DISTRICT OF COLUMBIA et al v. U.S. DEPARTMENT OF AGRICULTURE et al

Filing 3

MOTION for Preliminary Injunction by DISTRICT OF COLUMBIA (Attachments: #1 Declaration STEVEN BANKS, #2 Declaration EDWARD BOLEN, #3 Declaration TIKKI BROWN, #4 Declaration CATHERINE BUHRIG, #5 Declaration ALEXIS CARMEN FERNANDEZ, #6 Declaration STEVE H. FISHER, #7 Declaration HOLLY FREISHTAT, #8 Declaration JEFFREY GASKELL, #9 Declaration DEIDRE S. GIFFORD, #10 Declaration HEATHER HARTLINE-GRAFTON, #11 Declaration DANIEL R. HAUN, #12 Declaration KATHLEEN KONOPKA, #13 Declaration ED LAZERE, #14 Declaration BRITTANY MANGINI, #15 Declaration VICTORIA NEGUS, #16 Declaration ELISA NEIRA, #17 Declaration S. DUKE STOREN, #18 Declaration DAWN M. SWEENEY, #19 Declaration LAURA ZEILINGER, #20 Text of Proposed Order)(Konopka, Kathleen). Added MOTION to Stay on 1/24/2020 (znmw).

UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF COLUMBIA
DISTRICT OF COLUMBIA, STATE
OF NEW YORK, STATE OF
CALIFORNIA, STATE OF
CONNECTICUT, STATE OF
MARYLAND, COMMONWEALTH
OF MASSACHUSETTS, STATE OF
MICHIGAN, STATE OF
MINNESOTA, STATE OF NEVADA,
STATE OF NEW JERSEY, STATE
OF OREGON, COMMONWEALTH
OF PENNSYLVANIA, STATE OF
RHODE ISLAND, STATE OF
VERMONT, COMMONWEALTH
OF VIRGINIA and CITY OF NEW
YORK,
Plaintiffs,

Case No. 1:20-cv-00119

v.
U.S. DEPARTMENT OF
AGRICULTURE; GEORGE ERVIN
PERDUE III, in his official capacity as
Secretary of the U.S. Department of
Agriculture, and UNITED STATES
OF AMERICA,
Defendants.
DECLARATION OF HEATHER HARTLINE-GRAFTON IN SUPPORT OF
PLAINTIFFS’ MOTION FOR PRELIMINARY INJUNCTION
1.
I am over the age of eighteen (18) years, competent to testify to the matters
contained herein, and testify based on my personal knowledge and information.
2.
I am the senior researcher for nutrition policy and community health at the Food
Research & Action Center (FRAC). I am a Registered Dietitian and hold honors bachelors’
degrees in nutritional sciences and dietetics from the University of Delaware, an M.P.H. in
nutrition from the University of North Carolina, and a Dr.PH. in community health sciences from
Tulane University. I joined the FRAC staff in January 2009 and have extensive experience in
nutrition policy research, social determinants of health, obesity prevention, and healthy eating
strategies, including through my prior work at the American Cancer Society, Mathematica Policy
Research, and Tulane University. As FRAC’s senior researcher for nutrition policy and
community health, my work primarily focuses on obesity, dietary quality, and health outcomes
among low-income and food-insecure children and families, with emphasis on how the federal
1

nutrition programs improve health, nutrition, and well-being. I am also actively involved in
FRAC’s work on screening for and addressing food insecurity in health care settings.
3.
I am aware that the federal government recently issued a final rule “Supplemental
Nutrition Assistance Program: Requirements for Able-Bodied Adults Without Dependents,” 84
Fed. Reg. 66,782 (“the Rule”). Under prior authority, able-bodied adults without dependents
(ABAWDs) may only receive three months of benefits from the Supplemental Nutrition
Assistance Program (SNAP) unless they fulfill certain work requirements. However, states with
areas of high unemployment or insufficient jobs may apply for waivers of this time limit. The
new final Rule eliminates or restricts many of the criteria upon which states can rely when
applying for a waiver of the ABAWD time limit. I have reviewed the Rule and am aware of its
direct implications on the administration of the Supplemental Nutrition Assistance Program
(SNAP), formerly known as the Food Stamp Program, within the states. I understand that this
lawsuit challenges the Rule.
4.
FRAC is the leading national nonprofit organization working to eradicate povertyrelated hunger and undernutrition in the United States. FRAC leads efforts to identify and
communicate the connections among poverty, hunger, and obesity among low-income people;
conducts research to document the extent of hunger, its impact, and effective solutions; seeks
stronger federal, state and local public policies that will reduce hunger, undernutrition, and
obesity; monitors the implementation of laws and serves as a watchdog of programs; provides
coordination, training, technical assistance, and support on nutrition and anti-poverty issues to a
nationwide network of advocates, service providers, food banks, program administrators and
participants, and policymakers; and conducts public information campaigns to help promote
changes in attitude and policies.
5.
In 2018, more than 37 million people lived in food-insecure households. 1 Food
insecurity is a term defined by the U.S. Department of Agriculture (USDA) that indicates that the
availability of nutritionally adequate and safe food, or the ability to acquire such food, is limited
or uncertain for a household.
6.
Food insecurity is a health-related social need that contributes to poor physical
and mental health outcomes. 2 For example, studies have found that food insecurity increases the
prevalence and severity of diet-related diseases, including obesity, type-2 diabetes, heart disease,
stroke, and some cancers. In addition, because of limited financial resources, individuals that are
food insecure may use coping strategies to stretch budgets that are harmful for health, such as
engaging in cost-related medication underuse, postponing or forgoing preventive or needed
medical care, foregoing the foods needed for special medical diets, and making trade-offs
between food and other basic necessities (e.g., housing, utilities, transportation).
7.
Food insecurity and its related coping strategies can exacerbate existing disease
and compromise health, while also contributing to increased physician visits, emergency room
visits, hospitalizations, and expenditures for prescription medications. 3 As a result, food
1

Coleman-Jensen, A., Rabbitt, M. P., Gregory, C. A., & Singh, A. (2019). Household food security in the United States in 2018. Economic
Research Report, 270. Washington, DC: U.S. Department of Agriculture, Economic Research Service.
2 Hartline-Grafton, H. (2017). The Impact of Poverty, Food Insecurity, & Poor Nutrition on Health and Well-Being. Washington, DC: Food
Research & Action Center.
3 Ibid.

2

insecurity is a strong predictor of increased health care costs. According to recent analyses, food
insecurity contributed to $52.9 billion in excess health care costs for the nation in 2016. 4
California had the highest annual health care costs associated with food insecurity at $7.2 billion.
(See Exhibit A for cost estimates by U.S. states and the District of Columbia.)
8.
SNAP is the largest nutrition assistance program administered by the USDA and
serves as the first line of the nation’s public policy defense against hunger and undernutrition.
This invaluable program has a critical role, not just in reducing food insecurity, but in improving
the health of the nation, especially among the most vulnerable Americans. 5
9.
Several studies demonstrate that SNAP alleviates food insecurity, which, in turn,
can improve the dietary intake and health of SNAP recipients. For instance, a study by Urban
Institute researchers found that SNAP reduced the likelihood of being food insecure by
approximately 31 percent and the likelihood of being very food insecure by 20 percent. 6
10.
SNAP is a critical health intervention and support for vulnerable Americans, with
considerable evidence demonstrating the program’s effectiveness in improving health outcomes. 7
SNAP has been particularly beneficial for SNAP recipients with diabetes. Among a sample of
low-income, urban medical center patients with Type 2 diabetes, SNAP receipt was associated
with a lower risk of poor glucose control among those who were food insecure. The authors of
the study raised concerns that cuts to SNAP could result in “worse chronic disease control
among low-income patients with diabetes.” 8 Studies also have shown that hospital admissions
for hypoglycemia (i.e., low blood sugar) are higher at the end of the month for low-income
individuals with diabetes than high-income individuals with diabetes. 9 This suggests that lowincome patients are more likely to have hypoglycemia when food and other benefits (e.g.,
SNAP) are most likely to be depleted, typically at the end of the month.
11.
SNAP participation also has been linked to improved mental health for recipients.
A national study of SNAP households found that participation in SNAP for six months was
associated with a 38 percent reduction in psychological distress. 10 In a national sample of lowincome adults, low food security and very low food security were both associated with higher
odds of depression among SNAP participants, but the odds were not as great as those for
similarly situated non-participants. These findings suggest that SNAP may have a protective
effect on mental health. 11

4 Berkowitz, S. A., Basu, S., Gundersen, C., & Seligman, H. K. (2019). State-level and county-level estimates of health care costs associated with
food insecurity. Preventing Chronic Disease, 16, e90.
5 Hartline-Grafton, H. (2017). SNAP and Public Health: The Role of the Supplemental Nutrition Assistance Program in Improving the Health and
Well-Being of Americans. Washington, DC: Food Research & Action Center.
6 Ratcliffe, C., McKernan, S. M., & Zhang, S. (2011). How much does the Supplemental Nutrition Assistance Program reduce food insecurity?
American Journal of Agricultural Economics, 93(4), 1082–1098.
7 Hartline-Grafton, H. (2017). SNAP and Public Health: The Role of the Supplemental Nutrition Assistance Program in Improving the Health and
Well-Being of Americans. Washington, DC: Food Research & Action Center.
8 Mayer, V. L., McDonough, K., Seligman, H., Mitra, N., & Long, J. A. (2016). Food insecurity, coping strategies and glucose control in lowincome patients with diabetes. Public Health Nutrition, 19(6), 1103–1111.
9 Seligman, H. K., Bolger, A. F., Guzman, D., Lόpez, A., & Bibbins-Domingo, K. (2014). Exhaustion of food budgets at month’s end and
hospital admissions for hypoglycemia. Health Affairs, 33(1), 116–123.
10 Oddo, V.M., & Mabli, J. (2015). Association of participation in the Supplemental Nutrition Assistance Program and psychological distress.
American Journal of Public Health, 105(6), e30-e35.
11 Leung, C. W., Epel, E. S., Willett, W. C., Rimm, E. B., & Laraia, B. A. (2015). Household food insecurity is positively associated with
depression among low-income Supplemental Nutrition Assistance Program participants and income-eligible nonparticipants. Journal of
Nutrition, 145(3), 622–627.

3

12.
Increased SNAP participation also reduces health care utilization and costs. For
example, a national study found that “SNAP participation was associated with approximately
$1400 per year per person lower subsequent health care expenditures in low-income adults.” 12
The savings were even larger for SNAP participants with hypertension or coronary heart disease.
13.
Many of the ABAWDs who would lose their benefits under the new waiver Rule
also participate in Medicaid. SNAP participation and benefits have implications for Medicaid
spending, as demonstrated in studies examining the impact of a temporary increase in SNAP
benefits on health care utilization and expenditures. For instance, in a nationwide study, monthly
Medicaid admission growth fell from 0.80 to 0.35 percentage points after the temporary increase
in SNAP benefits, but then rose to 2.42 percentage points after the boost ended (and SNAP
benefits decreased). 13 Inflation-adjusted monthly inpatient Medicaid expenditures followed a
similar pattern and were associated with $26.5 billion in savings over the 55 months of the
benefit increase and $6.4 billion in additional costs over the first 14 months of the SNAP benefit
decrease.
14.
Recent research shows that expansions of SNAP work requirements would result
in rapid declines in caseloads and benefits. Researchers examined how changes in the
implementation of work requirements (i.e., the absence of waivers for ABAWDs) impacted
SNAP caseloads and benefits from 2013 to 2017.14 In analyses that accounted for
unemployment, poverty, and Medicaid expansions, SNAP work requirement expansions caused
approximately 600,000 participants to lose SNAP benefits between 2013 and 2017. Additional
estimates indicate that more than one-third of all ABAWDs lost SNAP benefits due to the
adoption of work requirements. The work requirement expansions also resulted in a loss of about
$2.5 billion in SNAP benefits in 2017. The authors wrote, “in light of research indicating that
SNAP reduces food insecurity and is associated with improved health and lower health
expenditures, our analysis suggests that work requirements could create hardships for lowincome adults, including increased food insecurity and impaired health.”
15.
SNAP improves local economies and access to healthy food. The positive
economic stimulative effects of SNAP, particularly during recessionary periods, are well
documented. According to recent studies, it is estimated that $1 of SNAP benefits leads to
between $1.50 and $1.80 in total economic activity during a recession. 15 Those dollars help all
parts of the food system, from farmers and food producers, to store owners and clerks. Many
farmers’ markets receive revenue from SNAP purchases and many of those markets also
participate in incentive programs that provide SNAP shoppers with bonuses for purchasing fruits
and vegetables. SNAP benefits help many food retailers who operate on thin margins to remain
in business, which improves food access for the whole community.
I declare under penalty of perjury that the forgoing is true and correct and of my own
12 Berkowitz, S. A., Seligman, H. K., Rigdon, J., Meigs, J. B., & Basu, S. (2017). Supplemental Nutrition Assistance Program (SNAP)
participation and health care expenditures among low-income adults. JAMA Internal Medicine, 177(11) 1642–1649.
13 Sonik, R. A., Parish, S. L., & Mitra, M. (2018). Inpatient Medicaid usage and expenditure patterns after changes in Supplemental Nutrition
Assistance Program benefit levels. Preventing Chronic Disease, 15, e12.
14 Ku, L., Brantley, E., & Pillai, D. (2019). The effects of SNAP work requirements in reducing participation and benefits from 2013 to 2017.
American Journal of Public Health, 109(10), 1446–1451.
15 Canning, P., & Stacy, B. (2019). The Supplemental Nutrition Assistance Program (SNAP) and the economy: new estimates of the SNAP
multiplier. Economic Research Report, 265. Washington, DC: U.S. Department of Agriculture, Economic Research Service. [Technical Note: See
pages 6-8 and Table 1 for research by Blinder and Zandi.]

4

personal knowledge.
Executed on January 8, 2020 in Tomball, TX.

_
Heather Hartline-Grafton, DrPH, RD
Senior Researcher, Nutrition Policy &
Community Health
Food Research & Action Center

5