Trump Administration Budget Cuts and the Impact of Food/Meal Delivery for NYC Residents in Need

by Alexina Cather, MPH

God’s Love We Deliver Funding Could Be Cut as Well as Other Medical-Meal Delivery Services

By Emily Payne

Craig, a 78-year-old who has lived in his Upper West Side apartment for 55 years, used to be a passionate singer, cabaret performer and world traveler. In the course of his career he got to know Julie Andrews, Lauren Bacall and Judy Garland, among other brilliant stars. Then, he was diagnosed with chronic obstructive pulmonary disease.

Today, he uses a wheelchair, takes 32 pills each day, and hasn’t been able to leave his apartment in three years. He suspects he wouldn’t recognize his neighborhood anymore. Before his friend Joan Rivers referred him to God’s Love We Deliver (GLWD), he was concerned about how he would survive on his own. Now, with GLWD, he receives nutritious, home-delivered meals tailored specifically for his nutritional requirements.

“I feel a difference—I feel more energized, like I could conquer the world,” Craig says of GLWD’s services.

GLWD is the only program in New York City that delivers free, medically-tailored meals to those in need. GLWD services all five boroughs as well as parts of New Jersey, Westchester County and Nassau County. Started in 1985, at the height of the AIDS epidemic, as one woman bringing a meal to a man who was dying of AIDS, it has since evolved to include treatment for all illnesses.

In addition to preparing and delivering medically-tailored meals to people who are unable to provide for themselves because of an illness or condition, the program also offers specifically tailored nutrition education and counseling to clients, families, service organizations and policymakers. The services are provided free of charge, and there are no age requirements, illness limitations or income thresholds.

Many of the more than 7,000 individuals who depend on the nearly 1.7 million meals that GLWD delivers each year have no other way to obtain, nutritious, medically-tailored meals. Without this service, they would be forced to rely on packaged, processed foods and would also likely incur additional healthcare costs.

“Our clients can’t get up and go to a food pantry, and even if they could, they might not be physically able to hold pans or cook for themselves or have the energy after radiation treatment to do that,” says Alissa Wassung, Director of Policy and Planning. “So we’re really addressing a smaller subset of the population, and a more focused subset” than other hunger-relief organizations.

Services such as GLWD are vital across the country to help prevent nutrition deficiencies that could lead to worsening illness as well as to monitor medication adherence and alleviate side effects. Organizations such as Project Angel Heart in Colorado, Ceres Community Project in California and Community Servings in Massachusetts provide similar medically-tailored meal services to their communities.

With recent federal funding cuts for charitable organizations, many fear that these services could be at risk. While these concerns have given GLWD and similar organizations a spotlight in the media, funding is more complicated than the media may portray.

Proposed Food Assistance Cuts

Despite his campaign promises, in March 2017 President Trump announced a plan for $4.1 trillion in budget cuts to go into effect in 2018, including deep cuts in federal assistance programs such as health care, food stamps, student loans and disability payments. The plan was passed by a narrow vote in October 2017.

Titled “A New Foundation for American Greatness,” the plan advocates for what the administration calls an “America First” policy. And the release of Trump’s 2019 Fiscal Year Budget proposal in February 2018 further supported this policy, calling for 22.5 percent cut to Medicaid and Obamacare subsidies and a 27.4 percent cut to the Supplemental Nutrition Assistance Program (SNAP) by 2028, with systemic changes that will increase the cost to some, cut costs for others.

The media coverage following the initial release of “A New Foundation for American Greatness” seemed to simplify a complex issue: where do food assistance programs get their funds, and is the Trump administration able to shut them down completely?

Funding & Public Confusion

GLWD focuses on those whose severe illness prevents them from physically accessing hunger-based resources like food banks. And the people they support require services that go beyond those supplied by organizations such as as Meals on Wheels in that the medically-tailored meals they deliver are intended to improve their patients’ health outcomes. They’re filling a gap in services that are funded by federal anti-hunger initiatives.

Since GLWD looks at food policy through the lens of people who are not just hungry but ill, it does not receive the same state, local or federal backing as programs like SNAP or the National School Lunch Program. Because it is not strictly an anti-hunger organization, there is no dedicated funding stream to support what GLWD does except in the cases of those with HIV, whose care is funded through the The Ryan White Comprehensive AIDS Resources Emergency Act (Ryan White CARE Act). And according to Wassung, even that is still not enough to cover the needs of every AIDS patient who comes to GLWD.

Wassung notes that private fundraising and community donations account for about 70 percent of the organization’s budget. The remaining 30 percent comes half from the Ryan White CARE Act, which only serves HIV/AIDS patients, and half from a partnership with the New York State Medicaid program through which GLWD maintains partnerships with more than 30 managed long-term care plans that provide covered benefits to the Medicaid population that is at highest risk and highest need.

“We also supplement that program with private fundraising,” Wassung says. “So, through the generous donations of our community we’re really able to keep our doors open and expand our services to keep helping those that come to us.”

Like many similar organizations, however, GLWD does depend on federal funding for a portion of their money. And every portion matters.

“So much of that is in flux,” Wassung said after the 2018 budget was initially proposed. “Like all people that serve vulnerable populations, we are on high alert.”

While the organizations themselves were unsure of the future, confusion also reigned in public opinion. Meals on Wheels, for example, was actually not specifically mentioned in the proposed budget cuts for either 2018 or 2019. However, among outlets responding negatively to the Trump administration’s budget proposal in March 2017, Meals on Wheels became the poster child for organizations that would take a hit.

Following President Trump’s budget cut announcement, the media disseminated the information with strong language:

45 million Americans rely on food stamps. Trump wants to gut the program.

Donald Trump’s Budget Cuts Would Leave Many Americans Hungry

Trump’s Budget Would Kill Funds for a Program That Feeds 2.4 Million Senior Citizens

Although a significant portion of funding comes from federal support, every Meals on Wheels affiliate gets money from a different mix of state local, and federal government funds, along with individual donations and the help of philanthropic organizations. Amidst the media attention, Meals on Wheels America posted a statement of clarification:

“Meals on Wheels services are provided directly to seniors by a nationwide network of 5,000 local community-run programs that, in the aggregate, receive 35% of their funding from the federal government.

Some media outlets have incorrectly reported this number to be 3%, confusing it with the federal funding received by Meals on Wheels America, the national membership organization that does not provide direct services (e.g., meals). This miscommunication dramatically understates the significant impact of any federal budget cuts that may affect Meals on Wheels.”

While cuts in federal funding might not have the potential to shut the doors of services like GLWD, as headlines may suggest, losing those funds would greatly impact their reach, as the Meals on Wheels’ statement makes clear.

“Our donor base is growing all the time regardless of political climate,” Wassung says. “We are fortunate to have a volunteer base that is ever growing and a donor base that is ever growing.”

The public’s increasing interest in the public health issues which GLWD and Meals on Wheels addresses is shown through both this growing donor and volunteer community as well as the widespread media coverage surrounding federal budget cuts. Can this interest be harnessed for concrete change?

Social Determinants of Health

The CDC defines social determinants of health as the “conditions in the places where people live, learn, work, and play,” which “affect a wide range of health risks and outcomes.” Throughout the country, an increased interest in the social determinants of health—which is a major focus of GLWD’s work—has been seen through the work of both physicians and government initiatives as well as within popular culture. Specifically, in the past two decades, there has been a large, growing body of research showing that social factors, in and of themselves, have a significant influence on overall health.

According to a 2014 study by the Institute for Clinical Systems Improvement, access and quality of healthcare determine only 20 percent of what influences the health of any particular group of patients. A new SaaS (Software as a Service) platform startup in NYC called Healthify is devoted entirely to helping organizations address social determinants of health such as income, education, employment, physical environments, gender and culture.

In 2012, the Department of Health and Human Services reported that 5 percent of the American population is responsible for 50 percent of the nation’s total healthcare spending—a large portion of that 5 percent being chronically ill. And that expenditure is steep. Despite seeing the doctor less frequently than people in other countries, people in America generally spend more on healthcare than those in any other country. Between 2012 and 2015 the national health expenditure (spending by governments, private corporations, and individuals) more than doubled, from from $1,369.7 billion to $3,205.6 billion.

According to GLWD, medically-tailored meals can do more than nourish those who are unable to shop and cook for themselves. Addressing chronic illnesses through a focus on the social determinants of health has the potential to make a big impact on the overall cost of healthcare in the United States, particularly that top 5 percent of healthcare spenders.

“More and more research is showing that addressing people’s care and health outside of the four walls of the hospital is really key to bending the cost curve, making sure that people are healthy, and also satisfied with their healthcare,” Wassung says. “What we’re seeing across the country and more specifically in New York State is an investment in addressing the nutritional needs of the higher risk populations, and that’s because it works.”

While the American economy spends more than $60 billion per year for industry research on drugs, biotechnology and medical devices, less than $2 billion is dedicated to nutrition and prevention, says Robert Graham, MD, MPH, and an Integrative Medicine Specialist who focuses on the benefits of food for health. Compounding this problem is the fact that our healthcare system is ill-equipped for and our doctors are ill-trained in lifestyle medicine, where nutrition is of the most importance, he explains.

A 2013 study published by the National Institutes of Health estimated that, “if all states had increased by 1 percent the number of adults age 65 or older who received home-delivered meals in 2009 under Title III of the Older Americans Act, total annual savings to states’ Medicaid programs could have exceeded $109 million.”

As a case in point, a study by the Metropolitan Area Neighborhood Nutrition Alliance (MANNA) of Pennsylvania compared 65 MANNA patients to a similar group of patients who did not receive medically-tailored meals and found that those who did had 55-percent lower healthcare costs, 37-percent shorter hospital stays, and a 50-percent lower chance of being hospitalized to begin with than those who did not.

Nutrition has a significant impact on disease prevention, but healthcare expenditure in the United States continues to focus on treatment and management rather than prevention. In 2006, three-fourths of U.S. health spending was directed toward treating chronic diseases. “Almost two-thirds of the growth in spending is attributable to Americans’ worsening health habits, particularly the epidemic rise in obesity,” according to Health Affairs. “The U.S. care delivery system favors paying for treatment of chronic diseases rather than preventing them in the first place.”

Now, the Trump administration is proposing further budget cuts for 2019 to many public assistance programs that support those preventative measures. How could this affect increasing national health expenditure numbers?

Public Action

Connecting those in need to healthy food is an important aspect of overall healthcare that doesn’t get very much federal support—even before any proposed budget cuts. Turning the American healthcare system’s focus to prevention, rather than treatment and management, doesn’t seem likely through the current administration’s policies. But an increasing public interest, and solid research to support it, does have potential to push the needle in this direction.

There are many things people can do to help connect those in need to nutritious meals. In New York City, Citymeals on Wheels, City Harvest, and GLWD are always accepting volunteers. Support those organizations that have proven outcomes and rely on in-kind donations, such as the above and Wholesome Wave, whose produce-prescription program empowers doctors to write prescriptions for fruits and vegetables. Every donation and every act of volunteering counts. While any cut to federal support is negative, many of these organizations, including GLWD, stay afloat primarily because of corporate and private donations. This support is now more important than ever.

And read past the headlines to stay informed. Call your representative to make your voice heard about charitable budget cuts. The House released the 2018 Farm Bill proposal, which contains significant implications for SNAP recipients including new work requirements, last month. Ensuring that nutritious meals reach the tables of those in need requires involvement from all players in the system—policymakers, activists, civilians, nonprofits, and corporations alike. 

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