ļ»æEpisode 75. Great Healthcare Plan & Threats to Food Security Interview with Larry Levitt and Gina Plata-Nino
Hello, one and all, and welcome back to The Rural Impact. I'm Michelle Rathman, and I am so grateful that you have joined us for another conversation that does work hard to connect the dots between policy and rural everything, and as we say so often, rural quality of life.
Now, before we dive into our serious conversations that we are having today, and they are serious conversations, I do wanna share with you that we have officially launched, drum roll please, our Rural Impact Merchandise, and you can find everything from hats to mugs, notebooks, and my favorite reusable shop rural bag. So, when you visit theruralimpact.com. Look for our merch link and we would love to have you have a look, buy a few things that we think that you're going to appreciate.
I'm gonna just show you one little thing right now that I love, which is my notebook, and on the very back it has, these are not light subjects. So, when you do purchase items from our store, not only are you supporting us, but I wanna tell you that we are also identifying rural-serving nonprofits and organizations that support rural.
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Okay. With that news outta the way I am gonna shift back to policy. So let me tell you about what conversations of what we're gonna cover today on the show. If you listen to our last episode, you know, we kicked off our, tracking transformation series and that is really about tracking the $50 billion taxpayer fund that was set aside in H.R.1 to, as they say, transform rural health.
So, I won't get into that, but. We are gonna have kind of conversation that is parallel to that. So, it's not gonna be about the Rural Health Transformation Fund per se, but it is really an extremely timely conversation because we are talking about the January 15th announcement that came out from the White House and that is President Trump's call for Congress to enact what he calls the Great American Healthcare Plan.
Which as is described, and this plan, this comprehensive plan, as they say, is to lower drug prices, insurance premiums, hold bigger insurance companies accountable, and maximize price transparency, all of which does have the potential to have a very positive impact for rural.
However, without specific details on implementation, many of the two-page plan that's been put out so far and its promises remain speculative at best. The devil as they stay is in the details. Okay, so what are we talking about today? If you guessed the Great American Healthcare Plan, you would be correct and to have this early in the game conversation, 'cause again, it's super early in the game. I am pleased to be joined again by Larry Levitt, executive Vice President for health policy at KFF, and grateful to have him back to be sure. If you recall, Larry joined us in early 2025 to talk about shifts in health policy back then. So, a lot has changed since that time.
Now after my conversation with Larry, in a very short break, we are gonna shift gears to one of the most pressing policy issues of our time, in my view, and that is the state of affairs with respect to food and nutrition policy.
Now, if you're not following along, let me just give you, get you up to speed. I wanna just give you a few numbers. The first number is $187 billion. $187 billion. That is the number that is had been taken out cut from the federal government in H.R.1 from the Supplemental Nutrition Assistance Program known as SNAP.
A few other numbers to know about that is 50, 25 and 75. Well, what does that mean? H.R.1 also reduces the federal share of SNAP administrative costs from 50% to 25%, and that means that states will be required to cover 75% of the administrative costs starting in fiscal year 2027. That is a big shift to be sure.
Now, if you're hearing about SNAP cost shifts, these are the numbers to pay attention to because, as you'll hear from my second guest, Gina Plata-Nino, Director of SNAP for Food Research and Action Center, these shifts will not, could, will increase hunger, strain state budgets, and deepen economic risks.
I've had several conversations about this very thing this week. So again, I'm just really grateful that you're here and paying attention, and that whatever you learned today that you might be able to share with those in your circle as well. As I said, these are not light subjects, but we are gonna do all we can to enlighten you. So, on these policies and the rural impact, that's what we're here to do.
So again, as I always say, I invite you to sit back and tune out that background noise. We know it's gonna be there waiting for you when your short time with me is over, and hear my conversations with Larry Levitt and Gina Plata- Nino, are you ready? I know I am. So, let's go.
Michelle Rathman: Hey, Larry Levitt, Executive Vice President for Health Policy at KFF. Welcome back to the Rural Impact. I mean it when I say it. I really do. We are grateful to have you join us again because a topic of health policy in America remains one of the most pressing issues of our time. Maybe some would not agree, but I think you do.
Larry Levitt: I do, and thanks for having me back.
Michelle Rathman: It is our pleasure. Okay, so Larry, as folks know who listen to this podcast, we are, we've launched a series in 26 that we are calling "Tracking Transformation," and that's all about the Rural Health Transformation Fund.
That's not what this conversation is about, but it's an adjacent conversation because on January 15th, just a few days ago, President Trump announced his, and quote, "Great Healthcare Plan." And if people have seen me write, just because we do put the word great in front of something doesn't magically make it so. And it's really what he says, in this quote, "broad healthcare initiative that will slash prescription drug prices, reduce insurance premiums, hold big insurance companies accountable and maximize price transparency here in the American healthcare system again.ā€¯ Well, this sounds really great. The one-pager I saw on it, is very short on details as they say. So maybe you, 'cause you are so in the know, maybe you can give us your analysis. Let's go, go down the list of the things that this promises to do.
Lower drug prices, lower insurance premiums, which includes the possibility of sending people money directly to those who are eligible. So, what can you share with us? What do you know?
Larry Levitt: Yeah. So, as you said, it's a one pager, a one-page plan. The more detailed version of it is two pages. So, you know, President Trump talked during the, the campaign in 2024 about having concepts of a healthcare plan. This, this is kind of the concept. This is not a, a detailed plan, by any means.
And, you know, going through some of the provisions and, and frankly a lot of this is, are things that President Trump has talked about before, at least in, in, in concept. There's not much new here. You know, in drug prices, I mean, you have to give President Trump credit for talking a lot about bringing drug prices down.
He did that in his first term. He's done that in his second term as, as well. There's been, you know, he's had very strong rhetoric, going after drug companies. When you look at what he is actually done, it's not clear how much of a difference it will really make for, affordability for patients.
So, you know, for example, he is talked about, accelerating the move to over-the-counter drugs. And, you know, that can make drugs more accessible for people. But perversely, it could actually cause people to pay more for their drugs because insurance generally doesn't pay for over-the-counter drugs.
So you might go from paying, you know. A $5, $10, 15, $20 copay to having to pay the full cost of the drugs isn't paying for it.
Michelle Rathman: Yeah, I'm really glad you brought that up because this is something I actually wanted to talk to you about as well. You know, we had to, we frame everything on this podcast in the context of rural, and when I think about all the rural places I've traveled over the last almost 30 years. The absence of pharmacies and drugstores, CVSs, for example, Walgreens, and so forth.
And I would imagine that for rural, we're talking about a completely different level of costs involved because of being able to keep inventory and so forth. Though these are the details that are important for us to not deal with later, but manage before something like this happens. And it ends up boxing people in rural communities out of their prescription drugs.
Larry Levitt: Yeah, certainly. And you know, I mean there are certainly real problems with access to drugs, and it's not even just rural areas anymore. I mean, we've seen these pharmacies close in urban areas as well. I mean, it's happening in my very urban community of Oakland, California, where, you know, many of the pharmacies have been closing. So, the access is a real issue, but the affordability is certainly an issue as well.
Now the other thing Trump has talked about is, creating Trump Rx, you know, an online drugstore for people. And again, for some people that could, produce more affordability. You know, if, uh, drug companies are offering prices on Trump RX that are comparable to what other countries pay. And you know, prices in other countries are roughly half or a third, of what we pay. That could be great.
But Trump RX would only be for cash-paying patients, not for people with insurance. Fortunately, most of us have insurance, so again, going from having your insurance cover the drug and paying a copay to having to pay the full cost on Trump RX, let's say, that's not gonna do you much good. And, a lot of this has been happening with these, uh, deals, President Trump has been making with, with individual drug companies. You know, that's not the same as passing a law.
It's not the same as a government regulation, of prices. We don't know what's in these deals. They're not public. We don't know how much drug companies will actually follow through on them. The drug companies are coming to the table and making these deals.
Michelle Rathman: Voluntarily.
Larry Levitt: Voluntarily, right? To avoid the threat of tariffs.
If those, that threat of tariffs is no longer there, will the drug companies really follow through on these deals? And when you look at the fine print of at least what we know about these deals, a lot of them revolve around, providing lower prices, supposedly lower prices to Medicaid. You know, providing prices to Medicaid programs that are comparable to what other countries pay.
In fact, Medicaid pays the lowest price of anyone now in this country for drugs because there are, uh, legal rebates that drug companies have to provide to Medicaid programs. So not even clear those, you know, those deals will, result in lower prices for Medicaid programs.
Michelle Rathman: Yeah, I, it brings it in my head. I am thinking nobody's gonna get away with this without wanting to make a profit. And transparency is not exactly the word that I would use about. As you say me, we don't know cer a lot of things at this point. You know, you bring up about bringing, you know, prices down in affordability, and of course, affordability is the buzzword of the year.
Of course you, you wrote a piece that appeared in JAMA Forum titled with the Question, really "How Unaffordable is healthcare?" And since we're talking, as I said, a lot about affordability, kind of walk us through that article because it's subjective, I guess. What does affordability mean to me versus somebody who is living in a different, uh, income bracket?
So talk a little bit about that, if you will.
Larry Levitt: Yeah, and you know, I think this really, arose out of the debate over extending the enhanced ACA premium subsidies, you know, those subsidies expired at the end of 2025. There are ongoing negotiations in Congress about extending them and doing it retroactively. Those negotiations I say, are hanging by a thread at this point.
They're very unlikely to amount to anything. President Trump's great healthcare plan, did not include anything about extending these ACA subsidies, and in fact proposed converting them to just giving cash directly to people, and letting them buy, you know, the implication is they could buy unregulated insurance.
That might be great for people who are currently healthy, for people with health conditions, or people who live in very expensive areas like rural communities. Those direct payments may not, may not go far and may not make coverage truly, or healthcare truly, affordable.
But when you, when you kind of pull back and, and you, you think about, affordability, you know, you can think about it on, on many levels. You could think about it as what we as a country spend on healthcare. We spend almost double, the average of what other high-income countries spend over $13,000 a year, now per person, approaching a fifth of the economy, we spent on healthcare.
But you know that, that, that's very kind of theoretical and intangible for people. What people really care about is what they themselves are spending, you know, what's being taken out of their paychecks. For health insurance, which, you know, for a family now averages almost $7,000 a year. That, that feels like a lot to people. But amazingly, that's not even the whole premium.
You have people who have employer-based insurance. The employer is paying most of it. And, the premium per family now averages $27,000 a year. Which is, I mean like the cost of buying a new car
Michelle Rathman: And high-deductible plans. I literally just had a conversation this morning. I won't disclose with who ER visit with their son. You know, we're talking 10 grand right off, right off the bat, and that still doesn't meet the family's deductible requirements for the year. So, affordability, again, quite subjective.
Larry Levitt: I mean, when you're, you know, when you're, and there's been this push to high-deductible plans, you know, having people have more, more skin in the game. I think people have a lot of skin in the game now. And, you know, for, particularly for low- and modest-income families, if you're talking about a deductible of $10,000, that's gonna feel like not having insurance at all.
Michelle Rathman: And you know, Larry, I was looking for this on the KFF website. I haven't found it yet. Maybe, you know, but I was thinking about, again, in, from a rural perspective, employer-based plans are not prevalent, as prevalent as they are in other areas. And so we take a look at so many people in rural, you know, gig workers, self-employed folks, farmers, and so forth.
It's a very different landscape for them. Is it not?
Larry Levitt: Absolutely. And that, you know, that gets back to the Affordable Care Act, or Obamacare. Which, you know, in many ways has been a lifeline, for people in rural communities. I mean, over a quarter of farmers and ranchers get their coverage, through the ACA marketplaces. And that's why those enhanced premium tax credits were, were such a big issue.
You know, without those enhanced, tax credits or premium subsidies, the premiums that people pay out of their own pockets are gonna, more than double, and, or, or increase by over a thousand dollars a year per person.
Michelle Rathman: Yeah. Oh my goodness. All right, so in another article you wrote, you're very busy writing, but this was back in June of 2025. Still incredibly relevant. You started out by pointing that, well, MAHA is a worthy goal and it's make America healthy again and make rural America healthy. People hear me say, I wonder when the again is because rural has been identified as older, sicker, and poorer for as many decades as I've been doing this work.
But it is an important goal for us to be focusing on. And, you know, it seems nearly impossible to consider that we're gonna be healthier considering our current circumstances related to cuts in federal healthcare spending. Almost a trillion dollars, over the next 10 years or so. Which was an H.R.1 and the ACA premium tax credits, as you just mentioned, which has, as this conversation is dropping, has not been extended.
So what are your thoughts about how realistic it is from this plan, this, great America Health plan and all of this other stuff going on from a legislative perspective? How do we achieve healthier with all these uncertainties swirling around us? Any ideas?
Larry Levitt: Yeah, I mean, you know, there, there's a lot in the, the MAHA agenda that, you know, I think would be broadly supported by people across the political spectrum and, and across the country. I mean, we do have higher rates of chronic disease, than the rest of the world. We don't always eat healthy, you know, we don't always exercise as much as we should.
You know, getting additives out of foods we eat. I mean, I think there's broad support for those ideas, and they would make us healthier. The challenge is that that's coming along with, massive cuts in federal health spending, you know, a trillion dollars in cuts, from the so-called One Big Beautiful Bill Act, uh, last year, which is expected to lead to 10 million more people without health insurance.
The expiration of the enhanced ACA premium subsidies, which we're expected to lead to another 4 million people without health insurance and, and higher costs. So, you know, on the one hand we're promoting health, through the MAHA agenda, but on the other hand, we're making healthcare, more expensive and harder to access.
And that's certainly not gonna, not gonna make us healthier.
Michelle Rathman: Yeah. And on top of that, we, we also look at the other side of hospital closures. I just read something yesterday, a double-digit number of Pennsylvania hospitals, on the verge of closing. Another piece yesterday about Colorado and Kansas hospitals. So, it makes it really rough when you think about the fact that these rural hospitals, they typically own the clinics, not all of them, but when a hospital goes, the clinic goes, the doctors don't come. And it just, again, the domino effect that we're seeing.
Okay, I'm gonna go here because in this ongoing series, as I said, we're tracking the RHTP, this $50 billion taxpayer, fund that is supposed to be you know, allocated for transforming, rural health.
The rural health landscape looks quite different than it does in metro places. We all know that. So, let's talk for a few minutes about how some of the, some of the early concerns people are having about not having the details as of yet. So, and I think there's a considerable amount of us out here who are, we've got our fingers crossed, but as they say, hope is not a strategy.
Larry Levitt: Yeah. And, this, you know, this is a $50 billion fund, which I thinkin isolation would be very welcome in rural communities and, and rural health systems. You know, it's $50 billion over five years. We've seen some of the details of the initial $10 billion allocations.
And, you know, they vary somewhat by, by state. You know, for example, from a low of $147 million in New Jersey to a high of, $281million dollars in, in Texas. But when you, you dig down and you look at, okay, how much, how much of this money, how much does this money represent per rural resident?
And there the range is just enormous. I mean, so for example, in Texas, it's only $66 per rural resident. I mean, Texas is a big state, with a lot of people living in rural areas. And this money is not being targeted, to the amount of, number of people who, who live in rural areas in the state.
And you know, when you line this $50 billion, temporary, $50 billion rural, uh, transformation fund up against the trillion dollars in cuts, over the next 10 years, which, which are permanent. And you look specifically at rural areas that that trillion dollars in cuts translates into $137 billion in cuts.
You know, this money won't even cover the cuts, you know, so it's important, an important infusion of money. It will help with workforce issues. It'll help with, improving technology, telehealth, interoperability of, of electronic, health records.
You know, some of it is tied to MAHA goals, like physical fitness tests. You know, limiting what people can use, SNAP, you know, what kind of foods they, they can, they can buy. You know, this money will do good, but it's, it's coming at a time when there are huge cuts that will, will also threaten, rural health systems.
Michelle Rathman: I think we forsake the fact that, you know, fitness. Let's just talk about that for a moment. You know, I think about how many rural school districts have lost their funding for just PE programs and so forth. And so I think about the, an investment that's kind of being put into a, a dark hole because if the support services are not there to actually implement in the administrative costs and so forth. My fear is that we're gonna see a lot of this money go to administrative costs, startup costs. And as one of our previous, guests said new toys that really, you know, they go into the drawer with all the other electronics that you no longer can use anymore.
And I hope that is not the case. Plus, I think we also have to take a look at so much of what's in this healthcare plan. You know, it's gonna require Congress to come together and, and actually make some things happen. And I don't know if you guys are paying attention, but it's really hard to get bipartisan support for many things around healthcare these days.
Larry Levitt: It is, I mean, we've seen, you know, like glimmers of bipartisan cooperation on, you know, some, some recent, recent health funding legislation, you know, regulation of pharmacy benefit managers. But, yes, it is very hard to get Congress, together on, on anything these days.
Michelle Rathman: Yeah. Well, speaking of that, before we let you go, I'm just wondering if you have any insights into the, 2026 Labor Health and Human Services Funding Bill that just came out I this week, from the house, and now it moves as if I, remember it right onto the Senate. So, any insight where you think that's gonna go from here?
Considering again, everything that's happening.
Larry Levitt: Yeah, it's, you know, I think there, there, there are certainly concerns about what the Trump Administration will do with this funding. We've seen them, you know, rescind funding, you know, eliminate USAID, you know, massive layoffs across HHS. But, you know, I think when, when Congress is, is coming together and making these funding decisions, they are rejecting, you know, many of the cuts that, that, that, that the Trump Administration has proposed. So, you know, this looks a little bit more like a normal, budget than, what we've been seeing over the last 12 months.
Michelle Rathman: Normal is welcomed at this point in time. Oh my gosh. Listen, Larry, you are welcome to come back and join us anytime. Any information that you have to update us, we'll be following your work. And for folks to know where to follow you, tell us real quick where they can find you.
Larry Levitt: Yeah, no, you can find, all of our information on kff.org. It's freely available, and, you know, just, consistent with our goal of trying to inform these, big healthcare discussions.
Michelle Rathman: Yep. And it's on my reading list every single morning, so I'll make sure that we put those links on our website. So, thank you, Larry, for joining us, and for the rest of you do not go anywhere because this conversation is certainly not over. We'll be right back.
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Michelle Rathman: Hey, we are back, and as promised, we are gonna shift gears to a new subject that is very much connected to health and as it happens very much closely tied to rural economies and so much more. And that topic is on agriculture, but specifically nutrition, food supply, and the Supplemental Nutrition Assistance Program, or as we all know it, as SNAP.
Now for this conversation, who better to join us? I can think of nobody better than Food Research and Action Center, SNAP Director Gina Plata-Nino, who as it happens, previously served as a Senior Policy Advisor for Nutrition and Agriculture and the Biden-Harris Administration's Domestic Policy Council. She did help to lead the national strategy on hunger, nutrition, and health.
Gina, I mean it when I say it is really great to have you back. I know you are super busy back-to-back with meetings. Welcome back to The Rural Impact. We need to hear from you today.
Gina Plata-Nino: Thank you for having me.
Michelle Rathman: Oh, it's our pleasure. So, honestly, I do wish we were having a different conversation, but here we are talking about policy that will create hardship for millions of Americans across this country.
Millions of people in this country with rural, of course, never being spared on this front. Bracing for almost a double dose of pain is the way I am analyzing these policies. Real quickly, I just wanna mention to you that, to our listeners and to you in case you didn't see it yesterday. USA today published a piece by Christopher Bert and Kathleen Marrigan from Arizona State and it headlined and the headline says it all "2026 could see the end of the farm bill era of American agriculture policy."
And of course, it is the farm bill where nutrition, and this is my saying, this nutrition and food production policy, with the exception of a few programs out of HHS, that's where this all lives. They're saying that we might not even have a farm bill again. So, on January 16th, your organization's president, Crystal Fitzsimmons released a statement regarding the farm proposal by the Republican Senate Agriculture Committee in which its leaders fail to mitigate harm of SNAP caused on families, farmers, communities and states.
That's a lot. So, let's dive in and lay out for listeners the latest on this front. We are recording on the 20th of January. This is gonna drop next week. Just a few days before we could be seeing another shutdown, maybe not.
Gina Plata-Nino: I don't think we are going to, to see the, the shutdown. I don't think there's any appetite for either Republicans or Democrats to engage. What was disappointed was, you know, once again, there is this false narrative that who benefits from, from this aid, right? And, who sort of should take priority?
SNAP is an economic generator, right? The people who grow the food, there are the people who purchase it, right? It goes directly tied to our local economies. And the bill, unfortunately, by the Republicans included no sort of elevation for the working families.
You know, food may be growing in rural areas, but it's not access there because it is being sent out to other areas where people have to travel many distances to access this food. So once again, we see this, unfortunately, this, idea that people who should receive certain benefits and others don't.
Michelle Rathman: And, so much that was included in H.R.1. I mean the, harms really because of so, so many factors, work requirements being one of them and, and so many other things. But I wanna talk specifically 'cause we did have some folks on from, Farm Aid, and they were talking about the impact of these policies on small and family farms, but your, your organization discusses projections of about $24 billion over the next decade in terms of a negative impact on farmers.
Can you expand on that? Why, why is that so?
Gina Plata-Nino: Because we know how much the benefit amount is. We know how much people consume it based on USDA data. So, it means less people are going to be able to purchase that food because they have less resources to do so. And we forget the original parts of the SNAP program was farmers had extra food, someone needed to purchase it, and the federal government said, "oh, people are going hungry. This is a perfect marriage. Let's make sure that people are asking the, the extra food that individuals have."
And it has had different reiterations over the years, but there's always been this understanding that the Farm Bill, that the farm community, it's interrelated because many of the people, we have different, right? We have our very large farmers. We have a small sort of farmers who feed their community directly, and many of them at one point or another, may have benefited from the program because farming is a volatile, it's a volatile job, right? You're look at if it's snows, if it's too cold, there goes your produce.
So, it's, they understand, and they understand how important it is for them to feed the community, and there's a pride that goes around that. So yes, we are seeing that not only the direct cuts that we see to SNAP, but there are the intentional, unintentional cuts, um, that we could say that will happen, which is like farmers will lose about $24 billion.
Michelle Rathman: Yeah. And, with so many other pressures that they're facing as well. I mean, how do you keep your head above water? I don't see how that happens. So, let's talk a little bit about the cost shift to states and you guys talk a lot about the decisions that they will be forced to make, and that really is the right word to use.
I think, and I wrote about this this morning. Someone told me, you know, listen, I don't really pay attention to health policy. And I thought to myself, how do you not pay attention? Well, I look at food policy. How are we not paying attention to the fact that states are not gonna be able to just automatically carry this extra weight and then expect there to be equity in the distribution of how these funds that make it to families, ultimately to their grocery stores and their tables.
So, let's talk about the cost shifts. What kind of break it down. What are some of the costs that will actually shift over? It's not, you know, it's not just one thing, it's many things.
Gina Plata-Nino: It is. So, there's various provisions in H.R.1 that are happening that are causing the state agencies, to having to need more capacity, right? To be able to administer all of these changes. When we talk about capacity, we really mean money and funds that the state needs to be able to provide for the state agency to make sure that the program is running accurately.
So, we're seeing two cost shifts beginning next fiscal year, the federal government will only cover 25% of those administrative costs. That means that your state is going to have to provide another 25% in order for the program to continue. At a time where the state agencies are being asked to do more with less.
And then beginning FY 28, the state for the first time in history is gonna have to pay a benefit, a partial benefit amount of, benefit cost. And it's significant because, you know, we might, we talk about rural areas, we talk about states, but SNAP has never been a line item budget. Because it's been fully covered.
Majority of, state's budgets goes to healthcare followed by K-12 education. So even individuals who say, well, I don't follow healthcare. I don't follow this, but maybe I have children, and all of a sudden my town couldn't hire that teacher. That's because of the federal disinvestment that's trickling down.
We, you know, why are our taxes rising? Why are our property taxes rising? Because you need to increase, even for some states who may say, well, I may not be responsible for those cost shares. Some of those states are in, many of states are experiencing at the brink of a recession. There is no new investment coming in.
So all of that trickles down. A dear friend of mine says that when states catch a cold, municipalities catch pneumonia.
Michelle Rathman: That is so true.
Gina Plata-Nino: So you're gonna be seeing at a local level where people are like, okay, how are we going to continue to be able to provide this? Because if states can't do it, and the congressional budget offices says this, that many states are gonna make it more difficult for people to access or pull out of the program entirely, that means that the millions or billions of dollars of SNAP benefits that were coming into your community, because that's the way it works, right?
Federal government gives it, individuals, put it in a card, it goes straight to that grocery store. That grocery store operates on a very small margin, particularly in rural areas. It may be the only ones, and when 50% of your customer are SNAP recipients, and they can no longer utilize that, that means that this grocery store owners small business can no longer pay the rent or pay their mortgage so they will close.
When they close, that means less income tax income, federal, and both taxes, and then less people that you are hiring. So, it's just such a negative cycle.
Michelle Rathman: Gina, what you've just done so brilliantly is do exactly what we intend to do, which is to connect the dots. If only it were just this, but the magnitude, the ripple effect of what happens as a result. And these are, these are going to cause long-term pain for what gain? And, we don't have to go into kind of what I'm thinking what I'm looking at in terms of the budget that was just, we were talking about earlier, you know, the markup from the house about what the FY 26 budget looks like.
But at the end of the day, I also want folks to recognize that food is medicine. We are talking about and we're gonna talk about before we, before I let you go, we're definitely gonna talk about that.
But, you know, scaling back of the funding, for the actual food to table. But we are also talking about the scaling back of funding policy that scales back funding for technical assistance. We talked earlier or late last year about kind of the reorganization of USDA field offices and so forth.
Where do you see see the impact on the ground of scaling back technical assistance and maybe talk about it that's the relationship to SNAP.
Gina Plata-Nino: Everywhere. Right? You know, the US Department of Agriculture has technical assistance for rural programs, for SNAP program, for the state agencies who are trying to implement this program. And then the state agencies are being penalized if they don't do their job correctly. But the way I describe it to people is like, you're asking your boss for guidance so that you can do your job, but your boss doesn't respond.
Right? Like USDA has laid off under DOGE people with institutional knowledge that they could have helped these individuals navigate. They haven't provided the necessary guidance, and when they do provide it, it's inconsistent. Right, like last month in November, they issue December, I apologize.
They issue three different sets of guidance that they had to update. And so you're like, but if they do it incorrectly, they are the ones who are going to be res, you know, responsible for this. And I, and I think it's also like you talked about food as medicine. They defunded SNAP education, which taught people, you know, nutrition, how to help.
So, it's how do you talk about food as medicine? How do you talk about accessing individuals when you're taking those resources? And at is core, we need to remember that hunger is the worst health outcome. We know all the negative impacts that it has on your body, on the economy, on, you know, a weak workforce.
Disciplinary issues in schools. We know it costs almost $180 billion a year for our economy. That's how expensive it is. But we also know what the solution is.
Michelle Rathman: Yeah, we do know what the solution is, and it confounds me that this is so hard. Alright, so now we talk about eroded benefits. And I think, and I really love the way that you all have laid it out, because you know what we really need to take a look at is what's being taken away? The why, I am challenged to, to talk about, but I have some understanding why.
But the impact it will have on access, like for example, on the internet expense is no longer a factor in calculations. And why this is important because we're pushing in the, rural health transformation program, we're pushing technology, and the use of, you know, technology, but then you have this, so I feel like we we're, on one hand we're holding it up. On the other hand, we're just punching ourselves on the side of the head because it doesn't make sense.
They don't comport the two.
Gina Plata-Nino: No, and especially for rural areas where broadband is even more expensive. Where you rely on it more because you things are so further apart, right? Automation has terminated a lot of the jobs that are available. Computers are not a privilege, they're a necessity, but for many individuals it does become a high expense, and where depending on your zip code, it's either more accessible or not reliable.
This has a negative impact where we've recognized that internet broadband is like another significant mandatory utility in order for children to be able to go to school, to access healthcare, for me to go to my job, and in rural areas, there is not enough access. And so to say like, nope, you can't cut this as a deduction.
It means that you won't be able to show a significant, you know, an adequate SNAP benefit.
Michelle Rathman: Yeah, absolutely. And I think about, I'm looking at a line item here right now in this budget, which allocates, $15 million for maternal produce prescriptions for an example. But if you don't have the grocery stores in rural communities that have the produce, oh my gosh. It's just, it's so complex and sticky.
At the end of the day, Gina, I think it's important for us to lay out who pays the price, from these policies, the positions that they're taking, and not funding the programs and putting up all sorts of roadblocks if you ask me on accessing the programs in terms of individuals and communities. You did talk a bit about how counties will pay, and we are gonna be talking to county officials over the next several months about the impact on their budgets from cuts all over the place.
But lay out a little bit about, you know, what you're seeing in your predictions and the models that you have put out about who will pay the price and what exactly will that look like.
Gina Plata-Nino: Yeah. Anyone who's not a billionaire or a corporation will pay the price.
Michelle Rathman: So, raise your hand, right?
Gina Plata-Nino: No, I say that because there's like, you know, this was the, the bill was like the biggest transfer of wealth to the top 20%. You know, majority of Americans, we are not in that. And nowhere do you see that more than in rural areas, right?
Federal disinvestment, low jobs, lack of childcare. There are many issues within rural areas that need to be taken into account. Closing of healthcare systems is another, right? A closing of grocery stores. So who's gonna pay the price, right? The grocery stores who are closing, meaning that individuals are now going to have to travel further distances to access food. Whether or not you're on SNAP.
Which means that your food is going to cost a lot more money because now you're traveling further distances. That's one thing. Counties, we have 10 states that our county operated. Some of 'em have, are responsible for a hundred percent of those administrative costs. I mentioned that they now beginning FY 27 have to pay 75%.
Where is that money coming from? Most states no longer have a rainy fund. Rainy funds are like an emergency happens, but it's not ongoing. It's not sustainable. Many of states, ended on with a deficit of millions of dollars. Where would this money come from? And that's why I mentioned taxes. So whether or not you know you're impacted by the healthcare costs or the SNAP cost of what happened with education, well, your bills may rise in terms of why my property taxes higher.
And again, in rural areas there's more distance between land, there's less property. So that means that fewer are gonna have to be responsible for a large pocket of costs than they are in more areas where there's more organization. So, all of us as Americans will face the rise, the price because of the generational disinvestment, right?
Children who won't have access to food. We saw during the shutdown, for example, in Oklahoma, people who didn't get their SNAP benefits on time, there was a higher increase of evictions, right? We're gonna see a higher raise of unhoused individuals because people, when 80 to 90% of your income is going to shelter, you have very little left when emergencies come up.
And so we're going to see more of increase in poverty, which affects us all as as a nation because cities and states could have invested this money into better childcare, and to more education, and to better roads, and to better transportation. But now states have to step in for federal disinvestment and they don't have those resources.
Michelle Rathman: You know, if I could just say to our listeners,I have a closing question for you, but first I just wanna say, now would be a really important time for you to be paying attention what's happening at your state level and at your county level? Because Gina, I agree with you.
I do work, for example, with hospital districts and ambulance districts and you know, they really hesitate to go to their communities to have a levy increase to cover things that you know that they need to cover. And most rural communities do not have the biggest appetite for seeing a property tax increase or a special purpose tax. At the end of the day somewhere, somehow this has got to be paid for if we're ready to make sure that our communities are fully resourced and that no one, no child goes hungry, as they say, and that we work at addressing this to the point where we can sustain it versus, to your point, reaching into the emergency funds to try and, you know put out a raging inferno, when, when we should be managing the fire. Okay?
So, the last topic I wanna talk to you about. You know, there's a lot of talk about make rural America healthy again, make America healthy again. And I've said before, I'm not sure what the, again, what we're referring to, what I look at as the present and the future and how policy has the power to influence whether we lift people up, communities up, provide them with what they need, or conversely what happens on the other side, which is what we've been talking about.
Rather than ask you how these policies are going to hurt health. Let's talk about what would help. Let's talk about what would help make rural America healthier in terms of access to food and from there may be some things that we need to be talking to our legislators about to make that happen.
Gina Plata-Nino: Let's start with access. I think that's the key word. The previous federal guidelines said it best in their introduction where it says, how can people access a healthy diet? They need to be able to afford and purchase it where they live, where they work, and where they gather.
We do know the majority of places are not benefiting from that. They are very limited places where people can be able to purchase food, fresh produce, food that they need for their families. When you have to travel 30, 40, 50 miles. You only purchase once because can you really afford the gas? And many people don't have their own transportation. They have to pay someone to get them.
And I know I hear a lot of people say, well, there's online places that charges a lot of money. And in some rural areas it doesn't cover it. It's just not significant for individuals to be able to benefit from that. There's an entitlement, mentality in terms of how people access food without really realizing what can we do.
We need to make sure that there are no SNAP cuts, right? How can you say we wanna make people healthier? Again, if people don't have the resources to be able to purchase their food, they have to make really difficult choices. And what type of items to buy?
Healthcare needs to be supported? Transportation. More funding for more stores to, go into places. Those are the things that we need. We need more funding and we also need grocery prices to decrease. The fact that many of the items, whether it be meat, whether it be fresh produce, particularly with liberation tariffs and so on, food is expensive. And you know, we always say that SNAP is about $6 a day. We can't really say that anymore because food is really expensive and those $6 don't go far enough.
Michelle Rathman: I'm so tired of hearing the word affordability. 'cause affordability is subjective. It depends on how much money you have in your wallet, so to speak. And so I'm gonna just encourage folks, you go into a rural community, there's a lot where there's a lot of tourism, and I want you to go into the local grocery store and note how much a jar of peanut butter, a small jar of peanut butter costs.
So, you know, again, we gotta make sure that policy is addressing everyday people where they meet them where they are. And I'm really glad that you talked about who is benefiting from this as well. The billionaires.
Oh my gosh, Gina, you are welcome to come back anytime. Any news you have for us on SNAP and where, where the interface with rural, I mean, of course, again, this is very near and dear and it should be to, to our hearts on this podcast in particular because SNAP policy is not just about feeding people. It's much bigger than that, although that is at the heart of the matter, as they say.
Gina, real quick, where can people find you and where can they read about your advocacy efforts so that they can get on board and do some effective advocating for better SNAP policy?
Gina Plata-Nino: Yes, they can go to frac.org. And Michelle, you know, I just just wanna say that it's important to say that this is an issue for everyone, regardless of what side of the aisle you're in, regardless of your income guidelines, regardless of where you are, it impacts all of us. We, as a community, rise together, right?
We all rise when there is investment into our communities. So, people can go to frac.org. And there you can find all of the research that we have, but also how you can engage with your state legislators or your federal legislators so they can hear loud and clear that if you care about rural communities.
You have to care about healthcare. You have to care about SNAP so that people can have the access and the resources so they can live healthier and more meaningful lives.
Michelle Rathman: Absolutely. Well said. Well said. Oh my gosh. Well, even though we have to say goodbye to Gina, just stay with us for a few more minutes 'cause I'll be back with some closing thoughts here on the Rural Impact. We'll be right back.
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My sincere thanks to Larry Levitt and Gina Plata-Nino for their insight and to all of you, again, I'm so grateful that you've joined us for another dot-connecting conversation. A quick reminder, our merch is now available on our website, so head on over to theruralimpact.com.
We cannot wait to hear your feedback when you see what we have in store for you. And while you're on the website, go ahead and hit that subscribe button because that way you'll get our e- newsletters when they come out to you from time to time. And again, I always invite you to subscribe wherever you'd like to get your podcast. And please leave us your comments and send us notes and let us know the kinds of policy issues you would like for us to cover here again on The Rural Impact.
To Sarah Garvin and Brea Corsaro for all the behind the scenes support. I thank you, and until next time, I'm gonna invite you once again to please take really good care of yourself and to the best of your ability, all those around you. We'll see you again soon on a new episode of The Rural Impact.
