
independent, nonprofit organization dedicated to promoting health, well
being and quality of life for people across the nation and around the
world, and one of the largest and most comprehensive nongovernmental
public health organizations in the nation.
I want to thank Chairman Baca and the Members of Subcommittee for
providing PHI with the opportunity to testify today regarding the
Federal nutrition programs. We are pleased to have the opportunity to
provide our perspective and recommendations on this important topic.
For more than twenty years, PHI has partnered with the State of
California to assist the California Department of Public Health (CDPH)
implement a series of programs and initiatives focused on nutrition
education, obesity prevention, and chronic disease surveillance,
including the statewide SNAP-Ed program. This close working
relationship and our decades of experience in program implementation
provides PHI with a unique perspective on the status of the Federal
nutrition programs in California, and specifically in regard to their
impact on public health and food insecurity.
The impact of the obesity epidemic confronting the United States is
not news to any of us here today. Obesity is linked to increased risks
for many serious diseases, including type 2 diabetes, heart disease,
stroke, and some cancers. The costs in healthcare, disability, workers
compensation, and economic losses from lost worker productivity are
matched by the personal toll on individuals and their families.
People with low incomes, including those in households eligible for
food stamps, are at highest risk for chronic disease resulting from
poor eating and inactive lifestyles. Food stamp recipients live in the
most underserved communities, environments where making healthy choices
can be challenging, if not impossible, due to a lack of safe, well-
equipped and well-maintained places to walk and play; lack of nearby
retail stores and other services within walking or biking distance;
inadequate access to supermarkets and reliance on local corner stores;
and a higher concentration of fast-food outlets.
In these circumstances, food stamps can provide an essential
resource for low-income families, helping to ensure that very-low-
income Americans can afford a nutritionally adequate diet. Good
nutrition underpins public health, education and work productivity, and
food security is a fundamental social determinant critical to community
well being.
However, despite the tremendous need and the importance of the
program, still too many eligible Californians are going without the
benefits to which they are entitled. According to recent data from
UCLA, among the 3.1 million adults in California struggling with food
insecurity, 77 percent do not receive food stamps. California is second
to last in the nation for overall participation in the Food Stamp
Program and last in the nation for participation amongst the working
poor. The need has only increased due to the current economic crisis,
making these figures all the more alarming. Although the Federal
nutrition assistance entitlement programs are designed as a nutrition
safety net, many are under-used and operate in silos.
Today, I would like to describe a series of recommendations that we
believe would help to enhance SNAP and other Federal nutrition programs
and ensure that they can better help to confront the twin threat of
obesity and hunger that threatens the health of our children.
Program Participation and Outreach:
1. Congress and USDA should establish cross cutting national
participation targets for all Federal programs and reduce
penalties and sanctions for errors in eligibility, instead
providing stronger, non-competitive incentives to state and
local agencies that increase program participation. For waivers
or mandates intended to increase participation but which
require new administrative costs or expensive retrofitting of
computer systems, USDA should provide administrative
supplements to offset the initial costs of system upgrades.
USDA should institute monitoring and evaluation systems that
report to the public regularly on rates of food insecurity and
progress of Food and Nutrition Service (FNS) program access and
participation.
2. USDA should revise Federal program requirements to ensure that
barriers to full participation are minimized:
Index eligibility criteria to actual cost of living: To
end childhood hunger successfully, income eligibility
criteria should not exclude children whose families happen
to live in high-cost states. To extend eligibility to all
families facing food insecurity, USDA should index income
criteria for food assistance program eligibility to local
or regional cost of living, such as the ACCRA Cost of
Living Index or other recognized measure, rather than the
nationally-applied Federal Poverty Level (FPL).
Improve access and reduce stigma to food assistance
program participation and implement Electronic Benefits
Transfer (EBT) for delivery of the Women, Infants and
Children's Nutrition Program (WIC) to mirror SNAP.
Reduce administrative barriers to full participation in
child nutrition programs, for example:
--Allow state WIC agencies the option to certify children for a
period of 1
year, aligning with the current policy for other
participants and ensuring
the availability of resources for nutrition services; and
--Align WIC screening for iron-deficiency anemia with lead and
substance
abuse protocols by referring to medical care when verbal
screening criteria
are met and removing the requirement to document blood
tests.
--Use SNAP and Temporary Assistance for Needy Families (TANF)
categor-
ical eligibility to qualify all school-aged children in
families for free meals,
not just individual students.
--Eliminate the current tiered system in the Child and Adult Care
Food At-
Risk Snack Program to encourage greater participation by
family daycare
homes.
3. USDA should mobilize its resources to establish technical
assistance networks for community food security that can be
available to help states and localities with adapting,
implementing and taking to-scale successful techniques,
methods, and initiatives from throughout the country. Topics
and activities that could be part of such technical assistance
networks for the nation include: community food system
assessments, Electronic Benefits Transfer (EBT) in farmers'
markets, corner store conversion projects, community-supported
agriculture, farm-to-fork sourcing, state or local food policy
councils, agricultural preservation, small farm and new farmer
programs, and community/school gardens. This low-cost network
might be established using grants or cooperative agreements
with nonprofit public health, anti-hunger and food security
organizations; the existing Cooperative Extension system; FNS
programs; partnerships with other sectors like foundations,
nonprofit health plans, insurers and hospitals; and sister
Federal agencies like the Centers for Disease Control and
Prevention (CDC), Department of Transportation, Department of
Education, and Housing and Urban Development.
4. In SNAP, USDA should modify the use of the Thrifty Food Plan as
the fiscal base for SNAP and increase the benefit value to
accommodate the generally-higher prices of healthy food and
regional variability in cost of living, allow retailers to
offer EBT customers sale--and promotional prices for healthy
foods such as fruits and vegetables and push for higher
standards for retailers to provide for the availability of
fresh foods in all four food categories. This would have the
benefit of increasing the availability, accessibility and--
possibly--lower the price of healthy food in many low-income
communities.
Supplemental Nutrition Assistance Program Education (SNAP-Ed):
One Federal nutrition program that is a lynch pin, linking together
opportunities to address access to healthy food, while addressing
hunger and obesity, is SNAP-Ed.
SNAP-Ed is a Federal-state partnership that provides matching
reimbursement funds to support nutrition education for low-income
persons currently and potentially eligible for SNAP. Prior to the
renaming of the food stamp program in the 2008 Farm Bill, SNAP-Ed was
known as Food Stamp Nutrition Education, or FSNE. SNAP-Ed programs
improve the likelihood that SNAP participants will make healthy choices
within a limited budget and choose active lifestyles consistent with
the current Dietary Guidelines for Americans and MyPyramid.gov.
In California, SNAP-Ed is overseen by the California Department of
Social Services (CDSS) and delivered through interagency agreements
with the CDPH and the University of California. CDPH has established
the Network for a Healthy California (Network) which supports a
comprehensive statewide nutrition and physical activity campaign,
working through diverse channels and hundreds of local programs to
target an estimated seven million SNAP-Ed eligible parents and
children.
Throughout the United States, SNAP-Ed programs are doing tremendous
work to promote healthy behaviors and help low-income families
understand the importance of a healthy choice. However, current USDA
FNS program guidance restricts ``allowable SNAP-Ed activities'' to
focus exclusively on traditional approaches which, when used alone, are
often inefficient, outdated and a poor use of limited resources.
The rules, established during the last Administration,
significantly limit the use of effective and proven social marketing
interventions and disallow the use of environmental and system change
approaches despite a wide-body of research that illustrates the power
of these methods to deliver sustainable improvements in eating habits
and other lifestyle changes. The present guidance makes it cumbersome,
costly or impossible to successfully execute state and local programs.
The current USDA guidance also restricts state programs from
effectively reaching large proportions of their target populations. In
California over half of the SNAP population lives outside USDA approved
SNAP-Ed Census tracts and the figure is as much as 90 percent in some
rural states.
Congress has already acted to address these problems and provided
direction in the Manager's report that accompanied the 2008 Farm Bill,
stating that ``The Secretary will support and encourage implementation
of the most effective methods for nutrition education . . . consistent
with recommendations of expert bodies. Dietary and physical activity
behavior change is more likely to result from the combined application
of public health approaches and education than from education alone''.
We have welcomed the willingness of the new leadership at USDA,
under the direction of Secretary Vilsack and Under Secretary Concannon,
to engage with those of us who are seeking these changes to the
program. However, we have yet to see specific proposals to undo the
harmful and costly rules that were instituted during the prior
Administration. Timing is critical to make changes to the USDA SNAP-Ed
guidance so that state programs can most effectively use the state and
Federal dollars currently being spent on nutrition education.
USDA can take immediate no cost steps to unlock the potential of
SNAP-Ed and allow state and local programs to play a greater role in
helping to address childhood hunger and prevent obesity Specific
actions are as follows:
1. SNAP-Ed programs should be encouraged to use existing Federal
share to support population-based, evidence-driven public
health interventions--including community-based social
marketing, mass communications, and environmental and policy
change approaches--that reach the target audience where they
live, work, go to school, and make their food and physical
activity choices.
2. State and local programs must be able to utilize approaches that
enable and support healthy behavior change at the individual
level by addressing social, environmental and community factors
that limit healthy choices.
3. USDA should allow state and local agencies to use administrative
funds and/or SNAP-Ed reimbursement to conduct marketing
campaigns that increase participation in the Federal nutrition
programs, especially in SNAP, school breakfast, summer meals,
after-school snack, and the child and adult care food program.
4. Congress and USDA should encourage all nutrition assistance
programs, including SNAP-Ed, to conduct counter-marketing
campaigns to address the marketing of unhealthy foods and
beverages, learning a lesson from the strategies and
innovations that worked so well for tobacco control here in
California and elsewhere. In addition, where food is sold a la
carte or in vending machines, programs should take other steps
such as increasing the prices of competing foods like soft
drinks, other sweets, salty snacks, and deep fried foods to
help lower the prices of healthy foods like fresh fruits and
vegetables, low-fat milk products, whole grain products, lean
and vegetarian protein sources. These efforts should be
accompanied by education and promotion that increase demand for
healthier food, including fresh fruits and vegetables.
By empowering parents and their children to make healthy choices,
SNAP-Ed can and must play a greater role in improving dietary and
physical activity practices, while helping to increase community food
security, prevent obesity and reduce the risk of chronic disease for
low-income Americans.
PHI welcomes the opportunity to work Congress and USDA to identify
measures that can identify and remove obstacles limiting the reach,
impact and effectiveness of the Federal nutrition programs, including
SNAP-Ed, and create sustainable healthy change in underserved
communities. We believe these programs are a central pillar in a
concerted effort eliminate childhood hunger and provide the opportunity
to address poverty, a root cause for health, social and economic
problems that affect a growing number of Americans. In many cases, the
simplest solutions have little or no cost and may in fact generate
considerable savings over the long-term. In addition, many of the
recommendations I have outlined here and echoed by others testified
today can help to simultaneously address the scourge of obesity and
overweight in children and adults that leads to ill health and
perpetuates the cycle of poverty.
Thank your for your time and consideration of our recommendations.
I am happy to answer any questions you might have.
The Chairman. Thank you very much, Mr. Marsom.
At this time I would like to call on Ms. Claudia Page.
STATEMENT OF CLAUDIA PAGE, CO-DIRECTOR, THE CENTER TO PROMOTE
HealthCare ACCESS, OAKLAND, CA
Ms. Page. Good morning and thank you for the opportunity to
share some comments. I am the Co-Director of a nonprofit
organization that is focused on using technology to connect
low-income individuals with public and private benefits for
which they may be eligible. We created a system called One-e-
App. It stands for One Electronic Application. It is a web-
based system that screens individuals for a variety of programs
such as Medicaid, food stamps, SCHIP, Earned Income Tax Credit,
low-income energy subsidies, and more. It is used in
California, Arizona, Indiana, and Maryland as one channel, and
not the only channel, to connect families with benefits for
which they may be eligible.
In those states it is used both by the individuals who help
families who work at community-based organization and clinics
and hospitals and food banks. It is also used by families
themselves in some locations. In the State of Arizona consumers
themselves go online and apply and in several places in
California that is happening.
The goal of One-e-App is to bridge the silos that exist
between all of these various programs. We know that food stamps
and Medicaid, Earned Income Tax Credit and all of these
programs live in silos whether it is around the financing
streams, the administration of those programs, the systems, or
the application forms. What One-e-App has done is create a
front-end that is modeled somewhat on Turbo Tax',
asking questions that are relevant, error checking the data,
making sure that data is complete. On the back-end, and
wherever possible it is delivering that data electronically for
final determination.
We have integrated fully in the State of Arizona so that
when an applicant is applying for Medicaid, food stamps, TANF,
the data goes directly into the state system and disposition is
returned. In California that journey is different, mostly
because of the county variation and the presence of 58
different county systems.
We have been successful in that integration and that
integration is one of the most important factors in terms of
deficiency for the administrators in preventing manual data
entry of all these paper forms, and for the consumer because
the loop is closed more fully when their data gets there
electronically. We have screened, to date, 3.3 million people
using One-e-App and we have generated applications for over six
million different programs.
In terms of Food Stamps, Food Stamps is a relative newcomer
to One-e-App in California, but we have some important pilot
efforts underway including: a partnership with Los Angeles
unified school district to test public kiosks; and a
partnership with the California Association of Food Banks, with
whom we built a fast track in One-e-App to assist in applying
for Food Stamps.
In Arizona, where One-e-App is available statewide, in the
last calendar year 230,000 households representing 625,000
people submitted Food Stamp applications, 70 percent of them
without assistance and 70 percent of those applications were
approved.
We are sort of on a journey that some have called radical
incrementalism. We started with the health programs. We
realized quickly that once you ask a family the questions you
need for Medicaid there is not a lot left to ask a family.
Certainly when you combine Food Stamps and Medicaid you have an
incredibly rich set of data that can be used to see if people
qualify for really important programs like Earned Income Tax
Credit which also brings important resources and helps with
fiscal stability of communities and local communities.
This work is not without challenge. Systems reform is
incredibly difficult. Our success is only because we have had
important visionary leaders and partnerships with our states
and counties. I just wanted to mention a couple of the
challenges and some things that have been mentioned today that
can help to overcome those.
Using technology to have systems talk to one another is
incredibly important. Back-end data matches help to reduce
cumbersome documentation requirements; and linkages between
programs, other means-tested programs. While the systems may
exist in silos, an individual's need does not exist in a silo
and their eligibility and need for one program usually suggest
their need for additional services.
Some of the other recommendations you heard here today,
removing mid-year reporting requirements, increasing the use of
innovations like telephonic signatures, removing fingerprinting
in interviews. Those are the kinds of barriers that make
technology not as efficient as it can be and that, ultimately,
prevent people from becoming more seamlessly involved in the
programs for which they are eligible.
I will be happy to talk about some of the pilot projects
underway and answer any questions. Thank you very much for your
attention to this important issue.
[The prepared statement of Ms. Page follows:]
Prepared Statement of Claudia Page, Co-Director, The Center to Promote
HealthCare Access, Oakland, CA
My name is Claudia Page and I am a Co-Director at The Center to
Promote HealthCare Access (The Center), a nonprofit technology solution
provider improving quality of life by connecting people to needed
public benefits. The Center's signature solution is One-e-App, an
innovative, one-stop, Web-based system for connecting families with a
range of publicly funded health and human service programs. My comments
today on participation in Federal nutrition programs will be offered
through this One-e-App lens.
The Center works with a variety of states, including the State of
California and 15 California counties, to use One-e-App software to
screen and support enrollment of families in programs ranging from SNAP
(i.e., Food Stamps) and WIC to Medicaid and Earned Income Tax Credit
(EITC). Nationally, adoption of the One-e-App technology is increasing.
To date, One-e-App, has been used to screen more than 3.3 million
people, generating roughly six million applications for more than 20
programs. Food stamps (SNAP) was implemented less than 2 years ago in
Arizona and more recently in a couple of California counties. In this
short time, more than 627,500 of these people were screened potentially
eligible for Food Stamps through One-e-App and applications were
submitted for final determination to states or counties.
The opportunity to provide testimony on this topic is timely and
important. While technology is not a cure-all for the myriad enrollment
challenges families face, it is a critical component in bridging the
``silo phenomenon'' and improving the enrollment process for Federal
nutrition and other health and social services programs. Further,
conversations around Federal healthcare reform provide a potential
opening to promote broader enrollment reform, with improved systems
development, data sharing and a more thoughtful way to support families
and make sure they do not fall through the cracks as major new
enrollment changes are rolled out.
I will focus my comments on discussing the ``silo'' phenomenon and
missed opportunities to connect needy individuals with assistance and
the One-e-App experience in bridging the silos created by complex
disconnected enrollment processes. I will also provide suggestions for
overcoming challenges related to using technology to improve access and
participation.
Context and the Silo Phenomenon
If there was ever a time to focus attention on the efficiencies of
the screening and enrollment process for low-income families into
public benefits, now is that time. Hundreds of thousands of Americans
have lost and continue to lose their jobs, their homes and their
savings as a result of severe economic stress at both state and
national levels.
For county and state governments this means increased demand for
government sponsored programs such as Food Stamps and Medicaid.
Governments are facing the largest budget crisis in recent history and
have cut and furloughed staff, with additional cut backs likely in
coming months. Government cannot afford to do business as usual under
these circumstances. Technology offers promise in redeploying the
workforce to focus on high-value tasks like answering substantive
questions about benefits programs instead of tasks like manually
entering data from paper forms, denying applications when hand writing
cannot be deciphered, correcting common errors, dealing with duplicate
applications and rescheduling missed appointments.
For applicants, the current process of applying for programs for
which they may be eligible in the current environment means waiting in
long lines (sometimes snaking outside offices along sidewalks),
completing multiple paper forms (supplying much if not all of the same
information each time), traveling to different locations sometimes
multiple times and navigating an incredibly complex maze of referrals
and programs. Imagine a single mother trying to hold on to a low-wage
job, who cannot pay for child care and who's car has been repossessed;
applying for the very help that may change her situation has become
nearly impossible. Ultimately, this siloed approach results in missed
opportunities for assistance because there is no one place to be
screened for all programs.
One-e-App was created to not only bridge silos between programs but
to equip community support networks and families with channels and
tools to do more for themselves and to relieve pressure on already
constrained state and county social services and Medicaid departments.
The goal is to help communities and government better serve individuals
and families.
One-e-App Solution
One-e-App is essentially like a ``turbo-tax'' for public and
private benefits: it is available online, the system is intuitive and
asks only relevant questions, data is error checked and complete, data
is stored and retrievable and the system can transmit data and
documentation electronically where needed for final dispositions.
Created in 2002 to support enrollment in a variety of health
programs, over the last several years the system has evolved to include
a range of government and non-government health and social services
programs. The following programs are currently available in One-e-App.
Programs:
Food Stamps.
TANF (Temporary Aid to Needy Families).
Medicaid.
SCHIP.
Early Periodic Screening Diagnosis and Treatment (EPSDT).
School Lunch Medicaid (known as Express Lane Eligibility
(ELE--a School Lunch and Medicaid linkage) in California.
County Indigent Care and Coverage Expansion Programs (for
adults and children).
Kaiser Permanente Child Health Program.
Kaiser Permanente Bridge Program.
Medicare Cost Sharing.
Sliding Fee and Charity Care Programs.
Family Planning.
Cancer Detection (Breast, Cervical and Prostate).
Supplemental Nutrition for Women, Infants and Children
(WIC).
Earned Income Tax Credit (EITC).
Voter Registration.
General Assistance.
Discount Utility Programs.
Low Income Auto Insurance.
Child Tax Credit.
CalKIDS Health Programs.
Pharmacy Discount Programs.
Hospital Charity Care Programs.
Work Force Investment Programs (under development).
And other local programs.
One-e-App integrates with other systems to electronically deliver
applications and supporting documentation and signatures for many of
these programs. Electronic interfaces have been built from One-e-App to
state systems in Arizona and state and county systems in California. In
addition, Maryland is in the process of building an interface from its
version of One-e-App to the state system for Food Stamps, Medicaid and
other programs. One-e-App also interfaces with a variety of other
entities including PG&E, Kaiser Permanente, health plans, patient
management systems, electronic health records, U.S. Postal Service for
address verification, and more.
Innovation and Impact
One-e-App is currently used in Arizona, California, Indiana and
Maryland by state and county workers and community-based assistors in
hospitals, clinics, schools, health plans and other locations. With
local and state partners, The Center is testing new approaches to
streamlining access to nutrition and other programs. Activities
include:
Bridging the Silos--Full Integration to State Systems:
In Arizona, One-e-App has been fully integrated with the state
systems enabling applicants to apply across a range of programs.
Applications and supporting documents can be delivered and shared via a
fully electronic approach. Disposition data is provided so applicants
know the outcome of their application. This fully integrated approach
is the first of its kind in the nation. Maryland is also going to be
adopting this model and One-e-App, known there as Health-e-Link, should
be fully integrated across all state and local programs by the end of
2010.
Public Access:
In Arizona and California (and soon in Maryland) One-e-App
is publicly accessible, which means applicants themselves go
online (at home, libraries, school computer labs, work) to
complete and submit applications.
Publicly accessible One-e-App (called Health-e-Arizona in
AZ) launched in Arizona on December 15, 2008, and at the end of
2009 nearly 230,000 households submitted Food Stamps
applications electronically to the state. This represents
almost 626,000 individuals applying for benefits. Of the
applications submitted, 68% were approved or benefits were
retained (some applications are renewals or change reports.)
The approval rate would likely be over 90% had the applicants
followed through with interviews and provided verifications
(75% of denials are for failing to follow through). Of the
230,000 Food Stamps applying households, more than 217,000
(almost 95%) had at least one individual likely eligible for
Medicaid.
In Los Angeles, One-e-App is available via public kiosks
located at school enrollment sites where families can complete
the application process themselves, or with assistance from on-
site counselors. In Fresno, applicants can apply from home,
libraries and other locations.
Fast Track for Food Stamps:
In California, the One-e-App system also provides a newly created
``Fast-Track for Food Stamps'' that allows Food Banks to assist with
the Food Stamps application process while a community partner completes
the application process for additional programs, using the
electronically stored data and documentation from the Food Stamps
application as the starting point. This approach allows resource-
strapped Food Banks to more effectively assist with Food Stamps
applications while leveraging the effort to assist families with other
programs. Pilot initiatives are underway in Humboldt, San Diego and
soon in Alameda and Fresno.
Impact of Missed Opportunities to Reach and Enroll in Public Benefits
As you will have heard from others providing testimony, low uptake
in benefits programs results not only in missed support for families,
but also in missed revenue for local economies.
Earned Income Tax Credit (EITC) program: One-e-App screens for EITC
and calculates the projected refund families will likely receive, based
on data provided. To date, One-e-App has referred users to roughly $1.8
million in EITC credits. It is important to note that we did not add a
single question to the system to be able make this preliminary
calculation for EITC; the questions asked of the applicant to calculate
eligibility for other programs is sufficient to make the EITC
calculation. This means no added work for assistors helping families,
but significant opportunity for families to be connected with what is
considered to be the most powerful anti-poverty tool, and one of the
most underutilized. The dollars received by families through the EITC
program make their way back to the local economy, thus supporting local
economic activity.
Food Stamps: Missed participation in Food Stamps results in lost
revenue for local economies. With each dollar of food stamp benefits
generating $1.84 in economic activity, in Arizona alone, connecting
households to Food Stamps through One-e-App has put $50 million into
local economies.
Health Coverage: It is difficult to put a dollar amount on the
enormous impact of uninsured and lack of health coverage. As an
uncompensated Emergency Room visit costs a hospital $1,200 to $1,900,
frequent utilizers of uncompensated Emergency Room care are therefor
costly. Further, the downstream impacts of missed preventive care and
lack of timely treatment are also costly (physically and emotionally
for families who worry about children getting sick, or getting sick
themselves.)
Food insecurity does not exist in a silo. Those challenged to put
food on the table are also likely struggling with health coverage,
paying bills, keeping their homes and more. And the numbers are
significant--on average, roughly 13 million people nationally are
eligible but not enrolled in Food Stamps, nearly 3.1 million California
adults are not receiving benefits and 645,000 residents in Riverside
County alone suffer from food insecurity (data sources respectively:
USDA, UCLA Center for Health Policy Studies, California Food Policy
Advocates). In addition, nearly one million Medi-Cal recipients in
California are also likely eligible for Food Stamps based on their
eligibility for Medi-Cal, yet there is no linkage or connection for
these families.
So while hunger is a powerful indicator of need, when food
insecurity is addressed as a stand-alone concern, we miss opportunities
to more fully help families with other issues related to poverty.
Similarly, when access to health coverage is addressed in a silo, we
miss opportunities to connect eligible individuals with food
assistance. There is an entrenched national history of creating silos
around specific benefit programs, such as Food Stamps and Medicaid.
These means-tested programs have separate financing streams,
administrative oversight, technology systems and eligibility rules.
Opportunities for Closing the Participation Gap
The following suggestions for removing barriers would permit
technology to be more effective at closing the enrollment gap in food
and other assistance programs:
Support development (create financing opportunities) of
systems like One-e-App and create incentives to encourage
states to permit data exchange in the way Arizona has done
(with appropriate securities and safeguards). Similarly, to the
extent appropriate, provide access to Federal systems (e.g.,
IRS, Federal IEVS, Federal housing programs). Experience in
Arizona points to immediate opportunities to break down the
silos through a community based tool that exchanges data in
this way.
Provide guidance to states on conducting data matches to
establish linkages for other means tested programs such as
Medicaid and Free and Reduced School Lunch. Conduct deemed
eligibility for programs where a match is identified.
Provide a mandate to state and counties to find secure and
safe ways to accept applications electronically through a
``One-e-App'' or similar tool so that applications can be
received and processed electronically, thereby extending reach
in the community and efficiency for administrators.
Continue to promote ways to reduce the number of in-person
meetings required to complete an application, including
eliminating the fingerprinting requirement in California and
other states requiring fingerprinting.
Promote broader awareness and utilization of telephonic
signatures and other innovations to streamline the enrollment
process.
These recommendations do not have to be something that happen in
the future; they can happen immediately. One-e-App has demonstrated
success in bridging the silos and while broader systems reform is
ultimately called for, modernizing enrollment in public benefits is
complex and disruptive and will take years to accomplish. It is
critical to start with immediate wins and ready partners while more
integrated systems reform takes place through healthcare reform and
driven by economic realities of maintaining outdated, disparate
systems.
The Center to Promote HealthCare Access is happy to provide more
information or to connect interested stakeholders with One-e-App users.
Thank you for the opportunity to share these comments and experience
today and for your leadership on this important issue.
The Chairman. Thank you very much, Ms. Page.
I want to thank all of you for your testimony. At this time
we will begin with some of the questions, and I will begin
myself by asking Dr. Valenzuela:
Obesity is a major health crisis for our entire nation but,
as the saying goes, the journey of 1,000 miles starts with the
first step. I believe that we must tackle this issue not just
from the Federal perspective, but head on at the local level.
As someone who has vast experience in this field, what do you
think is the key to obesity prevention at the community level?
Dr. Valenzuela. I believe that the only way that we can
deal with this problem, especially in low socioeconomics, is
through support in the community for the people's effort and
reinforcement. For instance, we recently told all our doctors
to tell the patients, ``You need to do some exercise.''
Reinforce exercise after each meal. But that patient as they go
back into the community they don't have any reinforcement
support, they are going to go their own way. I think this has
to be very important in order to succeed.
The Chairman. Thank you very much. Part of the problem is
that you as doctors can only see so many individuals and how do
we then get educational institutions, the communities and
others at the local level to do what needs to be done? USDA can
only do so much in terms of marketing, whether it is TV or
whether it is through other media, public broadcasting, or
radio, or whatever else needs to be done.
Dr. Valenzuela. I think that you need to get involved with
community-based organizations. If we educate and there are some
funds in order to coordinate the effort, but it has to be
coordinated through school and teaching by way of many
institutions of higher education to provide some system. We can
educate all the medical community, but it is very rare that you
confront the patient being obese.
It is an unpleasant conversation to have with a patient. It
is difficult to actually bring up the issue and, therefore, it
is something that we have to do and accept as a change in the
culture in the community. I think we have to be with the
doctors, be in the churches, be in the community-based
organizations and everywhere in the schools, too.
The Chairman. Thank you. I guess all of us realize we have
a lot of work in partnership and collaboration. We all need to
work and try to communicate throughout our communities, because
we are looking at the effects. The cost is going to be on
taxpayers. The consumers ultimately will pick up the cost in
the era of obesity for everyone else if we don't begin to
address it.
Dr. Wong, I thank you for your testimony on the obesity
epidemic and its powerful impact on America's children. The
figures that you threw out, the expenditures on obesity topping
$1 trillion by the year 2030, that is very alarming to a lot of
us. Sometimes we don't look at them, but we need to look at it
because ultimately we are going to pay and people are not going
to live longer.
When you combine the losses in work productivity that
obesity and chronic disease can produce, we need to really
understand that obesity can literally bankrupt our society. I
don't think we really understand that yet. We have not come to
grips with that yet and we need to.
I think that is what we are trying to do now. The hearing
that Congressman Fortenberry had in Lincoln, Nebraska, began to
look at the importance of this issue, and its impact. With that
what kind of role do you think nutrition education should play
in our schools and why, Dr. Wong?
Dr. Wong. It is a significant role that nutrition education
should play because essentially what we are doing is re-
educating the masses. We are going for a culture change. We
have to use and utilize all of the means that we have
available, systems issues, technological advances, and the
collaboration of everyone in the community.
However, what I feel is important is that we must
rededicate ourselves to the family unit, rededicate ourselves
to getting the message across to parents, because essentially
parents are the role models for their children. Right now,
unfortunately, children have many other role models that are
not as nurturing. For instance, the television and movie
industries and whatnot.
Unfortunately, we have somewhat lost our way in my opinion.
I think that with the aid of the medical community I have seen
in my practice where parents actually listen to their medical
providers with greater emphasis than, say, for instance other
people in the community. I think that is a benefit that we need
to explore. However, what we need to do is get down and talk to
the parents and be able to avail themselves of some time to
spend with their kids so that they can be role models again.
The Chairman. Okay. Thank you. I know that there will be a
second round of questions and I would like to follow-up. I know
that my time has expired but I would like to ask Mr. Sharp.
Again, thank you for your testimony. We are all aware of the
tremendous impact that the current economic conditions have had
on the demands for SNAP and benefits, but can you give us a
better picture of how our budget crisis in the State of
California is affecting the Administration's nutrition programs
like SNAP, WIC, and school lunch? I have the article by Arnold
Schwarzenegger that says they are cutting back and 150 families
may lose Food Stamp benefits.
Mr. Sharp. Each of the Federal nutrition programs depends
on a partnership at the state and local level that involves the
administrative funding. For example, the state budget crisis
that reduced funding for public schools in California by $4
billion in 2010 over 2009 evidently makes it far less probable
that nutrition education and physical education will be
expanded. So it is within that context that there are a variety
of challenges associated with expanding these programs.
At the county Welfare Office level where these programs are
administered, generally, in all 58 counties there are a range
of hiring freezes and budget cuts. The Federal SNAP program has
responded to that by providing an influx of additional
administrative funds both in the Stimulus Act in February, as
well as again this fall as part of the appropriations bill.
There are a range of additional challenges associated with
making one-time investments in the technology upgrades that you
heard about from Ms. Page.
There are a number of one-time investments needed to
modernize the program that will ultimately generate savings but
it is a time of extraordinary fiscal deficit. In Sacramento it
is very difficult for policy makers to invest in these kinds of
short-term improvements, even if they will pay long-term
dividends. Identical is true with both WIC and the Child
Nutrition Programs.
The Chairman. Thank you. I know that we are looking at
technology and I know Ms. Page made reference to it, but part
of what I have heard, too, is that we are not talking to one
another and we are not communicating in terms of the
technology.
Which is the best method and what do we need to do, for the
most cost effective set of programs that can speak to one
another, and at the same time provide the needed services? You
can develop the new technology and the new programs, but with
different programs within each county it presents a problem.
Mr. Sharp. When food stamps was really expanded 40 years
ago there was a strong Federal commitment to establish a
minimum level of access in all the counties across the country.
That sort of became a Federal program. Ever since then the USDA
has put a great deal of attention towards trying to understand
the different variations and participation.
There is an extraordinary amount of evidence on this as
well as on nutrition and health habits among participants. The
challenge is to try and translate those components of knowledge
and learning into different practices. That is very difficult
given the multiple jurisdictions involved. The Federal
Government has a clear established role, and in some of these
cases it may need to be extended in order to ensure and
establish new minimum floors in each of the program areas.
The Chairman. Okay. One final question since Jim Costa is
not here and I can ask the additional question. Of course, my
colleague here can too.
In your expert opinion what is the most important thing
that we can do, and I state, what is the most important thing
that we can do to increase SNAP or Food Stamp outreach in
California in under-served communities? There are a number of
them right here in this area.
Mr. Sharp. There are a number of initiatives that are
underway right now. Given the enormous scale of the under-
served population which, as we mentioned earlier, is three
million persons, there is not one strategy that is going to
effectively engage all three million nonparticipating
households. Many of those households will have had contact with
either the Medicaid system, as I pointed out in my remarks, or
have already applied for SNAP benefits and have been turned
down or discouraged during the process. The single most
effective strategy is to keep people on this program, or in the
program, who have indicated an interest and desire in the
government.
The second would certainly be to ensure that the confusion
that exist among Latino and immigrant households is clarified
regarding the eligibility for these programs in a way that
reassures families, particularly households that have immigrant
parents and citizen children that their eligibility for this
program is unaffected by the immigration status. I think those
two areas, both ensuring a more seamlessly integrated
application process that captures everyone that shows interest,
as well as clarifying confusions regarding eligibility among
immigrants.
The Chairman. Thank you. I now recognize the gentleman from
Nebraska for 5 minutes plus the additional time he needs to ask
to make sure that we are working bipartisan.
Mr. Fortenberry. You are all about fairness. This doesn't
happen in Washington by the way. Thank you, Mr. Chairman. Thank
you all again for being here and for your insights and
excellent testimony. Let me make a few comments that I think
encapsulates some of what you said, Ms. Page, and what some of
the doctors were referring to.
One of the frustrations of being in public service, an
elected official, is you inherit a big pipeline of
institutional processes and procedures and you refer to silos.
There is not an Administration that hasn't come into office
that says we are going to reduce the duplication. We are going
to make systems talk to one another. We are going to ensure
that if there is a nutrition program that existed 40 years ago
that is diminished that is in one department, it is simply not
going to be replaced by the advent of another one.
Sometimes, though, we ask questions in silos as well. We
have a problem with hunger. We have a problem with assistance
or people properly accessing assistance who deserve assistance.
I think this comes back to the commentary that the doctors gave
on the sociological problems here, the fragmentation in
society.
Dr. Wong, I think you did an excellent job, a courageous
job in attacking that. You see this first hand because you
doctors are more highly trusted than politicians. Well, not
here maybe. So there is an honesty and a transparency in those
relationships. You are clearly evaluating what is happening,
not only in individual lives, but in seeing it over and over
again you can generalize the broader difficulties that we are
having societally in terms of family disintegration, in terms
of poor role modeling that is out there, particularly in the
media, the pervasive media, the problems of crime and community
deterioration which prevent a child from playing outside which
was normal for us, or walking to school. We may have to come up
with a program that kids have to walk 30 minutes in school.
This was unthinkable 40 years ago. You just walked to your
school.
These are some of the hard realities that are out there in
addition to the pressures on educators who have to produce
outcomes. These older interests of life skills and the rest of
it are taking a second place as we are dealing with the
emergency needs that appear to be before us. This is what is
frustrating at this level because you have a responsibility to
deal with both; an emergency to put out the fire, but what is
causing this societal fragmentation in the first place.
In that regard, though, given the prestige and trust that
does exist with medical doctors particularly, one thing that I
am concerned about is, again, and I hinted at it earlier, is
the way in which we reimburse for services, the way in which
you are paid. You have to make a living. You have huge
opportunity cost in your own education and it takes a long time
to get some place where you have a stable income.
There is pressure on you, particularly given the supply
meeting the demand, more and more demand, that you move someone
along as quickly as possible with that which is, of course,
efficacious but that which is also reimbursed. How do you
reimburse for your time sitting down with a family and say,
``You know, what the difficulty here is, you really need to try
to get along. Your children need you. The consequences of this
are habits that are being inculturated that are going to lead
to disasters for your own children,'' and such.
That is a hard thing to do, I understand, but, again, you
being on the front line of this social difficulty, I think it
is something we can drive back to. As I was suggesting earlier,
in terms of the way in which we reimburse, because if you saw
someone that you know you could give some drugs or treatment to
and be reimbursed. But, it would be better simply if they
embraced some sort of lifestyle change that became disciplined
around healthy foods or exercise or just simply personal
interrelations. That could lead to better outcomes and reduce
the pressures that we are feeling on this end, potentially, in
the long term. That is probably a hearing in and of itself.
It is the frustration that Congressman Baca and I see when
we have real people in real pain and you have to put out a
fire, but how do we get underneath this and change directions
so that people are truly interconnected in communities, of
affirmation where they live out life in hope and love with
others. That is ultimately what the human heart is longing for.
When you have that guess what happens? Health improves. It
really does. That is a demonstrable fact. Mr. Sharp, you are
clearly an expert on statistics. I think you would agree there
is a direct correlation there.
Mr. Sharp. Absolutely.
Mr. Fortenberry. I just gave a speech. I was supposed to
ask a question. Anyway, what do you think of that?
Mr. Sharp. That was a very complicated question.
Notwithstanding from a provider standpoint reimbursement is a
major concern. From a pediatric standpoint historically we do
not get reimbursed for anticipatory guidance or spending more
time in educating families and trying to get families on board.
Mr. Fortenberry. That's true.
Mr. Sharp. However, we do get reimbursed through other
programs like pay for performance programs based upon outcomes
management. Also we want our kids, our patients, to be well and
we want out families to be well, or else we would not have been
in this business in the first place.
However, I think that one way to try to refocus on this
particular issue is to really engage providers on early
recognition. Some certain quantifiable aspects that we can
recognize patients early, very early, and be able to direct
them to community resources. We need a collaborative effort
with other people in the community to be able to get the
message out even when we won't be able to get out that message
because of time constraints.
I think that physicians need to speak with one voice on
this particular subject. Unfortunately, physicians don't have a
habit of doing that. However, it is important and physicians do
recognize that. It is just another aspect to healthcare reform
that we need to approach.
Mr. Fortenberry. Thank you, Mr. Chairman.
The Chairman. Just a quick comment in reference to Dr.
Wong's question. It is a good question that the gentleman from
Nebraska asked about the reimbursement. You mentioned that we
get reimbursed in other ways. I think that is what we have to
address as well. When you start looking at oversight
accountability, transparency, then we begin to ask questions
why is so and so getting billed for A, Y, and Z when they
provided something else out here.
That is where we have the difficulties in Washington, D.C.,
when we are trying to look at dollars that are coming back into
the area. So, we have to be very careful when we turn around
and say we get reimbursed in other ways and not bill someone
for something else when you actually provided the guidance
during that period of time out here.
I have a question for Ms. Jessup and this is not a question
from me. This comes from Congressman Jim Costa and I told him
that I would ask you. He told me to make sure I asked you this
question. He says, ``Thank you for being here representing
Fresno. Your experience in the nutrition and hunger programs is
much appreciated here. You mentioned that the county had
concerns about rural municipalities transmitting data back to
the county. What was the primary concern--errors on the
forms?''
Ms. Jessup. This is in reference to trying to find ways to
enroll people who live 80 or 100 miles away from where they
have to apply for Food Stamps. Last summer in the midst of the
real crisis around the food and the droughts in communities
that have 40 to 80 percent unemployment right now, I proposed
that the county allow the municipalities to act as a place
where people could apply for food stamps rather than trying to
apply for them standing in 110 heat while they were collecting
not enough food.
The county, I believe, is just worried about error rate.
They are worried about having their hand spanked for enrolling
somebody who maybe they find out later didn't quite apply or
didn't have all the information, all the documentation that was
required. It ended up not working out. It could have been a
first step for folks, but it didn't happen because they are
afraid. They are afraid of making a mistake and that overwhelms
the actual intent of the program and people aren't enrolled.
The Chairman. Thank you. He had an additional two questions
and I am just going to submit for the record and I will give
these to the staff here. As you mentioned in your testimony it
makes it clear that you have seen firsthand the inefficiencies
that can arise when Federal, state, and county authorities get
into jurisdictional fights? How can all of these different
levels best work together on an issue like nutrition education,
and obesity prevention?
Ms. Jessup. Okay. I would particularly like to address the
obesity prevention issue. Nutrition education, there is plenty
of it and it is out there, and it isn't the issue. I am very
concerned in terms of the spectrum of prevention looks at
things like individual behavior change and the kind of care
that the physicians are talking about. At the other end, the
end of policy and environmental change, is really a causal
factor and it is multi-sectored, and it really is the area that
we have to say, ``This is not right and we can't do it
anymore.''
I know that sounds pretty harsh but we really are moving
into a difficult situation.
The program I work with works in about 12 different sectors
to create environmental change so that when the physician says,
``You have to do better with your diet and physical activity,''
they go back into a community where the zoning is such that
there is food access for them that is healthy. That the parks
are open and available and have safe places for people to be.
Mr. Fortenberry. Can I interject, Mr. Chairman?
The Chairman. Yes.
Mr. Fortenberry. This is a very interesting point that we
have unpacked in previous hearings. The actual access to
healthy foods is another issue, not just retraining of habits.
Ms. Jessup. Yes. And so you can say that----
Mr. Fortenberry. Particularly in dense urban communities.
It may be a little different where you are.
Ms. Jessup. Well, no. In dense urban communities and in the
rural areas where there may only be a liquor store and that is
where people get their food. Until we make those changes and
create incentives for the business community to really--you
spoke before about having to go back. Our distribution systems,
the place in between the food and the person are broken, and we
really do need to go back to that. Those are big environmental
and policy issues around that.
Fresno, the city, we made a policy change that will allow
farmer's markets in Fresno. Prior to that change they were not
allowed, so we didn't have farmer's markets on every corner
which is what you would expect.
The Chairman. I think that is part of the problem we tried
to address in the ag bill with fresh fruits and vegetables in
the Snack program.
Ms. Jessup. Fresh fruits and vegetables, yes. Looking at
those as our valued crops and relooking at subsidies, which I
mentioned in my testimony. Otherwise, I would say that it
really is the community, but that physicians may need to write
prescriptions for food stamps or for school meals. It is an
environmental change. It is an environmental change that we
need to have happen.
The Chairman. Mr. Fortenberry, you wanted to interject
something?
Mr. Fortenberry. This is clearly what I was driving at
earlier, rethinking some of the frameworks in which the medical
system interacts with patients, particularly if we have drawn
the correlation between nutrition and healthcare outcomes. They
have to be paid. I mean, they can't do it and so they get paid
for certain behaviors and not paid for others.
These gentlemen are good public servants in the sense they
are clearly on a mission because their patients want to be
well, but changing the institution to incentivize that,
particularly through reimbursements, is something we have to
think through. I think that, again, is a way in which we do two
things as I said at the beginning, improve outcomes and we
reduce cost as they manifest themselves in the healthcare
system and other poor outcomes like you were talking about
depression, family disunity and the rest.
Ms. Jessup. I think that is so important. The California
Medical Association has an obesity prevention program and is
encouraging physician champions to actually talk to the wider
public. It is op eds about the issue of what you are seeing.
The Chairman. On that note, let me go on to ask Mr. Marsom
a question as well.
Can you give us some examples of effective marketing and
outreach techniques for Federal nutrition programs that you
have seen in communities across the United States and what
makes these programs effective?
Mr. Marsom. That is the big question. I think there is one
that we always like to share which started here in California.
It was a local program that has now been expanded around the
state which is Good Harvest of the Month. It is a program
funded through SNAP-Ed. What happens in the schools and
communities, where this program is taking place, is that they
choose a different fresh fruit and vegetable every month and
while that is seasonally and locally available they promote
that in schools.
These are low-resource, low-income schools. What happens is
as they engage with the teachers and the students and also then
with the parents. We have worked with retailers who are
actually showing those products are selling out in the stores
because the children come out of the classroom, they go home,
they are in the grocery store with their parents and they say,
``Oh, look. There is the blueberry. There is the squash that we
talked about in the classroom today.''
What we have been able to do at the state level with the
SNAP-Ed funding is have a program that is comprehensive. I
think the point that Edie raised is it is not enough just to do
the education alone. I think, certainly, there are many
families that need to have that basic one-on-one education, but
what has been shown time and time again to work whether it be
an obesity issue or smoking is you need to have a comprehensive
approach in all aspects of people's lives. At the faith
community when people are at church they hear about healthy
eating from their pastor or from the clergyman. When they are
in the grocery store at the point of sale they can see the Five
a Day message or the healthy eating message.
When they are at school or when they are at work we have
worksite promotional messages. What unfortunately is limiting
the program's success are the extremely burdensome
administrative requirements which, while we understand the need
and the importance of targeting, there comes a point where the
expense of the administration of the program is turning away
many local dollars, local funding that could be puts towards
this to draw down Federal dollars into the state.
It is unfortunate that Congressman Costa had to leave
because as a result of the USDA rules I have referenced in my
testimony Fresno County actually withdrew from the Federal
program. They didn't want to see their local dollars matched
against the Federal dollars for more traditional one-on-one
education. They realized that to address obesity to help the
Food Stamp families they need to address the spectrum of
prevention that Edie referenced so you are addressing the
individual, you are addressing the interpersonal in the
community, and you are addressing that norm.
On any approach, to answer your question again, it has to
be a comprehensive approach using media, using technology with
the kids these days using online tools and resources as well,
rather than just simply handing someone a brochure and saying,
``Go out and eat healthy.''
The Chairman. Thank you very much. I think we have to look
at it from the positive point of view, especially as we look at
fresh fruits and vegetables. For us adults we are trying to eat
a lot more blueberries now because some of us can't remember
what we did on the last hole when we play golf. I would love to
have that person jump back in, to remember. It goes right back
to education as well saying, ``This is what it does for the
mind.''
I am kidding. When we look at a child, if, in fact, they
start eating those kinds of fresh fruits and vegetables perhaps
their ability to think, their ability to act would improve
their ability in the classroom. I think we have to approach it
from that perspective as well, and not just from the
perspective of saying, ``Hey, I want to remember what I scored
last time I swung the club.'' The golf club that is on the golf
course. I want to make sure I clarify that for the record. On
the golf course, not anywhere else. Somebody had stories about
being swung somewhere else, but I don't want to mention where
they were swung but on the golf course.
Ms. Page, I would like to ask you a question: In your
testimony you mentioned that a few California counties have
already adopted the One-e-App process for SNAP. Which
California counties have already adopted that process? That is
question one, and question two, what do the results look like
for these California counties?
Ms. Page. Sure. The first county was Fresno County and the
process isn't just to flip the switch. Conversations had to
take place with the county agency to discuss how applications
would be received, because there is not an interface between
One-e-App to the county system in Fresno. That is really one of
the single biggest challenges.
It is the same challenge faced in Los Angeles, which also
includes Food Stamps and their version of One-e-App, but there
is no interface between One-e-App and the county Social
Services Agency. It means you have to have conversations about
will the applications be mailed? Are you going to require that
they be delivered in person? Would you permit a fax receipt?
Those details are part of what we have been working out in
both Los Angeles and Fresno and so the numbers, frankly, are
kind of low as we have launched only in the last several months
with both of those counties. We will now be able to start to
analyze what kind of impact we have, and more importantly, look
at why the impact isn't greater in part looking at the
integration issue.
The other counties are--Humboldt County is going to launch
in the next couple of weeks and there are organizations in
Sonoma and Napa who also use the system, but it is not county
wide. There are several other organizations and counties that
will be coming onboard.
I just want to say one thing about the adoption of food
stamps which is that our journey really began with the health
programs with a lot of our partners. This is the other
challenge, that it was a bit of a paradigm shift to have
traditional health organizations take on the responsibility of
doing the screening and assessment for Food Stamps, Earned
Income Tax Credit Programs, those other programs. It is going
to be incremental, but the inroads that we are making and
having a system that makes it more rational to do that
screening is going to be critical to making a food bank that
never does an assessment for a health program be willing to
take that on.
The Chairman. Okay.
Mr. Fortenberry.
Mr. Fortenberry. Just one more quick question. You well
know how particularly in this state, but also at the Federal
level, the resource constraints that we're under. Are there
ways to improve nutritional outcomes and participate in the
paradigm shift, as you well stated, without expenditure of
additional resources?
The Chairman. This is open to any of the panelists.
Mr. Fortenberry. That is my last question.
Mr. Sharp. Let me do one that hadn't come up yet at all
which is that the dietary guidelines for Americans spell out a
roadmap on how to live. There is a very slow process underway
to align all the Federal nutrition programs to not only serve
food that exemplifies the dietary guidelines but actually
teaches those lessons. The most cost effective thing you can do
within the current resources are to ensure that the programs
are teaching the healthy habits that are intended.
In 2004, you required the WIC program to update its food
package accordingly and you need to establish the same
expectations for the Childcare Food Program. There is a process
underway with school lunch now to do that. As in the context of
the previous panel's discussion about this pilot program to
incentivize, that would be a promising long-term direction
within the limited fiscal constraints to try and target the
benefits of SNAP more effectively.
Unlike childcare and WIC there has not yet been a
demonstration project to test out the cost and benefits of
relative approaches. That is the general direction that public
health is going is to restructure the guidelines, the meal
patterns, the standards in order to both encourage the healthy
habits, so that the healthiest choice is also the easiest
choice and that is the best way to teach the lesson.
Mr. Fortenberry. That is an interesting concept because the
healthiest choice is not always the easiest choice right now,
particularly, because of a lot of factors you pointed out, all
of you pointed out.
Ms. Jessup. I would like to offer a suggestion of a joint
initiative with Health and Human Services between the
Department of Agriculture, which has the food, and the SNAP and
nutrition programs. At that high level put the two together to
weed out some of the silos between the two and to really make
the point of the obesity issue real for the rest of the
country.
Mr. Fortenberry. Thank you.
Mr. Marsom. So quickly on the cost question. I mean, one of
the unique and wonderful aspects about SNAP nutrition
education, of course, is that it is a shared cost between the
Federal Government and the states. But we also know, and
elected officials are often especially aware of this, is the
mass media is an extremely powerful way of reaching individuals
and changing perceptions. However, it can be very costly.
What we found in recent years in California where the state
had tried to use mass media to reach the target population USDA
had called us because when you are reaching an audience with
mass media there are going to be people they use the term
``incidental outreach.'' There are people who are going to be
watching or listening to a radio station who are not
necessarily going to be eligible. They are going to be low
income but perhaps not in the program.
Headquarters USDA required that the state narrow the target
to show that the maximum number of people who are reached are
eligible. That actually cost a great deal more money.
Consequently they actually reached fewer of their actual target
population and that to me is where we get some fuzzy math going
on.
If we understand that the outcome is to reach the greatest
number of the target population, and if we can show that using
the types of evidence and media targeting that is available in
the private sector, we on the public program should be using
those types of expertise, that type of information. That way we
can actually in the long-term reduce those costs.
Another point specifically, we believe that if states were
today allowed to use their existing Federal share to include
some of these public health approaches, they could do so
without increasing the actual Federal share of the program
because that is how they draw it on the match. If they use the
existing Federal money and just include maybe 20 or 30 percent
of that to support public health approaches, we believe there
could be some tremendous results in terms of addressing obesity
and hunger.
Mr. Fortenberry. Thank you.
Ms. Page. From a systems perspective, on the cost front
with the precious resources that are being invested, it is
incumbent upon the Federal financing streams to be funding the
integration and the interoperability. So that Federal financing
comes with a requirement that investments in systems that the
states are only using those dollars to build systems that can
talk to one another, that they are building them in the right
architecture and on the right platforms. The Federal Government
might look at the investment in a state like California in four
separate systems that do not talk to one another, and how much
longer does that meet the criteria in this fiscally constrained
environment.
Mr. Fortenberry. Thank you.
The Chairman. Thank you. Before we adjourn, I would like
Mr. Fortenberry to make his closing remarks and then I will
make my closing remarks before we dismiss the panel.
Mr. Fortenberry. Great. Well, again, thank you all for the
investment of time today. Thank you all who have stayed with us
through the whole time. I am very impressed by your
willingness, again as a community, to come out and listen to
this. I hope this has been helpful to you. These types of
hearings are always very helpful to us as we try to unpack the
implication in real time the policies that we have made in
Washington, D.C.
I want to thank you and congratulate you on the excellent
spirit that I perceive in your community of both cooperation
but real intensity of care. You are, of course, using resources
well, but are taking community-based approaches to real complex
problems that are a convergence of a lot of factors.
Interestingly today our hearing unpacked a lot of those
social complexities in the one manifestation of it in terms of
hunger and nutrition-related healthcare problems. I think this
has been very helpful and I am really grateful to Chairman Baca
again for the privilege of being here with him but the honor of
the invitation as well. Congratulations, sir, on a great
hearing. I appreciate, again, the opportunity to be here with
you.
The Chairman. Thank you very much. Before we adjourn I
would also like to thank each of the panelists for being here
today and for your thoughtful testimony and your knowledge and
your participation. I hope Congress will find the best policies
and solutions to meet the challenges to our national health
problem including from nutrition, obesity, and cost
effectiveness.
I think when we have hearings like we are having here right
now we actually get to hear from each and everyone of you prior
to and in this hearing itself. It was helpful to hear you
express some of the problems that we are having, and some of
the solutions, some of the directions, and some of the
suggestions. I think if we had been back in Washington, D.C. we
probably wouldn't have heard as much as we have heard right
here.
Maybe that is a warning to us to say that we should have
more hearings out in communities throughout the states, because
we actually have the ability to hear all of your thoughts and
your inputs other than your written testimony. When we are back
in Washington, D.C. I believe the bell goes off and at that
time we are on a time schedule for us to get back in and vote,
and then trying to get back into a hearing and trying to pick
up where we left off.
This was very fruitful for us to have this kind of a
hearing and get the kind of input that will look towards
policies across our nation. It is always worthwhile to come
home anyway and get local perspective on our national
legislation and how we can best implement these policies. I
want to thank Congressman Fortenberry, Congressman Costa again.
A special thanks for both of you for traveling to the Inland
Empire.
Last but not least, also I want to thank Arrowhead
Regional, all the individuals that were involved, my good
friend Frank Reyes who has been wandering around to make sure
that everything was done. Also to Dr. Dev who was here as well
and making this hearing happen and making history right here in
the Inland Empire. This is a historical moment. Hopefully we
can go on and do the same things, another time.
Again, thank you very much, panelists, for being here. With
that I would like to state under the rules of the Committee the
record of today's hearing will remain open for 30 calendar days
to receive additional materials and supplementary written
responses from the witnesses and any question posed by Members.
This hearing of the Subcommittee on the Department Operations,
Oversight, Nutrition, and Forestry is now adjourned.
[Whereupon, at 12:48 p.m., the Subcommittee was adjourned.]
[Material submitted for inclusion in the record follows:]
Submitted Statement by Lorna Donatone, Chief Operating Officer and
Education Market President, Sodexo, Inc.
Mr. Chairman and distinguished Members of the Committee, thank you
very much for giving me the opportunity to provide input on innovative
practices adopted by Sodexo to improve child nutrition. I am pleased to
describe for the Committee examples of programs that Sodexo has found
successful in increasing the consumption of healthy and nutritious
meals by students. We know that access to good nutrition benefits
children not only in their health and wellness but also in their
ability to achieve academic success.
Sodexo is the leading provider of integrated food and facility
management services in the United States with roughly 110,000 employees
in 6,000 locations across the country. Through our School Services
Division, we are privileged to serve 2.8 million school meals each day
to students in more than 470 school districts across the country.
In California alone, we provide student nutrition services at over
65 public school districts throughout the state. In those districts,
which range from large city systems like the San Jose Unified School
District, to small rural systems, we provide wholesome meals that meet
or exceed all USDA nutrition guidelines for schools.
Sodexo is focused on the overall well-being of the students we
serve and we are committed to delivering effective programs that help
students, teachers, parents and employees understand nutritional
concepts and allow them to make informed decisions that support a
healthy lifestyle. Experience has shown us that persuading children to
eat more nutritiously is an evolving process that requires new and
creative methods that make healthy foods more acceptable to children.
Permit me to outline several specific parts of the Sodexo approach
which we have found to be especially effective in California.
Sodexo looks for opportunities to make healthy food fun and
interesting to childing. For example, Sodexo organized a special fruit
and vegetable booth for the Romoland School District health fair in
Homeland, California. The booth included fresh fruits and vegetables,
along with recipes and informational flyers about the produce. The real
highlight of the event was exotic foreign fruits including star fruit,
passion fruit, kiwi, kumquat and loquat. These fruits were both cut
into pieces for tasting and left whole so students could touch and see
them. Another example is the San Ysidro School District Waffle
Breakfast Bar--a promotion that encouraged healthy eating by using
fresh toppings like unsweetened strawberries, blueberries and bananas.
The promotion has been a major hit with students, and the school
district has seen a 50% increase in breakfast participation on
promotion days. On the days following the promotions, participation in
the school breakfast program also has increased, so we know that these
promotions and programs are working to encourage children to eat
healthy breakfasts at school.
However, it is still an unfortunate fact that many students who
qualify for free and reduced price school meals do not take advantage
of those services. Sodexo's research shows that a variety of reasons
contribute to this including failure to complete the application,
social stigma associated with subsidized school meals or, in the case
of breakfast, extenuating factors that impact the child's ability to be
in school in a timely fashion
Sodexo supports school districts by encouraging families to
complete and submit the meal benefit application. Completing the
application is the first step to ensuring that all students have the
opportunity to enjoy healthy meals everyday. Sodexo works with our
school district partners to find new ways of getting that message to
students and parents and encouraging them to sign up for the federally-
funded program. In Rhode Island, Sodexo works with a local radio
station on an annual promotion that provides rewards and incentives for
students at ten high schools throughout the state who complete free and
reduced program applications. The promotion, which started in 2005 and
was created to increase participation in the program, while also
removing the stigma associated with free and reduced meals, has been an
overwhelming success and has produced a 15% increase in applications
and a 25% increase in meal participation during school.
The next step in the process is developing new, creative solutions
and opportunities for students to access meals. An excellent example of
Sodexo's efforts in this area comes from our operations in Atlanta
Public Schools where we found that students were not eating breakfast
at school, despite the fact that we offer free breakfast to all
students in the district. In an effort to get more students the
nutrition they need to succeed, Sodexo and its partner Jackmont
Hospitality started a program that delivers breakfast directly to
students in their morning classroom or distributes nutritious breakfast
foods at special kiosks as students enter the building at the start of
the school day. The ``desk-side'' breakfast program, which Sodexo
launched last school year, has increased breakfast participation at
schools by 200 percent and school officials report that attendance
figures have increased over that same period of time. School district
officials also report fewer behavioral problems and increased
punctuality as a result of the innovative breakfast program.
Giving children a ``second chance'' to have breakfast during AM
recess in Cotati-Rohnert Park in Sonoma County, CA has also proven
extremely effective. The ``second chance breakfast'' was implemented in
January 2009. Cotati had previously offered traditional breakfast at
7:45 a.m. before the start of the school day and the participation in
the traditional program was minimal. Students were not able to get to
the cafeteria at the early time of 7:45 and many of the free and
reduced students were hungry and not receiving their much-needed
breakfast. The pilot at an elementary school was a huge success
allowing Sodexo to roll the program to the remaining breakfast sites in
the following months. As of September 2009, the before-school program
was eliminated; breakfast is now only available as the ``second
chance'' program at recess. The results for the first quarter of the
2009-2010 school year show an increase in participation by 22,413, a
60% increase over the same period last year.
Creating Pleasurable Food Experiences Add More Impactful Information
About Our Programs To Encourage Healthy Eating
Along with ensuring that students have access to nutritious school
meals, our goal is to provide children with affordable meals that they
enjoy eating. In order to meet the desires and needs of students,
Sodexo has a team of experts including executive chefs and registered
dietitians who monitor student insights and trends and also reviews and
evaluates evolving studies on student nutrition. We have discovered
that children tend to eat with their eyes first, so the food we serve
must be colorful, visually appealing and familiar. Sodexo has been
working closely with its vendor-partners to source food that meets high
nutritional standards while also being attractive to kids--both in
flavor and visual appeal.
Sodexo strives to find innovative ways to serve healthier versions
of the foods and beverages children love. For example, in California,
Sodexo switched to a sucrose-based chocolate milk as a healthier
alternative to the high fructose corn syrup version in 2010. This
change is happening at all Sodexo districts across the state.
In a school district in Hopewell Valley, NJ, the block shaped wax-
coated milk cartons that traditionally have brought milk to
schoolchildren have been replaced with eye-catching, pear-shaped,
recyclable plastic bottles that feature tasty low fat milk in regular,
low-fat chocolate and strawberry flavors. In addition, the school
provides a number of milk-based promotional items such as magnet,
buttons, rubber wrist band and the like. In other school settings, milk
machines have been moved to high traffic areas and the distinctive
``Got Milk'' posters are used to attract student attention. In all
cases, we are pleased to report that milk consumption has increased and
recent studies support the fact that offering a variety of milk choices
sustains student consumption of milk. In a recent study, when flavored
milks were removed from schools, there was an observed reduction in
milk purchase consumption for all grades (K-12). This reduction ranged
from 37 percent in high school to 62 percent in the lower elementary
school grades. This reinforces the fact that milk needs creative
packaging and variety so that students benefit from the additional
calcium and vitamin D afforded by milk.
In addition to the examples provided above, we also have increased
healthy eating through the utilization of age appropriate educational
programs. At the K-12 level, Lift-Off is Sodexo's school ambassador and
this character is presented in a variety of fun and engaging ways to
entice students to aim for better nutrition and physical activity.
In an effort to make good nutrition fun, we partnered with Martha
Montoya, the Los Angeles-based cartoonist behind the nationally-
syndicated ``Los Kitos'' comic strip. The partnership brought popular
``Los Kitos'' cartoon characters like Pikito, Mima and Solito to
elementary school cafeterias across the United States with a monthly
comic strip. Sodexo's nutrition mascot Lift-Off, joined the ``Los
Kitos'' characters in entertaining and educating students through comic
strips about valuable topics such as the importance of breakfast, daily
exercise, gardening, planning balanced meals and taking care of the
environment. To help celebrate the nationwide program launch, Lift-Off
was joined by Montoya and Mima from ``Los Kitos'' to bring a special
health and nutrition message to students at William McKinley Elementary
in the Burbank Unified School District. During this visit, Montoya
taught students to draw cartoons during a classroom educational session
while a registered dietitian also taught students about healthy eating
and then lead the class through an engaging activity session. The
cartoons have been so popular with students that we were asked to
convert the comic strips into coloring pages so students could bring
the cartoons to life with their creativity.
For middle school, we offer Performance Zone and at the high school
level we offer Balance Mind Body and Soul. Both programs highlight
nutritional content of meals, offer monthly promotional messages
through brochures, posters and signage, and offer vibrant, age-
appropriate signage to motivate students to make healthier lifestyle
choices. Students have access to a variety of wholesome menu choices
with pizza made from whole grains and low-fat cheese, and fresh salads
and deli options.
Along with our base nutrition programs, Sodexo has special
initiatives and promotions designed to teach students about the
importance of balanced nutrition and making healthy choices in the
cafeteria, at home and throughout life.
Sodexo's A to Z Salad Bar program offers students a chance to learn
about a wide variety of fruits and vegetables by providing a produce
item for each letter of the alphabet on a cart. Sodexo encourages
students to try all of the items and gives them information about why
fresh fruits and vegetables are an important part of a balanced diet.
The Produce of the Month program is another example of Sodexo's
commitment to nutrition education. Not only does Sodexo highlight a
specific produce item each month, but the company also creates
informational materials for students and parents, including nutritional
facts, educational games and activities and recipes to try at home, to
encourage healthy eating away from school.
Building Cross-Community Coalitions To Encourage Healthy Eating
We have also discovered that it is essential to involve varied
members of the educational community is influencing the food choices of
children. In many instances, we have formed Nutrition Teams, comprised
of parents, teachers, food service directors, dietitians, students,
school nurses and physical education teachers to develop healthy meals
and to coordinate and integrate educational messages at home, in the
classroom and on the playground. Our chefs and registered dietitians
have been invited into classrooms to teach nutrition and culinary
skills, and have offered after-school programs, such as cooking
demonstrations on creating healthier meals at home. Other school
communities have begun to build school gardening programs with the
assistance of Sodexo managers and chefs. Registered dietitians and
school managers work with parents and nursing staff to ensure students
with diabetes and food allergies are properly accommodated. And most
recently, we have signed a very important agreement with the Alliance
for A Healthier Generation to ensure beverages and snacks served to
students in all grade levels meet specific nutritional criteria. By
serving snacks and beverages with a healthier nutrient profile in age-
appropriate portion sizes we hope to visually educate students, parents
and teachers about better food choices.
Access To Healthy Foods Is Critical in Fight Against Childhood Obesity
At Sodexo, we know that children who don't have access to healthy
foods are more likely to suffer from childhood obesity--a condition
that will create other devastating health problems for life. Recently,
Sodexo joined First Lady Michelle Obama in her National Fight Against
Childhood Obesity Initiative, named ``Let's Move'', to positively
impact students nationwide in the next school year. The agreement will
affect 135,000 students in the 2010-2011 school year alone. In
addition, representatives estimate a potential increase of 18,700,000
meals conforming to standards outlined in the Healthier U.S. School
Challenge. The school lunch providers expect to reach two million
families with nutrition information.
Under the agreement, Sodexo and industry partners have agreed to
support the First Lady's Initiative by including more fruit, juice,
vegetable, whole grain and milk options in reimbursable lunches. Sodexo
also agreed to increase nutrition education efforts aimed at students
and parents, as well as encourage broader participation in the USDA's
Healthier U.S. Schools Challenge by providing technical assistance and
facilitating paperwork requirements for the schools they serve.
Sodexo also commits to working closely with the White House, and to
continue to work with Federal and state agencies, local school
districts and others in the private sector to achieve the First Lady's
goal to eliminate chilldhood obesity in this generation.
Conclusion
Mr. Chairman and Members of this distinguished Committee, these are
brief highlights of the many ways in which we strive to increase
student access and interest in school meals, and thus, promote
consumption of a healthier diet.
At a time of great need, increasing access to these vital programs
would benefit millions of American children. A recent survey conducted
by the Alliance to End Hunger showed that half of likely voters in
America live from paycheck to paycheck. Too often when families are in
a hand-to-mouth situation, children's nutritional needs suffer. We
believe the foodservice Sodexo provides to 470 school districts across
the country can be an even greater solution to this current problem.
Thank you for allowing us this opportunity to share our story. We
look forward to working with this Committee to inform the policy
discussions surrounding access to healthy food and ways to encourage
healthy eating in the Federal school lunch programs.
______
Submitted Questions
Response by Claudia Page, Co-Director, The Center to Promote HealthCare
Access
Questions Submitted by Hon. Jim Costa, a Representative in Congress
from California
Question 1. You mention that the One-e-App is being used in Fresno.
When was this system started and what sort of success rates have you
seen in terms of enrollment?
Answer. One-e-App was originally launched in Fresno in September
2005 with a focus on children's health coverage programs. Over time,
Fresno has increased the range of programs and the channels through
which applicants get connected to coverage.
Food Stamps was added to Fresno's version of One-e-App in 2009 but
is still in a pilot phase. Progress has been slow in part due to
challenges in working with the County Social Services Agency on the
process for accepting Food Stamps applications originating from One-e-
App.
The collaboration of the state or county agency(ies) responsible
for final eligibility determination is a critical success factor for
systems like One-e-App that are aiming to streamline and improve the
efficiency of eligibility and enrollment processes. The presence of
this collaboration in the State of Arizona has resulted in a
streamlined process that has generated Food Stamps applications on
behalf of nearly 628,000 people. In Arizona, One-e-App interfaces with
the state system to electronically deliver applications and supporting
documentation and signatures for Food Stamps and other programs.
Similarly, in California's San Diego County, county agencies are
supporting and funding the creation of an electronic interface with
One-e-App to better facilitate Food Stamps applications in that county.
There is no similar ``pipeline'' to deliver applications to the county
agency in Fresno.
In California, in addition to Fresno and San Diego, One-e-App also
facilitates Food Stamps applications in Los Angeles, Sacramento and
Solano (and soon in Napa and Sonoma). California's delegation of Food
Stamps eligibility determination to counties means that implementation
of a system like One-e-App happens incrementally on a county-by-county
basis, a slower and more resource-intensive process than in states
(such as Arizona, which uses One-e-App for Food Stamps) where
eligibility is centralized.
Question 2. What are the primary barriers to expanding this program
nationwide?
Answer. There are a number of barriers to expansion, including
competing demands for scarce resources, variable program administration
across states, and resistance to change in general and to technology in
particular. The current economic recession and national and state
budget crises have resulted in a perfect storm of competing priorities
where government agencies are confronted with a growing population of
people in need of food support and other health and social services at
the same time that they are facing layoffs and sharply restricted
budgets. Though the environment calls for the need to improve the
efficiency of outdated processes, it can be challenging to commit the
up-front costs needed to set change in motion. Compounding the scarcity
of resources, the current national focus (and the majority of available
resources) are focused on clinical IT rather than on enrollment
solutions.
National expansion is also complicated by the lack of consistency
with which the food stamps program is administered across and within
states. Program rules and business processes can vary significantly in
different regions, requiring different configurations and
customizations for One-e-App. Further, IT systems are often old and
outdated, making electronic data exchange challenging.
Finally, there is often resistance to breaking down the walls
between programs to make the enrollment process for all health and
social services programs more integrated and efficient. Programs such
as food stamps and Medicaid often operate in silos, and it can be
difficult to forge collaboration and partnership among agencies and
stakeholders that have not historically worked together. Adding
technology into this mix can create a further challenge. In spite of
these challenges, since 2006 One-e-App has screened more than 3.3
million people in four states and generated roughly six million
applications for a broad range of health and social services programs.
Question 3. What is the cost associated with starting up a program
like this? Where is your primary source of funding?
Answer. Costs to implement One-e-App cover a range of activities,
including requirements assessment, system development and
configuration, training, hosting and maintenance, ongoing user support,
and system enhancements to keep pace with changing program rules and
new technologies. Launching One-e-App in a new state requires an
assessment of business processes, system requirements, existing IT
systems, and local programs. Costs depend on the number of programs
included in the system, the number and types of users, the number of
interfaces to other systems, and other functional requirements.
One-e-App has two cost-structure models: (1) a customized One-e-App
implementation, enhancement and maintenance agreement available to
states and jurisdictions; or (2) a California Statewide Subscription
Agreement (currently available in California only). For the customized
implementation, which would be typical for new County or state agencies
interested in implementing One-e-App, the pricing is developed based on
a requirements analysis of the client agencies' programs and business
processes, number of interfaces, etc. For a statewide subscription
agreement, the pricing is based on the type of organization, number of
sites, and number of users. The Center is happy to discuss pricing in
more detail for interested parties.
In terms of funding, different localities have raised funding in
different ways. Sources have included Federal grants, foundation
contributions, local and statewide First 5 funds, Federal matching
funds, and contributions from health plans, hospitals, and clinics and
county funds.
Response by Edith C. ``Edie'' Jessup, Program Development Specialist,
Central California Regional Obesity Prevention Program,
California State University Fresno Department of Health and
Human Services, Central California Center for Health and Human
Services *
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* There was no response from the witness by the time this hearing
went to press.
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Questions Submitted by Hon. Jim Costa, a Representative in Congress
from California
Question 1. Did the rural municipalities that you dealt with have
the administrative capabilities to perform this function, or would they
require additional administrative staffing andfunding?
Question 2. Thank you for mentioning the bonus reward on the EBT
cards as a way to incentivize people to by more healthy fruits and
vegetables. We discussed this during the last Farm Bill, but concerns
were raised over administrative obstacles. Since you have a great deal
of experience dealing with low-income communities and obesity, can you
talk a bit more about why you believe this incentive structure would be
helpful?
Question 3. I agree that health and nutrition go hand in hand and
that agriculture has a tremendous role to play in improving our nations
health.
Each of you mentioned the need for increased partnerships between
the health and nutrition communities. With budget issues at the state,
local and Federal level, what types of new partnerships do you believe
would be the most effective in increasing the likelihood that low-
income populations will be able to access and will choose healthier
options In other words--where is our biggest obstacle--in education?
Access? Funding?