Food is medicine, so health insurance should cover it

As a doctor, I can’t write a prescription for an apple a day. But a recent study suggests I should.

In fact, doing so could prevent some 290,000 cardiac events and save almost $40 billion in health care costs for patients with diabetes. And those are only two groups of many who could benefit from easier access to healthy food.

Sadly, while insurance plans will cover prescription medications that cost thousands of dollars, they don’t cover something far more affordable and effective: access to healthy foods for patients who struggle to afford them. If our country is serious about improving health outcomes and lowering costs, we need to start treating food like medicine.

Many of us know we should eat more fruits and vegetables, but, for some people, simply finding and affording those foods presents a major barrier. Tens of millions of Americans live in “food deserts” with limited access to supermarkets and health options.

Most common in rural, inner-city, and lower-income areas, food deserts typically correlate to higher rates of obesity, cardiovascular disease and diabetes than other regions in America. Inflation has made the problem worse: With food prices rising at five times the historic rate in the last few years, more Americans are having trouble putting food on the table at all — much less healthy food, which tends to cost more.

Food deserts and inflation have created a preventable national health crisis. The lack of healthy food options leads to more chronic disease, which in turn leads to higher rates of morbidity and mortality. People die earlier, and their quality of life in that shorter time is worse. This increases health care costs nationally: About 90 percent of the yearly $4.1 trillion spent on health care in America goes toward chronic medical conditions. 

Fortunately, there are ways to stop this crisis. “Food as medicine” programs have been increasing in number. Through the 1115 Medicaid waiver program, many states have started pilot programs that address the social determinants of health — the nonmedical factors that contribute to our overall wellness. Food is one of these factors.

Several state-based programs are experimenting with allowing physicians to write prescriptions for healthy food for high-risk patients. So far, these programs have shown encouraging results. A meta-analysis looking at “food as medicine” pilot programs found that they increased the consumption of fruit and vegetable servings by 0.8 per day. A community-based pilot program increased healthy diet options and confidence in cooking healthy foods and reduced barriers to eating healthy.

At my hospital, through our Immigrant Health and Cancer Disparities Service, we run a Food to Overcome Outcome Disparities program. The premise is simple: If you are worried about your next meal, you are less likely to get appropriate treatment for your cancer. We never want anyone to have to make the decision between feeding their family or affording their next cycle of therapy. This program, which started in 2011, has delivered more than 400,000 meals to high-risk cancer patients in our community.

These pilot programs demonstrate that we need to implement such measures on a wider scale. Both commercial and government-funded insurance plans should include provisions to provide food for patients with food insecurity. As a doctor, I would much rather avoid prescribing a cholesterol-lowering pill and instead prescribe the “DASH” diet, emphasizing vegetables, legumes and nuts, which can lower your systolic blood pressure by 11 points.

Covering healthy food wouldn’t be a huge lift for insurance companies, which already try to encourage healthy practices to reduce costs and medical complications, such as offering discounts for fitness programs. Encouraging healthy diets through financial incentives would be a very cost-effective way to improve health outcomes. 

This doesn’t mean that all food will be free or covered — this type of insurance coverage would fill in gaps for those who cannot afford healthy food. Food as medicine programs would work directly with the Supplemental Nutrition Assistance Program (SNAP) to help provide food for Americans in need, which will become more important as more restrictions are placed on SNAP beneficiaries. 

It’s hard to see any downsides to such measures, which would improve Americans’ health and save money at the same time. The upfront costs to implement food as medicine programs through the government and insurance companies would be recouped many times over in lower future health care costs.

Food and nutrition, so critical to our health and development, often cost a fraction of other medical interventions. New cholesterol-lowering medications can cost more than $5,000 a year. Other weight loss medications, such as Wegovy or Ozempic, can cost even more.

As a health care system, we’ve decided these medications are likely worth it, since weight loss, better glucose control and better blood cholesterol levels can prevent more expensive medical care in the future.

If our insurance plans are willing to cover these expenses, why not do the same for far more affordable healthy food? In my medical opinion, that’s the most effective prescription for our country’s physical and economic health.

Dr. Joshua A. Budhu is a neuro-oncologist and health equity researcher at Memorial Sloan Kettering Cancer Center and a Public Voices Fellow of The OpEd Project and AcademyHealth.