COLUMBIA South Carolina, long at the back of the line in health care, wants to take the lead among states in the battle against obesity by allowing only healthy foods to be purchased with food stamps.
Gov. Nikki Haley on Thursday joined leaders of three state agencies to announce plans to seek a waiver from the federal government to change the food stamp program. Haley noted that South Carolina has the eighth highest rate of obesity among states.
“All of that is about to change, not in what we say but in actions,” Haley said. “We are going to make changes … so we actually can see results. Then other states will say, ‘What are they doing?’ ”
Food stamps – officially the Supplemental Nutrition Assistance Program – are a U.S. Department of Agriculture program coordinated in the state by the Department of Social Services. In order to change what can be purchased with food stamps, the state must ask for a waiver to federal regulations. About 18 percent of the S.C. population uses food stamps.
Waivers turned down
At least 10 states or municipal governments have asked for waivers to the system in recent years. The USDA has turned down each of them. A response two years ago to a New York City request indicated it was too broad and would affect too many people.
S.C. DSS director Lillian Koller thinks South Carolina can break that trend with a different game plan. Rather than a top-down request put together by government bureaucrats, she wants to hear from all sides of the issue in a series of public meetings. The waiver request will grow out of what state leaders hear in those meetings.
“I don’t think it’s been framed that way before. The power is in all these people,” Koller said in motioning to the variety of health advocates who had gathered at a statewide obesity task force meeting.
Their ideas will be gathered, along with those of food stamp users, food manufacturers and retailers. To Koller, the goal is simple and makes so much sense that “it’s like one big ‘Duh!’ ”
The meeting will help determine what purchases should and shouldn’t be allowed. Haley thinks it shouldn’t be difficult.
“That $1 billion no longer will go to candy and chocolate and sodas and chips,” Haley said. “It’ll be going to apples and oranges and things that are healthy.”
878,000 in South Carolina
People qualify for food stamps based on their incomes and family sizes. The most recent statistics indicate 878,000 people in South Carolina use food stamps. They can buy just about any food product with them, but not alcohol and cigarettes.
Haley and Koller were joined in the announcement by Catherine Templeton, director of the state Department of Health and Environmental Control, and Dr. Marion Burton and Dr. Janice Key, pediatricians. Templeton has made obesity a focus of her agency and first floated the idea of food stamp limits last month. Burton is the medical director of the state Department of Health and Human Services. Key is director of adolescent medicine at the Medical University of South Carolina and has researched childhood obesity.
They all noted the problem: About one-third of the state’s residents are obese, and another third are overweight. That contributes to the state’s abysmal rankings in many health categories, including diabetes, stroke, high blood pressure and heart disease.
“It’s not about appearance at all,” Key said. “It’s about health. An obese teen already has the thickened arteries of a middle-aged person. Think of what that means for their health later in life.”
Obesity as a disease
Burton also used the forum to announce an upcoming change that, while a positive, also points up the state’s problems: His agency has begun the process to have obesity classified as a disease in the state Medicaid system.
With obesity not considered a disease, there are limits on steps physicians can take with patients under Medicaid. For instance, Burton said, he can’t call in a nutritionist to help an obese patient. But he can if the patient has diabetes caused by obesity because diabetes is recognized as a disease.
“This is a huge difference,” Burton said. “There’s not a lot we can do about it until you recognize obesity as a disease.”
The kicker: The federal government began allowing state Medicaid agencies to recognize obesity as a disease in 2005. Back then, there was still debate in the medical field on such a change, and many states balked at the obesity designation, Burton said.
But as the obesity epidemic has risen nationwide in recent years, 48 states have taken the step to declare it a disease for Medicaid payment purposes. Only South Carolina and Nebraska haven’t.