Pandemic Impacts on Mental, Physical and Educational Outcomes for American Children: Session Four

SPEAKER 1: Thank you.

DIANE CHANZENBACH: Thanks go to Kristen, who I guess has left, but also to the Fed for sponsoring this. This is a really important

Conversation to be having because it affects our economic growth both today and potentially for the next 100 years, more or less. So, thanks. I'm going to talk about suffering, and the safety net, and disparities during COVID 19. It's joint work with Hilary Hoynes and Marianne Bitler.

So just to set the stage, we have a patchwork of safety net programs in the United States. And those are aimed at different people. So job losers get unemployment insurance. Low income families sometimes are eligible for Supplemental Nutrition Assistance Program. Families with children might be eligible for WIC or the child tax credit. Or if you're low income and have children, different pieces.

So it's a complex system that needs to be navigated by folks. And what we want to do in this is try to understand how changes to that safety net during the pandemic impacted different groups. And so I'll show you that we made substantial changes and expansions to these programs during COVID.

So first, I'll show you how much money went out across the different programs. Then I'll show you what the impact was on child poverty. And then I'll show you what's the differential impacts of this additional spending on poverty reduction across race and ethnicity groups for children.

And then we'll think a little bit about, what can we learn in good times? So what happened when the expansions ended? And then, how can we use these lessons to try to improve the functioning of the social safety net? All right.

So to start, I am going to show you the amount of new money that we pushed out during COVID. This is the four big programs, the economic impact payments-- which you'll just think of as the stimulus payments-- unemployment insurance, SNAP, and the child tax credit. You can see this is total spending for every month from April 2020 through December 2021.

So we'll start-- it's color coded. The colors are going to stay the same across time. So the economic impact payments-- it's the one-time and sporadic cash payments. In April 2020, we sent out a lot of money, $1,200 per adult, $500 per child, and then later, passed in December but paid out in January, another $600 per person, and in March, another $1,400 per person. It didn't all go out in the exact same month because some of it was done through the tax system. And some of it, you had to file for it.

But you can see the green bars are driving a lot of the spending. They're very tall and sporadic. Later on, I'm going to show you-- I'm only able to disaggregate poverty impacts by race and ethnicity for the year 2020, so far. I am able to do more. I just haven't done more. And so I just want to highlight that this is only one set of EIPs and some other programs.

So blue here is unemployment insurance. And so this is a weekly amount of cash benefit that goes to people who've lost their jobs. And we did a lot to change the unemployment insurance system during the pandemic to plug known holes in the social safety net in this stage. So, for example, we expanded eligibility, making for the first time people like Uber drivers and other types of things eligible for unemployment insurance.

We also increased the level of benefits topped up first by $600 additional per week and then $300, and then also extended the duration of time for which you're eligible. So you can see that's the second biggest amount of money that went out every month behind the economic impact payments.

Then here in orange is SNAP benefits. We really dramatically increased SNAP payments. Those are monthly food benefits. We saw that participation in SNAP increased. Everyone became eligible for the maximum benefit instead of having your benefit level decline as your income goes up. And then eventually, in March and April 2021, they changed the pandemic benefits to give everybody at least an extra $95 per month in SNAP benefits.

And you can see, while this is the most targeted of the four programs in terms of targeting to low-income families, it's also the smallest amount of money that we spent, in the orange. And then finally, you might remember the six months where we had a fully-refundable child tax credit. Those were monthly cash payments for children 17 or younger. They were $250 a month. For children age five or younger, they were higher, both reflecting the increased vulnerability of young children to economic deprivation.

And then also the fact that their parents tend to be younger and at a different part of their age earnings profile. So there are lots of reasons why we think it's as evidence-based as anything could be during a pandemic, to put more money in the pockets of families with low income, with young children.

So I'm going to add all this up. So that was monthly spending. Now this shows it cumulatively. And what you can see is the COVID response. This is the response that we had on the right-- was a lot more than what we spent after the Great Recession, which is there on the left now. And the colors are the same.

You can see we did some cash payments-- stimulus dollars during the Great Recession. But we're nowhere near the amount of money that we pushed out through that green bar during COVID. Same with the blue bars, are much larger here in COVID.

Now, real macro economists would grouse a little bit at this and remind us that we didn't just do direct spending during the Great Recession. We also reduced payroll tax collections on purpose. So that would push this up a little bit more. But let me assure you that still we spent a lot more money during the COVID aftermath than we did during the Great Recession. And of course, it took us a decade to regain the lost jobs after the Great Recession. And that was a lot quicker during the COVID recession.

So I'll go through some figures today. We've spent a lot of money on relief programs. Only some of that went to people who either were low income or lost their jobs. And we want to ask ourselves, what were the impacts of these various programs? How do they differ? Those impacts differ by race and ethnicity.

How do they differ for kids? And I'm going to really focus in on kids. But there is a whole paper behind this where I'm going to skip a lot of what's in that paper. But I'm just going to give you a little bit of a teaser in case you are interested in that.

So today I'll talk about the general impacts of relief payments. I've already described that we have this patchwork of programs. And I can do a deep dive into calendar year 2020, where I can measure by race and ethnicity. But the problem with this analysis is that there is substantial known measurement error. We think we under report these benefit programs and the source of data that you can use. And we don't really know by how much we're under reporting it. So that's not great.

So in order to complement this, we were able to also do a deep dive into the Supplemental Nutrition Assistance Program, what used to be known as food stamps, where we have very detailed administrative data. But in my experience, audiences that aren't me and my two co-authors are much more bored by those results. And so I'm going to stick to the stuff with the known measurement error, and happy to talk SNAP with anybody who would be willing to talk with me any time.

All right. So let's talk about impacts on poverty rate. And this is, of course, the poverty rate that uses the Supplemental Poverty Measure approach to this. For those of you who are not in the know about that, our official poverty measure ignores the impacts of a lot of our social safety net spending like SNAP and other programs like the Earned Income Tax Credit, whereas the Supplemental Poverty Measure accounts for these.

So just to set the stage prior to the pandemic in 2019, 12.4% of children lived in poverty, according to this measure. And then, generally, Black and Hispanic children are more likely to live in poverty. About 1 in 5 were living in poverty, about 7% of white children, and almost 10% of Asian children. So that's prior to the pandemic.

And so then usually when there's a recession, poverty rates go up. But because we pushed out so much in terms of benefits, in this case, poverty rates went down. So let me orient you to this. The blue numbers are what the poverty rates were in the year 2020.

And the orange shows how much of a decline it was, relative to the previous year. And so you can see overall that child poverty dropped by about 3 percentage points, dropped by more, 5 and 1/2 percentage points among Hispanic families with children, et cetera.

So we see, generally, that there were larger declines in terms of percentage points for, well, children, which I pulled out the adults because we are not interested in them today, but also for Black, Hispanic, and Asian children.

So then, here we go from 2020 to 2021. The difference in 2021 is we spent more in economic impact payments. Actually, we pushed out more money through SNAP and then also had that fully-refundable child tax credit.

During that period, we saw an all time low in child poverty down to 5.2%, lower than 3% among white children, were living in poverty. And these were just enormous declines, even relative to the strong declines we saw in the first year.

So that was great news until then, it ended in 2022. A lot of this was designed to be temporary. Some of it we had hoped would be permanent. But those relief payments ended, including that fully-refundable monthly child tax credit. And so we saw child poverty rates go back up. And again, the total height of the bar here is total poverty rate.

And then the orange shows you how much increased relative to the prior year. And so for Black and Hispanic-- actually all of these groups basically saw a doubling of child poverty after the payments ended. And so then this just traces all of that over time so that you can pick your favorite group and follow them.

Just pick the same color across time. And what you can see is by 2023, poverty rates had gone down. But then we're back to where they were in 2019, at or above those levels. This suggests to us that poverty is a policy choice that we make and that we have the tools to reduce it.

Of course, whether you think it's the right thing to do or whether we've targeted this efficiently, those are all completely legitimate questions. But we do know that we can pull some levers and see child poverty dramatically decline.

So we want to talk a little bit, think a little bit about which programs are doing the work here. And so what I have is, by how much did each policy reduce child poverty in 2021, which is that second year where we got to all time low in orange, and then that first year where we did the deep dive later, in blue.

And I just need to nerd out with you for a quick second. This is, if you turn each one on or off and leave everything else the same, so you can't add all of these on top of each other because you can only lift somebody out of poverty once.

And so you can see here that the economic impact payments, and the Earned Income Tax Credit and Child Tax Credit, which they bundled together in the analysis, did the lion's share of the anti-poverty work for families with children.

Unemployment insurance, it came in very strong, especially in that second year of the pandemic. To no one's surprise, the anti-poverty effect of unemployment insurance ebbs and flows as the economy gets weak or not.

And then, of course, I want to mention the Supplemental Nutrition Assistance Program, here combined with school lunch, reduces child poverty by about 2 percentage points. And then this is one of the places where I really want to lean on. And we know that is understated because of problems with the data.

When researchers do a careful dive into this, to try to correct for the measurement error, they find that the anti- poverty impact of SNAP is maybe twice that, or maybe a little bit larger. So we have to work with the data that we have, and especially when we're looking at real-time outcomes.

So I had mentioned that we only have this-- how do each policy impact poverty rates across race and ethnicity groups for 2020? We needed the microdata to do that. And the research assistant moved on. And so we have not yet done 2021.

But you can see the colors are the same as they were the whole time. So the top row is cash stimulus payments, then the EITC, unemployment insurance, and SNAP. And you can see across white children, Black children, and Hispanic children.

What's the decline that we saw in 2020, that first year, due to these policies? And what you can very clearly see is that the anti-poverty impact on Blacks and Hispanics, especially for the universal economic impact payments and the EITC.

This is not the second year when everyone got the child tax credit. We're quite large. And in fact, even the anti poverty effect of SNAP and unemployment insurance is stronger in families where Black and Hispanic children live.

So we've gone on this roller coaster of the decline, the unexpected decline in poverty, and then the rebounding of that. And at this point, it makes a lot of sense to think about, well, what have we learned? And how can we take what we learned during the pandemic to try to think more about how to make the safety net as effective as it can possibly be?

So I'll start by summarizing and then walk through a few more things. First, that the safety net can dramatically reduce child poverty. And second, that which levers we pull, which policies we choose or not choose will have different impacts on child poverty, both overall and by race and ethnicity. So it's important to understand that.

Some of the reason for that is because some of these programs are tied to work and some are not. And so that means that whether your family normally has workers or parents have lost jobs because of different sectoral hits that just correlate with racial and ethnic groups for various reasons, all of these come together to influence that.

Now, of course, as an economist who cares tremendously about policy making, we always need to be thinking about balancing, keeping a steady balance between the protection. We want to reduce child poverty. But we also know that there are real incentives built into these systems. And so if we could reduce child poverty, but every adult would leave the labor market, that's probably a trade that most of us wouldn't want to make.

Now, I don't think that that's what the magnitudes are. But we want to keep in mind that there's a balancing act we have to do there. There's also a balancing act that we have to think about between targeted programs and more universal programs. Targeted programs are often more expensive to administer in terms of just the administrative burden. But at the same time, because you're only giving money to some people, means the overall bottom line is a lot lower.

And then also, as we've seen over the last 30 or so years of social safety net policy, where we've shifted a lot of our anti-poverty policies into promoting and rewarding work, we need to make sure that we have a social safety net that continues to be responsive to when people lose their jobs, to cyclical down downturns. You don't want insurance that only pays off when your house is not on fire. You also want insurance that pays off when the house is on fire.

So to end, I want to talk a little bit about what we know about the social safety net here in Illinois, and maybe things that we can learn about other places. So just to start, this is really nice recent work from the Urban Institute. And it shows the share of Illinois families with children who are eligible for these various safety net benefits.

So about 1 in 10 are eligible for cash welfare through the TANF program. A little over a quarter are eligible for SNAP, 20%, almost, are eligible for WIC, 30% for the Earned Income Tax Credit, et cetera. So these policies have a wide potential to affect families. But, of course, not everybody participates in programs, even if they're eligible for them.

And so what the Urban Institute did was calculate up how much money have we left in Washington, DC, that could be here in the state of Illinois because of incomplete take up, people who are eligible for programs but decide not to participate.

So, for example, 81% of eligible families with children who are eligible for SNAP participate. That's four out of five. That's pretty good. But it's still a B. Only 57% of families, overall, in Illinois with or without children are participating in SNAP.

Our WIC participation rate is among the lowest in the country at 42% of people who are eligible. And so what you can see is, all right, well, we brought in $9 billion as it stands. But if more people would have participated, you can see if we would have had full participation in SNAP and SSI, it would have been another $2 billion in Illinois.

For those of you who live here, our budget's not in great shape. And we could definitely use the cash. And then we can follow it out and say, well, and then also, if we fully funded some of these programs that are more discretionary, we would see almost a doubling in the amount of money that comes to Illinois residents.

And so then this is what it looks like. They break it out for all people, adults, older adults, and then families with children. And what you can see is on our current system, 12.3% of Illinois families with children experienced poverty. But if we really maximized the social safety net as it stands today, that number would be almost half of the rate.

Finally, we can look a little bit at, how does the participation rate among those who are eligible vary here in Chicago, in Cook County, versus the rest of our large and diverse state? And you can see we actually do a little bit better in Cook County than in the rest of the state. So if we increased participation rates, not only would it help Chicago, but it would help Peoria. It would help downstate. It would help lots of places.

So to conclude, the safety net response during COVID 19 was large, unprecedented, and it impacted a wide range of population. And those economic impact payments and the refundable tax credits, which went to everyone, drove a lot of the anti-poverty impact, especially for Black and Hispanic children. And so we can conclude that that universal money had really strong protective impacts for them.

But because participation rates in these programs are well south of 100%, we still have substantial relief payments that we could bring in, have more money in Illinois, and protect more children from poverty. Thanks. Not my first rodeo. It's my third one.

SPEAKER 2: Thank You, Diane. And obviously you're not going far. I am happy to introduce my colleague, Shanti Ramnath, who is a Senior Economist here at the Chicago Fed, to give a policy reflection.

SHANTI RAMNATH: Thank you, Kristin. And thank you so much for inviting me to participate in this amazing conference. I have the pleasure of talking and giving some policy reflection about Dr. Bock's paper, "Suffering, the Safety Net and Disparities during COVID 19." So I just wanted to start by giving a broader scale context for child poverty in the US.

And what I did here is I plotted the share of child poverty as a share of population. So this is children defined as being under the age of 17. And these numbers just come from the OECD. And out of the 38 countries here listed, the US is ranked 33rd. So I think that is a generally known fact that the US doesn't do that great in terms of child poverty. But it's still always stunning to me that we're that bad compared to other developed countries.

And so as a side note, we all know the US has among one of the highest GDP per capitas in the world, so just to put it in that grander context. Now, zooming in to just the US, we talked a lot about what child poverty rates look like across different ethnicities and race. But one thing I wanted to also mention was that there's a lot of differences across states. And when we talk about the patchwork of policies, we know that there's also a lot of different policies at the state and local levels.

And so I think it's important to highlight that child poverty in the US varies a lot by state. So we have this child poverty rate is a little different than the one used by the OECD. So you don't want to compare the numbers across the two graphs. But within this graph, we see that child poverty rates in New Hampshire are among the lowest at 7% and almost more than double, actually, in Arkansas, at 19%, so huge amounts of variation. And it's not, I think, shocking to know that those poverty rates are correlated with places of high food insecurity.

And so, looking at that same map of the US, we see that there's a lot of variation in food insecurity. And there's 13.5%, on average, across the US, 13.5% of households face food insecurity. And among households with children, that number is 17.9%. So these are big numbers and a lot of variation across the country. And the reason I bring this up is because we have seen tons of evidence that food insecurity negatively impacts children's ability to cognitively function, their behavior, and as a result, their academic success.

So it's not just about the impact right now. It's also about their ability to accumulate human capital in the future. And so I think it's important to make that long-run connection, as well. So in terms of what we know, there's been a lot of literature on the effects of these different policies. And so you saw a lot of what happened when these policies were increased and how that impacted poverty rates immediately.

But there's also a lot of evidence that access to SNAP during childhood leads to better health outcomes in adulthood. There's work that the Earned Income Tax Credit improves educational employment outcomes. And that means better test scores, increased high school completion, college attendance, and also employment. So there's a lot of these effects that impact people's abilities to earn income, as well.

And, finally, there's work that Medicaid is not only linked to better health outcomes, but also better educational outcomes and higher earnings in adulthood. And so just thinking about this idea of what policies are out there, what can we do? We talked a little bit about incomplete take up. And so one thing I am very passionate about, I guess, is that there's a lot of direct spending on SNAP and different nutritional programs that are an important anti-poverty tool.

But much of the safety net, in fact, one of the largest programs that target children, families with children, is going to run through the tax code, so the Earned Income Tax Credit and the Child Tax Credit. And unlike direct spending, as was mentioned, these are pro-cyclical. But even more so than that, these benefits rely on people filing a tax return. And for anyone who's filed their tax return, there's a filing threshold. Not everyone is required to file a tax return.

So in terms of thinking about take up of programs, we also have to think about all these different constraints and features in the system itself that may prevent people from actually getting the benefits they're eligible for. So I have some work-- shameless plug-- that looks at how incentivizing people to file a tax return actually led to persistent reductions in poverty that we see over 10 years later. So I think it's important to think about how these systems are being administered.

And so, just in terms of trying to inspire discussion of policy and for the next panel, as well, I just wanted to leave with a couple of lessons from the pandemic. One thing that I think was valuable was that the government was able to use existing infrastructures to the tax system, SNAP, Medicaid, UI. And they were able to quickly and broadly distribute benefits on a very large scale during an unprecedented crisis.

And so you don't necessarily think of the government as moving quickly because it's not really designed to do that. And so this was an example where we saw lots of policies being put in place and done in an unprecedented pace. So I think some things that we can learn from this is that there were these benefits from these local and federal cooperation between different agencies at the state level.

At the federal level, for example, the USDA allowed for more flexibility in how the school lunch programs were administered. And so they were able to prioritize ways of providing access that was safe during the pandemic. So you saw these grab and go lunches.

There was also the allowance for free universal lunches, which basically temporarily took away the fact that some students had to pay some small amount for lunches. And even though that expired in June of 2022, some states continued to do this. And I know at the local level, there are places that also provide universal free lunch.

And so I think just along those lines, there's still a lot of lessons that could be taken from this extra shock of money that state and localities got to see what works and what doesn't in terms of what policies would best fit the unique needs of different areas at a local level. And so, yeah, use that use that as a potential experiment to see what can work. So that's all I have.

SPEAKER 3: So I guess this is the moderator seat so far.

DIANE SCHANZENBACH: Yes, that's right. That's right. It's a sign.

SPEAKER 3: Excellent, so this is really exciting for fun. It's great to have these two brilliant economists who I've known quite a while, Diane, actually since right after she came out of graduate school, I think I first met her. And Shanti, we hired her as a research assistant. And she went away to graduate school and is doing all this great research. So it's so much fun to actually see how the--

DIANE SCHANZENBACH: Life cycle effects of being associated with the Fed. That's right. That's right.

SPEAKER 3: So maybe I want to ask Diane to maybe say louder what I think you said at one point, which was like the EIP payments, they really reduced poverty. But there's a lot of money spent. So if you were going to think about it as poverty reduction on a per-dollar basis.

DIANE SCHANZENBACH: That's right.

SPEAKER 3: What would you sort of describe?

DIANE SCHANZENBACH: That's right. That would have been a smart thing, to do poverty reduction on a per-dollar basis. And that won't even be hard. I could probably do it when I'm sitting back there because I've got all the data. But yeah, I think if we knew how to politically target income transfers to low-income populations better than either conditional money or this universal money, we could have had the same or larger poverty reduction for just a fraction of the price.

Of course, I understand that it's not-- we didn't put out economic impact payments just to reduce poverty. And I understand that many people who didn't lose their jobs during COVID were still harmed. We understand why we sometimes want to do these general universal payments. But, boy, we really did those during the COVID pandemic.

And when you see just how much of our relief payments came through those big universal untargeted payments, you think maybe we could have thought about a different combination of spending, more targeted to either the poor or people who were directly harmed.

SPEAKER 3: By the way, people should let me know if they have some questions. I could probably go on a long time. But I do want to be able to share the--

DIANE SCHANZENBACH: And I can say that that's certainly not the position of the Chicago Fed. I'm not their employee. But I could see them all like starting to panic.

SPEAKER 3: How about we take one from [INAUDIBLE]?

AUDIENCE: I have one question. In this particular subject, especially around poverty and anti-poverty efforts, it seems like there's been a more concerted push around involving philanthropy, especially in places where government has taken more of a role, not being active, not necessarily funding some of these programs and the reliance on philanthropy to step in. Has any of that--.

DIANE SCHANZENBACH: Give me more of an example.

AUDIENCE: Situations where I've seen local groups get together and fund nonprofit organizations that support trying to close poverty gaps, versus government policies that support these income payments, SNAP programs, things like that, that shift of expecting philanthropy to pick up the social safety net versus government action.

DIANE SCHANZENBACH: So it's definitely the case that philanthropy plays an important role in this patchwork system that we have. I'm on the board of the Greater Chicago Food Depository, which is Chicago's food bank. And we are very clear that we need SNAP to be well functioning. And that we do better work in our setting when SNAP is strong.

And so I haven't seen those big programs be displaced by private philanthropy. But what I have seen is there are a lot of people who are at risk of food insecurity but are ineligible for SNAP because of how much they earn. Those folks are basically only eligible for funding through philanthropies.

Same goes for a lot of these programs, didn't pay to families with immigrants. And, again, a lot of times, philanthropy can, in many cases, be more innovative. They can provide that evidence base. And then they can also patch holes. But to be sure, we don't think that private philanthropy could do the anti-poverty work that the government does, nor would we want it to.

AUDIENCE: You mentioned that [INAUDIBLE] has one of the lowest state rates in Illinois of any state. Has your research shown--

DIANE SCHANZENBACH: Do we know why? Short answer, no. And long answer is, we're working on it. Given what we know about the importance of brain development and just very detrimental impacts of experiencing hunger, food insecurity, even nutrition inbalance as a young child, we shouldn't be allowing that. And we were like the last state to transition from the old paper WIC to electronic benefits.

There are sort of a lot of potentially small nudges that we could accumulate and try to move the needle on that. And I think there's interest in doing that. I hear from the governor's office that they're trying, but just putting my I'm definitely not a Fed employee hat on because I'm not-- Illinois has no business leaving money in Washington. We need that extra $2 billion or $7 billion here in our local communities.

SPEAKER 2: We can expand a little bit on that sort of problem of low take-up rates and whether the very cool thing about this gathering is we have a multidisciplinary group of people, people in schools, people in doctor's offices. And are there strategies that we bring people together to get higher take-up rates in this case?

[INTERPOSING VOICES]

SPEAKER 3: --version of this, as well?

DIANE SCHANZENBACH: OK, yeah, absolutely. So one really heartening trend that we've seen is school districts understanding how important it is to them that families sign up and stay on programs like SNAP and like Medicaid.

And during-- gosh, who was mayor then-- Emanuel's administration, they really started doing a lot of outreach to families to make sure that they were participating in SNAP. Now, that feeds back both through direct and indirect channels to the schools.

A direct channel is that the amount of money that we get through the universal school meals program is a direct function of the share of our population that's on SNAP. But then it's also indirect because when families have SNAP, the kids have better nutrition, come to school better able to learn, et cetera. So that's a win-win.

And then, we've also seen that the Chicago Public Schools have moved in a large way into Medicaid, making sure that kids stay on Medicaid. The hospitals do a lot of the good work of getting people in the first place but staying on is hard to do. You just have to recertify once a year. And it's complicated, et cetera.

But they understand that they can build some special education services to Medicaid, et cetera. And so kids are better served because they have more access to special education services. It's not bankrupting the school system, which is in a little bit of trouble right now. But it's sort of a win-win to make sure that we are all participating in these pretty well-designed government programs.

SPEAKER 3: So Shanti, I mean, you mentioned the tax code is relating to a lot of these things. And some people file taxes and they don't. Can it amplify that just a bit on what could be done to improve targeting perhaps, but also get more higher take-up rate of programs?

SHANTI RAMNATH: Yeah, so one thing that I noticed during my time at Treasury was that these programs don't talk to one another. And so people at Treasury don't know who's on SNAP. And, I mean, I don't know if SNAP knows anything about the tax code or people who are filing. But it does feel like there's reasons to-- and there are, I guess, reasons why SNAP may not want to have that partnership with the Treasury or IRS, since there may be a stigma there.

But it does feel like there's information that can be shared that can be used to improve take up, and-- yeah, giving people information. I know there's been success in terms of experiments done by the IRS to send out pamphlets that say, you're eligible for these benefits. Did you know that? And then that improves take up. And so I think there's definitely ways to at least share information, even if you're not working as a partner.

SPEAKER 3: I see one question from [INAUDIBLE].

AUDIENCE: First comment so you're. People science research I support. This may not be the most efficient if it gets you-- It's like. Let's do plenty of SNAPs. Do you view that as inefficient use of resources, efficient use of resources for funding and trying to [INAUDIBLE].

DIANE SCHANZENBACH: Yeah, I mean, I don't think that the evidence is out yet about whether this is cost effective for individual hospital groups, et cetera. But we can certainly draw a line to see why we think it would be. There's enough understanding of social determinants of health that there's a great study of when SNAP benefits are more adequate, fewer people come in with diabetic problems at the end of the month.

These pieces, just like we were talking about with the schools, are just hand in glove with the medical system, as well. And I think that schools have a special role as a trusted partner. And so do doctors, as a trusted partner who can help deliver information. And you hold your hand, do these handoffs, to make sure that people are getting the benefits that they're eligible for.

< />SHANTI RAMNATH: < />And I would just add that one of the ways that people learn about the EITC is through filing their tax return. And so if there's other ways to target people who wouldn't necessarily file a tax return, I mean, without doing the full analysis, I could see there being a lot of high returns from that. < />DIANE I thought we'll learn that it's cost effective when the ink is dry. But I don't think we know that, yeah. SCHANZENBACH:

SPEAKER 3: Other audience, Kelly.

AUDIENCE: It was a very similar question. I just recently went to a conference in other papers about getting people to re- enroll in Medicaid. And one of the preliminary findings is that it's complicated. It's a complicated process of having a person help you guide through it. It's beneficial but not cost effective. [INAUDIBLE] anybody have-- so I"m just curious, what are schools doing to help with the Medicaid enrollment and see if that's more cost effective?

DIANE SCHANZENBACH: Yeah, yeah. So you can imagine that schools might not make this universally available to everyone. But they can figure out which kids, let's say, are eligible for services that they can reimburse through Medicaid if that works out. And you might start by targeting those families and really holding their hands and then move out from there. And so I'm not sure that we have a great understanding of how does CPS do it.

But I've seen some analysis that whatever they're doing can really reduce what we call churn, people falling off at times of recertification. And frankly, that probably saves the state money. What I know about churn in the Supplemental Nutrition Assistance Program is it's really costly to process a new claim. And it's a lot cheaper to keep someone on.

And most people who fall off of SNAP fall off not because their incomes have gone up, but because-- just inertia. They missed an appointment or something like that. So they'll be off for a couple of months and then come back in, have to be processed as a new claim. That costs a lot of administrative costs. We could be better off reducing churn in the first place.

AUDIENCE: I'm just curious. One of the benefits that was also offered was the suspension of student loan payments. And I just wondered if either of you have studied that. And if you have, did you find any causation between the suspension of student loan payments and poverty reduction?

< />DIANE SCHANZENBACH: So it wouldn't show up in poverty, just by what we measure there. But I don't know anything more than that other than you might look for impacts on things like house buying or being behind in your credit cards, things like that. But poverty isn't the place I'd look.