Health conditions keep many SNAP participants out of the labor force

At both the federal and state level, there is a push to include work requirements in the Supplemental Nutrition Assistance Program (SNAP; formerly The Food Stamp Program) and Medicaid. In general, work requirements require certain program participants to work or participate in a training program for at least 20 hours per week each month in order to maintain access.

As the unemployment rate has hit its lowest level in nearly 50 years, and may not be able to fall much more, continued improvement in labor force participation will be crucial to economic growth. Leading up to the release of the October Employment Situation Report, the labor force participation rate of prime age individuals (those 25–54) has in fact been effectively flat thus far in 2018. Though nearly 20 percent of the prime-age population are not in the labor force, the critical open question is how many can be expected to join the labor force if they have not already done so by this point of the expansion. Similarly, while there is broad agreement that recipients of assistance who are able to work should work, it is an empirical question as how many nonworking beneficiaries could be reasonably expected to hold a job.

In a recent Hamilton Project report, Work Requirements and Safety Net Programs, we add evidence to a growing body of research demonstrating that the share of SNAP participants who are not working, could work, and might work if threatened with the loss of benefits is very small relative to those who would be exposed to sanction under the proposed policies who are working or should be exempt from work requirements.

We find that the majority of SNAP participants who would be exposed to work requirements are already in the labor force; however, a substantial share would fail to consistently meet a 20 hours per week threshold given the characteristic volatility of the low-wage labor market. Our evidence shows that there are sizable barriers to bringing many of those who are persistent labor force nonparticipants into the labor force.

In fact, among persistent labor force nonparticipants, we find that health issues are the predominant reason given for not working.[1] Just over half of younger SNAP participants and 87 percent of older SNAP participants who would be exposed to work requirements and who were labor force nonparticipants said the reason that they were not working was due to health or disability. Crucially, this analysis already excludes program participants who reported disability income because they would be eligible for a categorical exemption from a work requirement.

Some have questioned whether survey respondents are likely to provide accurate information about their health. This criticism stems from social desirability bias; survey respondents might feel pressure to report a more publicly acceptable reason for not working than what might actually be true. In this case, a respondent who simply does not want to work would say that they are not working because of a health condition; a health problem is a socially acceptable reason for not working, but the real reason is not.

In this analysis, we show that those reporting health as a reason for not working do appear to be in poor health. We investigate the prevalence of reported health conditions among SNAP participants who would be exposed to work requirements under the House proposal [2] using the 2013 and 2014 waves of the Survey of Income and Program Participation (SIPP). We look at whether SNAP participants who would be exposed to work requirements are in self-reported fair or poor health, take a prescription medication daily, respond affirmatively to at least one in a battery of questions about disability, or spent more than 30 days over a two-year period in bed due to ill health. These questions about health are self-reported, but are considerably less subject to the social desirability bias that may affect how a respondent answers the question as to why they are not working. In fact, these questions are asked in the survey long before the respondent is asked about their labor force status, reducing the likelihood they are manipulating their response to justify not working.

We divide the SNAP participants into five groups:

1. Stable work – those who worked consistently for two years;
2. Transitioned in and out of work due to health – those who were in the labor force but experienced a period of unemployment or nonparticipation due to a health condition or disability;
3. Transitioned in and out of work, other – those who were in the labor force but experienced a period of unemployment or nonparticipation for a reason other than health or disability;
4. Labor force nonparticipant due to health – those who did not work at all for two years due to a health condition or disability; and,
5. Labor force nonparticipation, other – those who did not work at all for two years for a reason other than health or disability.

In keeping with prior work, we examine two populations that will be newly exposed to work requirements under the Republican House proposal: SNAP participants 18-49 with a dependent child 6-17 in the household and those 50-59 with no dependent children under 6. Those 18-49 without dependents already face work requirements.

Among younger SNAP participants with children at home who would be subject to work requirements, about one-third worked stably, half were in the labor force but experienced a period of unemployment or nonparticipation, and 14 percent were persistent labor force nonparticipants.

Looking at persistent labor force nonparticipants, 52 percent said the reason that they were not working was due to health or disability. Turning to their self-reported health status (shown in Figure 1), the light purple bars show that 88 percent of those stating health is why they do not work reported at least one health-related condition; 74 percent reported a disability and 80 percent reported taking prescription medication daily.[3] These figures are far higher than the overall population of those out of work for the long term for non-health reasons (dark purple bars) and even higher than those who have stable work (green bars).

For those temporarily out of work (unemployed or nonparticipation), just 10 percent said the reason that they were not working was due to health or disability. Again, this group (light blue bars) appears to be in worse health than SNAP participants who worked stably or reported a non-health reason for not working. Sixty-six percent of this group reported at least one health-related condition, twice as many reported a disability and four times as many reported being in fair or poor health as those who are temporarily out of the labor force for a non-health reason.

Among older SNAP participants without young children at home who would be subject to work requirements, about one in five worked stably, one in three were in the labor force but experienced a period of unemployment or nonparticipation, and almost half were persistent labor force nonparticipants.

While the health of older Americans has improved over time, health disparities by income have increased, meaning many older low-income Americans face serious health challenges. The older SNAP population reports far worse health than those 18-49. Most (87 percent) of those 50-59 year old SNAP recipients who are out of the labor force for 24 consecutive months report health as the reason for not working. One hundred percent reported at least one health condition: 94 percent of this group reported taking prescription medication daily, 94 percent reported a disability, and 89 percent were in self-reported fair or poor health.

While the older SNAP participant population has worse self-reported health than the younger population, those 50-59 year old SNAP participants who were consistently working reported much better health than those who were not working. In fact, fewer than one in five self-reported poor health and just under a third reported any sort of disability. The most extreme marker of poor health (having spent more than 30 days in bed over the last 24 months) shows the most stark contrast. Almost none (5 percent) of those consistently working reported such problems while 42 percent of those out of the labor force due to health spent more than a month in bed.

Health or disability was also a major reason for temporarily not working amongst the 50-59 year old population – 39 percent. Among this group, 95 percent had at least one health condition, 89 percent took a daily prescription medication, and 72 percent reported a disability.  Those temporarily out of the labor force for a reason other than health (dark blue bars) look distinctly different. Far fewer reported a disability, took prescription medication daily, were in poor health, or were in bed for a long period of time than those who were temporarily out of the labor force for a health-related reason.

Those who are SNAP participants with health issues who are unable to work and who would be exposed to work requirements would be required to obtain documents verifying their health problems frequently in order to retain an exemption. These people could lose access to the program due to paperwork requirements unless administrative capacity were expanded greatly to monitor and adjudicate these health concerns. Even then, administrative failures could lead to loss of access to food benefits.

There may be some SNAP participants who might join the labor force if they were threatened with the loss of benefits. Recent evidence shows that this group is very small relative to those who would be improperly sanctioned by work requirements who are already working or are legitimately unable to work. This piece shows that those who report not working due to health do suffer from health problems.

This analysis suggests that those reporting not working due to health have consistently-reported health concerns: 88 percent of the younger group who said that they were persistently not working due to health or disability reported at least one health condition, including 74 percent reporting a disability. For those older group of SNAP participants, 100 percent of those who were persistently not working due to health reported a health condition elsewhere in the survey. Among those temporarily out of the labor force due to health, the numbers are nearly as high.

Health problems among SNAP participants, particularly among labor force nonparticipants and older beneficiaries, are widespread. Half of those who were not stably employed and more than 80 percent of those who were persistently out of the labor force list health as the reason. And, as we show, it appears health truly is a barrier to work for them.

Endnotes

[1] Those who were no working due to health or disability reported that they were not working for pay because they were unable to work because of chronic health condition or disability, temporarily unable to work due to injury, or temporarily unable to work due to illness.

[2] In June 2018 the House voted to expand the scope of who is required to work in order to receive SNAP benefits to include adults 18–59 with dependent children aged 6–18 as well as those aged 50–59 without dependents under the age of 6. As of publication, the conference committee is considering this proposal. Most SNAP participants between the ages of 18 and 59 without dependents under 6 are required to register for work, accept a job if one is offered to them, and not reduce their work effort. SNAP work requirements and benefit time limits are currently imposed on individuals aged 18–49 without dependents under the age of 18, requiring them to register for work and accept a job if one is offered to them. This population is allowed to receive 3 months of benefits out of 36 months if they do not work or participate in a training program.

[3] The high level of prescription drug medication amongst this group mirrors a finding from Krueger (2017) examining a different population. He finds that 43.5 percent of prime age men out of the labor force take took pain medication yesterday. This population of younger SNAP participants out of work due to health taking prescription medication is even higher. Higher rates of prescription drug taking are both due to sample differences (all prime-age men in Krueger’s paper versus both-gender prime-age SNAP participants to age 50 who have a child in the home) and because prescription medication is a more expansive category than Krueger’s focus on pain medication.

[4] Those in the stable work category did not experience a period of unemployment or nonparticipation over the two-year period. Those in the period of unemployment or nonparticipation group were at least once not working for pay during the two year period. Labor force nonparticipants did not work for pay at all during the two year period. Those in the labor force nonparticipant due to health group did not work for pay at all during the two year period and the most frequent reason given for their nonparticipation was health. Those in self-reported poor health responded “poor” to the question “what is your health status?” Those in the daily prescription medication group responded affirmatively to the question “Did you take prescription medication on a daily basis?” Those in the any disability responded affirmatively to at least one of the following questions: Do you have serious difficulty walking or climbing stairs; do you have difficulty dressing or bathing; do you have serious difficulty concentrating, remembering, or making decisions; do you have a serious physical or mental condition or a developmental delay that limits ordinary activity; do you have difficulty doing errands alone; do you have difficulty finding a job or remaining employed; are you prevented from working; are you deaf or do you have serious difficulty hearing; are you blind or do you have serious difficulty seeing? Those who spent more than 30 days in bed responded to the question “How many days did illness or injury keep you in bed more than half of the day” for at least 30 days over the two-year period.