In the most recent edition of the Journal of Policy Analysis and Management, there was an article titled Medicaid generosity and food hardship among children. In this paper, the researchers Nicholas Moellman and Cody Vaughn explored the impact that Medicaid had on food insecurity.
They found that having a child eligible for Medicaid reduced household food insecurity by 20%. This effect was stronger for Black and Hispanic households.
At first glance, this seems like a surprising result. Medical expenses covered by medicaid are not always consistent like food expenses.
More generally though, resources are resources. If a family has unavoidable medical expenses, then Medicaid may allow them to not sacrifice spending in other parts of their lives. As noted in the Federal Reserve’s Survey of Household Economics and Decision Making, 37% of adults would not be able to cover a $400 emergency expense with cash.
One inpatient day at an Ohio non-profit hospital costs on average $3,402 according to data from Kaiser State Health Facts. It makes sense that if a low-income family had to pay for a hospital stay for any reason, it could impact their ability to afford food.
This result is interesting in itself, and policymakers should pay attention. Additionally, this paper reveals some key insights about the policy analysis process. In particular, I think it highlights the importance of two steps of the Eightfold Path.
Problem Definition
Food insecurity is not strictly an issue about lacking food, it is an issue about lacking resources. There are very few places in the United States where the reason someone is food insecure is only because they don’t have access to food, even though they have enough money.
Food insecurity is often the result of people having to stretch their limited resources too thin, and sacrificing food intake as a result. As these researchers show, when we reduce resource burdens in one area, we find that people shift their consumption in response.
As policy analysts, the lesson we can learn is that no problems exist in a vacuum. When identifying and defining problems, it is important to find the root cause.
Imagine a hospital is regularly over capacity. Without understanding why, we might predict the best course of action is to build a new hospital wing. However, if we know that the primary reason the hospital is always crowded is because the city’s drinking water is contaminated, then we can more efficiently address the problem.
Criteria Selection
When selecting what criteria to measure a policy on, it is important to be open minded. All parts of the economy are connected, and analysts should always be thinking about what the impacts of a policy change might be several steps downstream.
This isn’t to say that analysts should always consider every possible impact. Policy analysis is always resource constrained, and there it is impossible to fully explore all outcomes. A skilled analyst should be able to both think outside the box and realize when certain avenues aren’t worth their time.
At the beginning of a project, everything should be on the table. Criteria selection is one area where a lot of analyst bias can inadvertently be introduced. Giving some consideration to what may appear to be unrelated criteria is one way to increase the validity of an analysis.