¹ Matthew J. Belanger et al., Covid-19 and Disparities in Nutrition and Obesity, New Eng. J. Med., Sept. 10, 2020, at e69(1), e69(1) (discussing how COVID-19 has highlighted link between diet and health disparities).

² Id.

³ Id.

⁴ Jesse Bradford et al., COVID-19 and Rural Communities: Protecting Rural Lives and Health, Mckinsey & Co. ( Mar. 10, 2021), https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/covid-19-and-rural-communities-protecting-rural-lives-and-health [https://perma.cc/7WMV-GB9E].

⁵ Belanger et al., supra note 1, at e69(1).

⁶ Sharon K. Hull, A Larger Role for Preventative Medicine, 10 Am. Med. Ass’n. J. Ethics 724, 725 (2008).

⁷ Katherine Keisler-Starkey & Lisa N. Bunch, Health Insurance Coverage in the United States: 2020 5 (2021). Public health insurance programs such as Medicare, Medicaid, CHIP, and VA benefits cover 34.8% of Americans. Medicare covers 18.4% of Americans and Medicaid covers 17.8%. Id.

⁸ Ctrs. for Medicare & Medicaid Servs. Medicare & Medicaid Basics, (Apr. 2022); Robin Rudowitz et al., 10 Things to Know about Medicaid: Setting the Facts Straight, Kaiser Fam. Found. (Mar. 6, 2019), https://files.kff.org/attachment/Issue-Brief-10-Things-to-Know-about-Medicaid-Setting-the-Facts-Straight [https://perma.cc/ZTA6-S9XU].

⁹ See, e.g., Ctrs. Medicare & Medicaid Servs., Background: The Affordable Care Act’s New Rules on Preventive Care (July 15, 2010), https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/preventive-care-background [https://perma.cc/KF7P-7P7X].

¹⁰ Id.

¹¹ Ali H. Mokdad et al., The State of US Health, 1990-2016: Burden of Disease, Injuries, and risk Factors among US States, 319 JAMA 1444, 1451 (2018). Dietary risks are the leading factor for number of deaths and a leading risk factor in percentage of disability-adjusted life-years in the United States. Id.

¹² Jennifer N. Aiyer et al., A Pilot Food Prescription Program Promotes Produce Intake and Decreases Food Insecurity, 9 Translational Behav. Med. 922, 922 (2019) (discussing how clinical health care providers are hesitant to screen for food insecurity because they feel like they have little to offer).

¹³ Katie Garfield et al., Mainstreaming Produce Prescriptions: A Policy Strategy Report 3 (2021).

¹⁴ Id.

¹⁵ Michelle Cavanagh et al., Veggie Rx: An Outcome Evaluation of a Healthy Food Incentive Programme 20 Public Health Nutrition 2636, 2636 (2016).

¹⁶ Garfield et al., supra note 13, at 4.

¹⁷ Id.; Press Release, USDA NIFA Invests $40M to Improve Dietary Health and Reduce Food Insecurity (June 1, 2022), https://www.nifa.usda.gov/about-nifa/press-releases/usda-nifa-invests-40m-improve-dietary-health-reduce-food-insecurity [https://perma.cc/LAS3-MXD4].

¹⁸ Garfield et al., supra note 13, at 4.

¹⁹ Id. at 3-6.

²⁰ Richard Bryce et al., Participation in a Farmers’ Market Fruit and Vegetable Prescription Program at a Federally Qualified Health Center Improves Hemoglobin A1C in Low Income Uncontrolled Diabetics 7 Preventive Med. Rep. 176, 176 (2017).

²¹ Cavanagh et al., supra note 15, at 2638-39.

²² Garfield et al., supra note 13, at 13.

²³ Ctr. for Medicare & Medicaid Serv., May 2021 Medicaid and CHIP Enrollment Trends Snapshot 3 (2021), https://www.medicaid.gov/medicaid/national-medicaid-chip-program-information/downloads/may-2021-medicaid-chip-enrollment-trend-snapshot.pdf [https://perma.cc/RD47-G92Z].

²⁴ Dep’t of Health and Hum. Serv., supra note 8, at 1.

²⁵ Ctr. for Medicare & Medicaid Serv., Medicare & Medicaid Basics 4 (2018), https://www.medicare.gov/Pubs/pdf/11306-Medicare-Medicaid.pdf [https://perma.cc/RD47-G92Z]. See Samantha Artiga et al., Health Coverage by Race and Ethnicity, 2010-2019, Kaiser Fam. Found. (Dec. 20, 2022), https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/# [https://perma.cc/9FLF-QN7A].

²⁶ Julia Paradise, The Impact of the Children’s Health Insurance Program (CHIP): What Does the Research Tell Us? 1 (Kaiser Fam. Found. 2014) https://www.kff.org/wp-content/uploads/2014/07/8615-the-impact-of-the-children_s-health-insurance-program-chip-what-does-the-research-tell-us.pdf [https://perma.cc/4FJG-7QE2]. See, Artiga et al., supra note 25.

²⁷ Belanger et al., supra note 1, at 1.

²⁸ See generally id; Jessie A. Satia, Diet-related Disparities: Understanding the Problem and Accelerating Solutions 109:4 J. Am. Dietetic Ass’n 610, 611-12 (Apr. 2010).

²⁹ Belanger et al., supra note 1, at 2.

³⁰ Id.

³¹ Id.

³² Mokdad et al., supra note 11, at 1451.

³³ Id.

³⁴ Tajwar Taher, Veggie Rx: 2019-2020 Program Results Summary 5 (Eecole Copen ed., 2021).

³⁵ See generally M. A. Van Duyn & Elizabeth Pivonka, Overview of the Health Benefits of Fruit and Vegetable Consumption for the Dietetics Professional: Selected Literature, 100 J. Am. Dietetic Ass’n. 1511, 1511 (2000).

³⁶ Garfield et al., supra note 13, at 2.

³⁷ Katherine Leach-Kemon, The Global Burden of Disease: Generating Evidence, Guiding Policy 14 (Univ. of Wash. 2013) (http://www.healthdata.org/sites/default/files/files/policy_report/2013/GBD_GeneratingEvidence/IHME_GBD_GeneratingEvidence_FullReport.pdf).

³⁸ See Hilary K. Seligman et al., Exhaustion of Food Budgets at Month’s End and Hospital Admissions for Hypoglycemia, 33 Health Aff. 116 (2014); Sanjay Basu et al., The Monthly Cycle of Hypoglycemia: An Observational Claims-based Study of Emergency Room Visits, Hospital Admissions, and Costs in a Commercially Insured Population, 55 Med. Care 630 (2017); Sandra P. Garcia et al., Incremental Health Care Costs Associated with Food Insecurity and Chronic Conditions Among Older Adults, 15 Preventing Chronic Disease 1 (2017).

³⁹ Patricia Crawford et al., The Role of Law and Policy in Achieving the Healthy People 2020 Nutrition and Weight Status Goals of Increased Fruit and Vegetable Intake in the United States 9 (2018); Belanger et al., supra note 1, at 1.

⁴⁰ Ctr. for Medicare & Medicaid Serv., supra note 25, at 4; Artiga et al., supra note 24.

⁴¹ Paul J. Feldstein, Health Policy Issues: An Economic Perspective on Health Reform 112 (Health Admin. Press, 7th ed. 2021).

⁴² Id.

⁴³ Ctrs. for Medicare & Medicaid Servs, supra note 8, at 1-2.

⁴⁴ Id. at 1.

⁴⁵ Id. at 1-2.

⁴⁶ Id. at 2.

⁴⁷ Meredith Freed et al., Medicare Advantage in 2022: Enrollment Update and Key Trends, Kaiser Fam. Found. (Aug. 25, 2022) https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/ [https://perma.cc/Y8DL-EC23].

⁴⁸ Feldstein, supra note 40, at 135.

⁴⁹ Id.

⁵⁰ The Medicaid and CHIP Payment and Access Comm’n, Racial and Ethnic Disparities in Medicaid: An Annotated Bibliography 1 (The Medicaid and CHIP Payment and Access Comm’n ed., 2021), https://www.macpac.gov/wp-content/uploads/2021/04/Racial-and-Ethnic-Disparities-in-Medicaid-An-Annotated-Bibliography.pdf [https://perma.cc/A9UJ-A7QS].

⁵¹ Feldstein, supra note 41, at 135.

⁵² The Medicaid and CHIP Payment and Access Comm’n, Medicaid and Rural Health 1 (The Medicaid and CHIP Payment and Access Comm’n ed., 2021), https://www.macpac.gov/wp-content/uploads/2021/04/Medicaid-and-Rural-Health.pdf.

⁵³ Id. at 1.

⁵⁴ Feldstein, supra note 41, at 126.

⁵⁵ Id. at 129.

⁵⁶ Ctr. for Medicare & Medicaid Serv., supra note 23, at 3.

⁵⁷ Tricia Brooks & Allexa Gardner, Snapshot of Children with Medicaid by Race and Ethnicity, 2018 1 (Georgetown Univ. Health Pol’y Inst. 2020), https://ccf.georgetown.edu/wp-content/uploads/2020/07/Snapshot-Medicaid-kids-race-ethnicity-v4.pdf [https://perma.cc/U8TR-7PSE].

⁵⁸ CHIP State Program Information, Medicaid.gov (last accessed Oct. 24, 2022), https://www.medicaid.gov/chip/state-program-information/index.html [https://perma.cc/QG3A-3H4M].

⁵⁹ See generally, Ctr. Medicare & Medicaid Serv., history (last accessed Dec. 1, 2022), https://www.cms.gov/About-CMS/Agency-Information/History [https://perma.cc/J3VM-JFP].

⁶⁰ Ctr. Medicare & Medicaid Serv., supra note 9.

⁶¹ Jim Abrams, Medicare: An Ounce of Prevention, CBS News (Jan. 10, 2005), https://www.cbsnews.com/news/medicare-an-ounce-of-prevention-8230/ [https://perma.cc/Q5R2-5X6U].

⁶² Id.

⁶³ Ctr. Medicare & Medicaid Serv., supra note 9.

⁶⁴ Id.

⁶⁵ Id.

⁶⁶ See generally, Ctr. for Medicare & Medicaid Serv., Your Guide to Medicare Preventive Services (Ctr. for Medicare & Medicaid Serv. eds., 2021), https://www.medicare.gov/sites/default/files/2021-08/10110-Your-Guide-to-Medicare-Preventive-Services.pdf [https://perma.cc/GN67-HWA7]; Alexandra Gates et al., Coverage of Preventive Services for Adults in Medicaid, Kaiser Fam. Found. (Nov. 13, 2014), https://www.kff.org/medicaid/issue-brief/coverage-of-preventive-services-for-adults-in-medicaid/view/print/ [https://perma.cc/D6TE-K52T]; Preventive care benefits for children, Health care.gov (last accessed Oct. 24, 2022) https://www.healthcare.gov/preventive-care-children/ [https://perma.cc/6S2D-3BAZ].

⁶⁷ Feldstein, supra note 41, at 31.

⁶⁸ Maria Elena Rodriguez et al., Produce Prescription Programs US Field Scan Report: 2010-2020 7 (Wholesome Wave & DAISA Enter. 2021).

⁶⁹ Ctr. for Medicare & Medicaid Serv., NHE Fact Sheet (Ctr. for Medicare & Medicaid Serv. 2020). The federal government pays 36.3% of total health spending in the U.S. State and local governments pay 14.3% of total health spending. Id.

⁷⁰ Feldstein, supra note 41, at 113, 125.

⁷¹ Ctr. for Medicare & Medicaid Serv., NHE Fact Sheet (Ctr. for Medicare & Medicaid Serv. 2020).

⁷² Ctr. for Medicare & Medicaid Serv., CMS Fast Facts (Ctr. for Medicare & Medicaid Serv. 2021), https://data.cms.gov/sites/default/files/2022-08/4f0176a6-d634-47c1-8447-b074f014079a/CMSFastFactsAug2022.pdf [https://perma.cc/A9VG-7CLK].

⁷³ Feldstein, supra note 41, at 114.

⁷⁴ Feldstein, supra note 41, at 114-15.

⁷⁵ Id. at 125.

⁷⁶ Id.; Ctr. for Medicare & Medicaid Serv., supra note 68, at 1.

⁷⁷ Feldstein, supra note 41, at 135, 139.

⁷⁸ Id. at 135.

⁷⁹ Robin Rudowitz et al., Medicaid Financing: The Basics 9 (Kaiser Fam. Found. 2021), https://files.kff.org/attachment/Issue-Brief-Medicaid-Financing-The-Basics [https://perma.cc/VA94-5GFJ].

⁸⁰ Taher, supra note 34, at 5 (describing how elderly persons often face diseases such as diabetes, hypertension, and arthritis which are significantly linked to food insecurity); Emily Hennessee, Veggie Rx in the 2018 Farm Bill 4 (Johns Hopkins Ctr for a Livable Future 2020).

⁸¹ Garfield et al., supra note 13, at 2; Hennessee, supra note 80 at 4 (“The total cost of obesity, including related cancers, diabetes, cardiovascular disease, other obesity-related conditions is estimated to be around $1.72 trillion” annually. This is approximately nine percent of the U.S. total GDP).

⁸² CIA, Field Listing - GDP (official exchange rate), https://www.cia.gov/the-world-factbook/field/gdp-official-exchange-rate/ (last visited Oct. 23, 2022) [https://perma.cc/G6MK-J42S].

⁸³ Cass R. Sunstein, Simpler: The Future of Government 76 (Simon & Schuster eds., 2013).

⁸⁴ Belanger et al., supra note 1, at e69(2).

⁸⁵ Id. at e69(1)

⁸⁶ Id. at e69(3).

⁸⁷ Sunstein, supra note 83, at 76.

⁸⁸ See generally Van Duyn & Pivonka, supra note 35.

⁸⁹ Garfield et al., supra note 13, at 2.

⁹⁰ Hennessee, supra note 80, at 4.

⁹¹ Erika S. Trapl et al., Dietary Impact of Produce Prescriptions for Patients with Hypertension, 15 Preventing Chronic Disease: Pub. Health Rsch., Prac., and Pol’y 1, 1 (2018).

⁹² Garfield et al., supra note 13, at 2.

⁹³ Bryce et al., supra note 20, at 176.

⁹⁴ Erika S. Trapl et al., Mixed Methods Evaluation of a Produce Prescription Program for Pregnant Women, 12 J. Hunger & Env’t Nutrition 529, 529 (2017).

⁹⁵ Id.

⁹⁶ Martha Clare Morris et al., Nutrients and Bioactives in Green Leafy Vegetables and Cognitive Decline, 90 Am. Acad. Neurology 214, 214 (2018).

⁹⁷ Faezeh Saghafian et al., Fruit and Vegetable Consumption and Risk of Depression: Accumulative Evidence From an Updated Systematic Review and Meta-analysis of Epidemiological Studies, 119 Brit. J. Nutrition 1087 (2018).

⁹⁸ Cavanagh et al., supra note 15, at 2636.

⁹⁹ Crawford et al., supra note 39, at 9. In 2015, only twelve percent of adults in the U.S. were eating recommended amounts of fruit and only nine percent were eating recommended amounts of vegetables. Trapl et al., Dietary, supra note 91, at 1. Americans only consume an average of 1.4 cups of vegetables and 0.9 cups of fruit per day. This is below the amount recommended by the USDA and other health organizations. Food Serv. Rsch. Grp., Food Patterns Equivalents Intakes By Americans 5 (2018) https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/DBrief/20_Food_Patterns_Equivalents_0304_1516.pdf [https://perma.cc/G3S9-GW39]. The USDA recommends 1.5-2 cups of fruit and 2-3 cups of vegetables per day. Seung Hee Lee et al., Adults Meeting Fruit and Vegetable Intake Recommendations — United States, 2019, CDC Morbidity & Mortalilty Wkly. Rep. at 1. https://www.cdc.gov/mmwr/volumes/71/wr/pdfs/mm7101a1-H.pdf [https://perma.cc/L9PN-CHU6].

¹⁰⁰ Id.

¹⁰¹ Belanger et al., supra note 1, at 1.

¹⁰² Olivia Dean, Lynda Flowers & Claire Noel-Miller, Food Insecurity Among Medicare’s 65+: Stark Racial and Ethnic Disparities, AARP: Thinking Pol’y (Mar. 11, 2020), https://blog.aarp.org/thinking-policy/food-insecurity-among-medicares-65-stark-racial-and-ethnic-disparities [https://perma.cc/C2AZ-G7JX]. Approximately one in ten Medicare Beneficiaries are food insecure and disadvantaged racial and ethnic minorities have even higher rates of food insecurity. Id.

¹⁰³ Garfield et al., supra note 13, at 14.

¹⁰⁴ See Crawford et al., supra note 39, at 9.

¹⁰⁵ Garfield et al., supra note 13, at 15.

¹⁰⁶ Dean et al. supra note 104.

¹⁰⁷ Christian A. Gregory & Alisha Coleman-Jensen, Food Insecurity, Chronic Disease, and Health Among Working-Age Adults 1-2 (U.S.D.A. Econ. Res. Serv. 2017) https://www.ers.usda.gov/webdocs/publications/84467/err-235.pdf [https://perma.cc/6JF9-FTEB].

¹⁰⁸ Cavanagh et al., supra note 15, at 2636. Low-income groups consume less fruit and vegetables than high-income groups. Nicole D. White, Produce Prescriptions, Food Pharmacies, and the Potential Effect on Food Choice, 14 Am. J. Lifestyle Med. 366, 367 (2020).

¹⁰⁹ Christine M. Burrington et al., A Pilot Study of an Online Produce Market Combined with a Fruit and Vegetable Prescription Program for Rural Families, 17 Preventative Med. Rep. 1, 1 (2020).

¹¹⁰ See, Dean et al., supra note 104. Medicare beneficiaries from historically disadvantaged racial and ethnic groups have even higher rates of food insecurity than the overall population of Medicare beneficiaries.

¹¹¹ Sandra P. Garcia, Anne Haddix & Kevin Barnett, Incremental Health Care Costs Associated with Food Insecurity and Chronic Conditions Among Older Adults, 15 Preventing Chronic Disease: Pub. Health Rsch., Prac., and Pol’y, 1, 3 (2018).

¹¹² Crawford et al., supra note 39, at 9.

¹¹³ See generally Am. Acad. of Pediatrics Council on Community Pediatrics, Poverty and Child Health in the United States, 137 Pediatrics 1, 1-2 (2016).

¹¹⁴ Aiyer et al., supra note 12, at 922.

¹¹⁵ See generally Nicole Darmon & Adam Drewnowski, Contribution of Food Prices and Diet Cost to Socioeconomic Disparities in Diet Quality and Health: a Systematic Review and Analysis, 73 Nutrition Rev. 643 (2015) (indicating that many individuals would like to each fruit and vegetables, but cannot afford these foods).

¹¹⁶ Trapl et al., Mixed, supra note 94, at 536 (finding that two out of seventy-five participants said they do not like fruit and vegetables and only one out of seventy-five participants said that their family does not like fruit and vegetables).

¹¹⁷ Cavanagh et al., supra note 15, at 2636.

¹¹⁸ Taher, supra note 34, at 4.

¹¹⁹ Trapl et al., Dietary, supra note 92, at 1.

¹²⁰ Diana Cassady, Karen M. Jetter & Jennifer Culp, Is Price a Barrier to Eating More Fruits and Vegetables for Low-Income Families?, 107 J. Am. Dietetic Ass’n 1909, 1909 (2007).

¹²¹ Dariush Mozaffarian et al., Role of Government Policy in Nutrition—Barriers to and Opportunities for Healthier Eating, 361 Sci. & Pol. Nutrition 1, 1 (2018).

¹²² See generally Paul Dutko, Michele Ver Ploeg & Tracey Farrigan, Characteristics and Influential Factors of Food Deserts (U.S.D.A. Econ. Res. Serv. 2012) https://www.ers.usda.gov/webdocs/publications/45014/30940_err140.pdf [https://perma.cc/786E-UTJ5].

¹²³ See, e.g., Tony Blakely et al., The Effect of Food Taxes and Subsidies on Population Health and Health Costs: A Modelling Study, 5 Lancet Pub. Health 404, 404 (2020).

¹²⁴ See id. at 412.

¹²⁵ Compare Daniel Kim & Ichiro Kawachi, Food Taxation and Pricing Strategies to “Thin Out” the Obesity Epidemic, 30 Am. J. Preventive Med. 430, 433-34 (2006) (listing potential barriers to implementing junk food taxes), with Patricia J. Lucas, Tricia Jessiman & Ailsa Cameron, Healthy Start: The Use of Welfare Food Vouchers by Low-Income Parents in England, 14 Soc. Pol’y & Soc’y 457, 458 (2015) (noting successful use of food subsidies).

¹²⁶ Tony Blakely, Christine Cleghorn, Anja Mizdrak, Wilma Waterlander, Nhung Nghiem, Boyd Swinburn, Nick Wilson & Cliona Ni Mhurchu, The Effect of Food Taxes and Subsidies on Population Health and Health Costs: A Modelling Study 404 (5 The Lancet Pub. Health 2020).

¹²⁷ Mozaffarian et al., supra note 125, at 2.

¹²⁸ Daniel Kim & Ichiro Kawachi, Food Taxation and Pricing Strategies to “Thin Out” the Obesity Epidemic, 30 Am. J. Preventive Med. 430, 433-34 (2006). Two main challenges exist for junk food taxation. First, many special interest groups and moneyed interests are strongly opposed to food tax implementation. Second, food taxes can potentially become regressive if improperly designed. Id.

¹²⁹ Blakely et al., supra note 127, at 404.

¹³⁰ Mozaffarian et al., supra note 125, at 7.

¹³¹ Id.

¹³² Blakely et al., supra note 125, at 410.

¹³³ Douglas E. Hough, Irrationality in Health Care: What Behavioral Economics Reveals About What We Do and Why 86 (Stanford Univ. Press 2013).

¹³⁴ Sunstein, supra note 83, at 191.

¹³⁵ Id.

¹³⁶ Whether or not junk food taxes are regressive or ultimately progressive is a heavily debated topic. Critics point to the fact that low-income individuals tend to consume large amounts of junk food and that junk food taxes would ultimately fall upon them. Some junk food tax proponents then suggest using tax revenue to subsidize healthier food options. This article instead proposes fruit and vegetable subsidies. In contrast to taxes and bans, subsidies are less likely to run into political challenges, are a better fit for American culture, and are less controversial.

¹³⁷ Cass R. Sunstein, Free Markets and Social Justice 5 (Oxford Univ. Press 1997).

¹³⁸ Id.

¹³⁹ Id. at 8.

¹⁴⁰ Mozaffarian et al., supra note 125, at 1.

¹⁴¹ Cavanagh et al., supra note 15, at 2637.

¹⁴² Garfield et al., supra note 12, at 1.

¹⁴³ Id.

¹⁴⁴ Hennessee, supra note 80, at 3.

¹⁴⁵ Garfield et al., supra note 12, at 4-6.

¹⁴⁶ Cavanagh et al., supra note 15, at 2637.

¹⁴⁷ Id. at 2636-37.

¹⁴⁸ Lucas et al., supra note 126, at 463.

¹⁴⁹ Cavanagh et al., supra note 15, at 2637. In particular, this Article explains that health care providers may influence expectations of how fruit and vegetables can improve health and that providers may also influence values of fruit and vegetable consumption. Id.

¹⁵⁰ Id. at 2637; Hennessee, supra note 80, at 5.

¹⁵¹ Hennessee, supra note 80, at 5.

¹⁵² Cass R. Sunstein, Conformity: The Power of Social Influences 6 (2019).

¹⁵³ Mozaffarian et al., supra note 125, at 4.

¹⁵⁴ Garfield et al., supra note 12, at 3-4.

¹⁵⁵ Id. at 3.

¹⁵⁶ Rodriguez et al., supra note 78, at 10-13. For a comprehensive examination of existing nonprofit-implemented produce prescription programs, see generally id.

¹⁵⁷ Garfield et al., supra note 12, at 4, 11.

¹⁵⁸ Rodriguez et al., supra note 78, at 4.

¹⁵⁹ Id. at 1-2.

¹⁶⁰ Garfield et al., supra note 12, at 4.

¹⁶¹ Id.

¹⁶² Hennessee, supra note 80, at 3.

¹⁶³ Garfield et al., supra note 12, at 3.

¹⁶⁴ Id. at 1, 3.

¹⁶⁵ White, supra note 103, at 367.

¹⁶⁶ Id.

¹⁶⁷ Press Release, USDA, NIFA Invests $40M to Improve Dietary Health and Reduce Food Insecurity (June 1, 2022) https://www.nifa.usda.gov/about-nifa/press-releases/usda-nifa-invests-40m-improve-dietary-health-reduce-food-insecurity [perma.cc/X2QL-K4BW].

¹⁶⁸ Hennessee, supra note 80, at 3.

¹⁶⁹ Alyssa Auvinen et al, Integrating Produce Prescriptions into the Health care System: Perspectives from Key Stakeholders, 19 Int’l J. of Env’t Rsch. & Pub. Health, Sept. 2, 2022, at 1, 2.

¹⁷⁰ Medicare and Medicaid provide care to more than one hundred million Americans including many disadvantaged people in our country. See Ctr. for Medicare & Medicaid Serv., Your Guide, supra note 8, at 1. Many of these people currently struggle with diet-related health conditions. Dep’t of Health and Hum. Serv., What’s Medicare, supra note 7, at 1; Rudowitz et al., 10 Things, supra note 8, at 1.; Many produce prescription studies have targeted specific low socio-economic status individuals who struggle to eat a healthy diet. Previous studies show that many of the people that meet these criteria are enrolled in Medicare or Medicaid. For example, in one study, eighty-three percent of participants were also beneficiaries of Medicare or Medicaid. Cavanagh et al., supra note 15, at 2638.

¹⁷¹ Anne Cafer et al., Examining the Context,Logistics, and Outcomes of Food Prescription Programs: A Scoping Review, 19 Rsch. Soc. & Admin. Pharmacy 57, 58 (2022).

¹⁷² See Garfield et al., supra note 12, at 5-6.

¹⁷³ See generally Cavanagh et al., supra note 15. Pilot projects have led to health improvements in a wide range of communities including Black and Indigenous communities. The Cavanagh study primarily benefitted Black Americans. See generally Leandra J. Jones et al., Impact of a Fruit and Vegetable Prescription Program on Health Outcomes and Behaviors in Young Navajo Children, Current Devs. Nutrition 1, 1-7 (2020). The Jones study showed successful health outcomes in an Indigenous community.

¹⁷⁴ See Rodriguez et al., supra note 78, at 12-17.

¹⁷⁵ Taher, supra note 34, at 12.

¹⁷⁶ Garfield et al., supra note 12, at 27-28.

¹⁷⁷ Id. at 104.

¹⁷⁸ Auvinen et al., supra note 181, at 1-2.

¹⁷⁹ Lucas et al., supra note 126, at 463.

¹⁸⁰ Id.

¹⁸¹ Garfield et al., supra note 12, at 4.

¹⁸² Taher, supra note 34, at 10-15.

¹⁸³ See e.g., Allison V. Schlosser et al., “You Guys Really Care About Me…”: A Qualitative Exploration of a Produce Prescription Program in Safety Net Clinics, 34 J. Gen. Internal Med. 2567, 2568 (2019). The Schlosser study is one such study. This study focused on largely older African American adults struggling with hypertension experiencing food insecurity in Cleveland, Ohio. Id.

¹⁸⁴ Id.

¹⁸⁵ Id.

¹⁸⁶ Id. at 2569.

¹⁸⁷ Id.

¹⁸⁸ Taher, supra note 34, at 11.

¹⁸⁹ Schlosser et al., supra note 197, at 2568-9.

¹⁹⁰ Id. at 2569.

¹⁹¹ Id.

¹⁹² Aiyer et al., supra note 12, at 922.

¹⁹³ See Hennessee, supra note 80, at 8.

¹⁹⁴ Auvinen et al., supra note 181, at 1.

¹⁹⁵ Garfield et al., supra note 12, at 4, 8. Research shows that produce prescriptions decrease blood pressure, reduce hemoglobin A1C levels, decrease depressive symptoms and improve overall health. All of these factors contribute to the high cost of medical care. Id.

¹⁹⁶ See Keisler-Starkey & Bunch, supra note 7, at 3.

¹⁹⁷ See Auvinen et al., supra note 181, at 5.

¹⁹⁸ Yujin Lee et al., Cost-Effectiveness of Financial Incentives for Improving Diet and Health Through Medicare and Medicaid: A Microsimulation Study, PLOS Med., Mar. 19, 2019, at 1, 1.

¹⁹⁹ Id.

²⁰⁰ Id.

²⁰¹ Id. at 5, 7.

²⁰² Id. at 4.

²⁰³ Id.

²⁰⁴ Id.

²⁰⁵ Id. at 1.

²⁰⁶ Id.

²⁰⁷ Id. at 4, 8.

²⁰⁸ Id. at 8.

²⁰⁹ Id. at 6.

²¹⁰ Id. at 4, 9.

²¹¹ Id. at 15-16.

²¹² Id. at 2.

²¹³ Id. at 1.

²¹⁴ Id. at 1, 10.

²¹⁵ Id. at 10.

²¹⁶ Id. at 1, 10.

²¹⁷ Id. at 10.

²¹⁸ See id. at 4, 8-10, 16.

²¹⁹ Id. at 16.

²²⁰ Id.

²²¹ Cavanagh et al., supra note 15, at 2636, 2639.

²²² See Morris et al., supra note 96, at 214.

²²³ See Am. Acad. of Pediatrics Council on Community Pediatrics, supra note 114.

²²⁴ Lee et al., supra note 212, at 4.

²²⁵ Donglan Zhang et al., Evidence of Dietary Improvement and Preventable Costs of Cardiovascular Disease, 120 Am. J. Cardiology 1681, 1685 (2017).

²²⁶ Sung Eun Choi et al., Cost Effectiveness of Subsidizing Fruit and Vegetable Purchases Through the Supplemental Nutrition Assistance Program, 52 Am. J. Preventive Med. 147, 150 (2017).

²²⁷ Produce prescriptions Can Save Money. New Project Asks How Much?, Univ. N.C. Gillings Sch. Of Pub. Health (Dec, 14, 2021), https://sph.unc.edu/sph-news/produce-prescriptions-can-save-money-new-project-asks-how-much/ [perma.cc/Z597-TQAY].

²²⁸ See Lee et al, supra note 212, at 8.

²²⁹ Mozaffarian et al., supra note 125, at 8.

²³⁰ Id. at 6.

²³¹ Id.

²³² Feldstein, supra note 41, at 31.

²³³ Id.

²³⁴ Id.

²³⁵ Id.

²³⁶ Id. at 31-32.

²³⁷ Id. at 32.

²³⁸ Auvinen et al., supra note 181, at 1.

²³⁹ Crawford et al., supra note 39 at 35. These discounts are known as the Double Up Food Bucks (DUFB) Program. Many Americans who do not receive SNAP benefits would benefit from produce prescriptions. This Article proposes produce prescriptions for a much larger number of Americans through Medicare, Medicaid, and CHIP.

²⁴⁰ See generally Get more fruits and veggies at Grocery Stores with Double Up!, Double Up Oregon (last visited Oct. 26, 2022), https://doubleuporegon.org/grocery-stores/ [https://perma.cc/7B5Y-4SBR].

²⁴¹ Exploring the Causes of State Variation in SNAP Administrative Costs, USDA Food & Nutrition Serv., https://www.fns.usda.gov/snap/exploring-causes-state-variation-snap-administrative-costs [perma.cc/7523-9JRG] (June 26, 2019).

²⁴² WIC Food Packages - Maximum Monthly Allowances, USDA Food & Nutrition Serv., fns.usda.gov/wic/food-packages-maximum-monthly-allowances [perma.cc/66YN-2AC3] (Oct. 5, 2015).

²⁴³ See generally USDA, WIC Farmers’ Market Nutrition Program (2021), https://www.fns.usda.gov/fmnp/fact-sheet-2021 [perma.cc/G9D5-8YVQ].

²⁴⁴ Id.

²⁴⁵ This program benefits pregnant women as well as infants and children within the WIC program. Many other Americans would benefit from produce prescriptions.

²⁴⁶ Katie Garfield et al., Produce Prescriptions: A U.S. Policy Scan 15 (Harvard L. Sch. Ctr. for Health L. & Pol’y Innovation 2020). This program helps people purchase food at farmers markets, but does not assist with food purchases at brick-and-mortar grocery retailers.

²⁴⁷ Jim Krieger & Kirsten Leng, Healthy Food Pricing Incentives: Designing Successful Programs 8 (Healthy Food Am. 2019).

²⁴⁸ U.S.D.A Food and Nutrition Serv., WIC Farmers’ Market Nutrition Program (FMNP) 1 (2020), https://www.fns.usda.gov/fmnp/wic-fmnp-profiles-grants-and-participation [https://perma.cc/3PPD-FH74].

²⁴⁹ Id.

²⁵⁰ See, generally Kristin Smith, Fewer Than Half of WIC-Eligible Families Receive WIC Benefits (Univ. N.H. Carsey Sch. of Pub Pol’y 2016).

²⁵¹ For a discussion on food labeling, see generally Sunstein, supra note 83, at 78-80.

²⁵² Mark Bittman et al., How a national food policy could save millions of American lives, Wash. Post (Nov. 7, 2014), https://www.washingtonpost.com/opinions/how-a-national-food-policy-could-save-millions-of-american-lives/2014/11/07/89c55e16-637f-11e4-836c-83bc4f26eb67_story.html [https://perma.cc/D7LH-Q7PS].

²⁵³ See, e.g., Zoë Neuberger, WIC Coordination With Medicaid and SNAP State WIC Programs Can Reach More Eligible Families by Collaborating With Other Major Programs That Serve Low-Income Families With Young Children 1 (Ctr. on Budget and Pol’y Priorities 2021).

²⁵⁴ Id. at 2.

²⁵⁵ Id.

²⁵⁶ See generally Lucie Schmidt et al., Safety Net Program Interactions and Impacts on Low-Income Families, 4 Nat’l Bureau of Econ. Res. 10 (2021), https://www.nber.org/reporter/2021number4/safety-net-program-interactions-and-impacts-low-income-families [https://perma.cc/E8B2-WW5P].

²⁵⁷ Suzanne Macartney & Robin Ghertner, Off. of Assistant Sec’y for Plan. & Evaluation, Dep’t of Health & Hum. Serv., Many Children in HHS Safety Net Programs Are Eligible for Nutrition Assistance But Are Not Enrolled (2022), https://aspe.hhs.gov/reports/hhs-programs-wic-snap [https://perma.cc/8F2W-6GH8].

²⁵⁸ For an explanation of opt-in and opt-out policies in general, see generally Richard H. Thaler & Cass R. Sunstein, Nudge: Improving Decisions About Health, Wealth, and Happiness 86, 109-110 (Yale Univ. Press, 2008).

²⁵⁹ Auvinen et al., supra note 181, at 11.

²⁶⁰ White, supra note 103, at 367.

²⁶¹ Id.

²⁶² See generally id.

²⁶³ Id.

²⁶⁴ Id.

²⁶⁵ Id.

²⁶⁶ Id.

²⁶⁷ Hennessee, supra 80, at 13.

²⁶⁸ Id. at 17.

²⁶⁹ See id.

²⁷⁰ Mozaffarian et al., supra note 125, at 4.

²⁷¹ Wuest Interview, supra note 313.

²⁷² Id.

²⁷³ Krieger & Leng, supra note 260, at 6.

²⁷⁴ Id.

²⁷⁵ Rodriguez et al., supra note 78, at 17-18. Many nutritional education programs have historically focused on diets from a white cultural perspective. This creates additional barriers for participants with other cultural backgrounds. Instead, nutritional education programs should focus on improving overall diet within the context of differing cultural and cuisine perspectives and contexts.

²⁷⁶ Lee et al., supra note 212, at 2-3.

²⁷⁷ Diane Whitmore Schanzenbach, Pros and Cons of Restricting SNAP Purchases, Brookings: Testimony (Feb. 16, 2017), https://www.brookings.edu/testimonies/pros-and-cons-of-restricting-snap-purchases/ [https://perma.cc/9DQ5-CBV8 ].

²⁷⁸ Id.

²⁷⁹ Id.

²⁸⁰ Id.

²⁸¹ Hennessee, supra note 80, at 14.

²⁸² White, supra note 103, at 366.

²⁸³ Hennessee, supra note 80, at 5.

²⁸⁴ Rodriguez et al., supra note 78, at 13.

²⁸⁵ Krieger & Leng, supra note 260, at 8.

²⁸⁶ Id.

²⁸⁷ See Trapl Dietary, et al., supra note 91, at 5.

²⁸⁸ Haley Swartz, Produce Rx Programs for Diet-Based Chronic Disease Prevention, Am. Med. Ass’n J. of Ethics 960, 967 (2021), https://journalofethics.ama-assn.org/sites/journalofethics.ama-assn.org/files/2018-10/org2-1810.pdf [https://perma.cc/Y9HE-GG3H].

²⁸⁹ Id.

²⁹⁰ Id. at 967.

²⁹¹ Krieger & Leng, supra note 260, at 6.

²⁹² Hennessee, supra note 80, at 8-9.

²⁹³ Id. at 9.

²⁹⁴ Ctr. for Medicare & Medicaid Serv., Opportunities in Medicaid and CHIP to Address Social Determinants of Health (SDOH) (Ctr. for Medicare & Medicaid Serv. 2021) at 1.

²⁹⁵ Lucas et al., supra note 126, at 462.

²⁹⁶ Id.

²⁹⁷ Id.

²⁹⁸ Rodriguez et al., supra note 78, at 14-15.

²⁹⁹ Krieger & Leng, supra note 260, at 6.

³⁰⁰ Lucas et al., supra note 126, at 462.

³⁰¹ Id.

³⁰² See generally id.

³⁰³ See generally An Updated Look at Rates of Churn and Continuous Coverage in Medicaid and CHIP 1 (The Medicaid and CHIP Payment and Access Comm’n 2021) https://www.macpac.gov/wp-content/uploads/2021/10/An-Updated-Look-at-Rates-of-Churn-and-Continuous-Coverage-in-Medicaid-and-CHIP.pdf [https://perma.cc/CZS7-SWQT].

³⁰⁴ Interview with Thomas K. Wuest, Ret. Chief Medical Officer, Trillium Cmty. Health Plan, in Eugene, Or. (Nov. 4, 2021) [hereinafter “Wuest Interview].

³⁰⁵ Auvinen et al., supra note 181, at 1, 9.

³⁰⁶ Wuest Interview, supra note 313.

³⁰⁷ Id.

³⁰⁸ Daniel Kahneman, Thinking, Fast and Slow 414 (2011).

³⁰⁹ White, supra note 103, at 366; Cavanagh et al., supra note 15, at 2636-37.

³¹⁰ Garfield et al., supra note 12, at 4.

³¹¹ Hennessee, supra note 80, at 3.

³¹² Swartz, supra note 290, at 961.

³¹³ U.S. Dep’t. Health & Hum. Servs., Ctrs. For Medicare & Medicaid Servs., Accountable Health Communities Model (2017), https://innovation.cms.gov/files/worksheets/ahcm-screeningtool.pdf [https://perma.cc/V8SM-REAU].

³¹⁴ Lucas et al., supra note 126, at 461.

³¹⁵ See Garfield et al., supra note 12, at 1.

³¹⁶ Garfield et al., supra note 12, at 1.

³¹⁷ Krieger & Leng, supra note 260, at 3.

³¹⁸ Id.

³¹⁹ Id.

³²⁰ Id.

³²¹ Id.

³²² Id.

³²³ Trapl et al., Mixed, supra note 94, at 530.

³²⁴ Id.

³²⁵ Id.

³²⁶ Burrington et al., supra note 110, at 1.

³²⁷ Crawford et al., supra note 39, at 33.

³²⁸ Cavanagh et al., supra note 15, at 2637.

³²⁹ Diana Cassady et al., Is Price a Barrier to Eating More Fruits and Vegetables for Low-Income Families?, 107 J. of the Am. Dietetic Ass’n 1909, 1910 (2007).

³³⁰ Id.

³³¹ Id.

³³² Id.

³³³ Mozaffarian et al., supra note 125, at 4.

³³⁴ Wuest Interview, supra note 313.

³³⁵ Id.

³³⁶ Krieger & Leng, supra note 260, at 10.

³³⁷ Ctr. for Medicare & Medicaid Serv., supra note 68, at 10.

³³⁸ Ctr. for Medicare & Medicaid Serv., Chronic Conditions Charts: 2018 (Ctr. for Medicare & Medicaid Serv. 2021) https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Chartbook_Charts [https://perma.cc/9RSP-NZ3S].

³³⁹ Garfield et al., supra note 12, at 15.

³⁴⁰ Id. at 16.

³⁴¹ 42 U.S.C.S. § 1395x(s)(2) (LexisNexis 2022).

³⁴² Garfield et al., supra note 12, at 16.

³⁴³ Id.

³⁴⁴ Id.

³⁴⁵ Id. at 15.

³⁴⁶ Id. at 16.

³⁴⁷ Id. at 15.

³⁴⁸ Id. at 20.

³⁴⁹ Id. at 15.

³⁵⁰ Id.

³⁵¹ See id.

³⁵² Id. at 15-16.

³⁵³ Id. at 15.

³⁵⁴ Id.

³⁵⁵ Id.

³⁵⁶ Id. at 16.

³⁵⁷ Id.

³⁵⁸ Id.

³⁵⁹ Id.

³⁶⁰ Id.

³⁶¹ Id.

³⁶² Id.

³⁶³ Id.

³⁶⁴ Id. at 23.

³⁶⁵ Sunstein, supra note 149, at 335.

³⁶⁶ See, Feldstein, supra note 41, at 136. Medicaid is a state-administered program. While the federal government pays between fifty and seventy-four percent of the costs of the program for each state, a substantial portion of the program cost is ultimately carried by states.

³⁶⁷ Garfield et al., supra note 12, at 24.

³⁶⁸ Meredith Freed et al., Medicare Advantage in 2022: Enrollment Update and Key Trends (Kaiser Fam. Found. 2022) https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2022-enrollment-update-and-key-trends/.

³⁶⁹ Feldstein, supra note 41, at 115.

³⁷⁰ Garfield et al., supra note 12, at 24.

³⁷¹ Vrushab Gowda et al., PRODUCE PRESCRIPTIONS as a Novel Supplemental Benefit in Medicare Advantage 1 (Harvard L. Sch. Ctr. for Health L. & Pol’y Innovation 2022).

³⁷² Id.

³⁷³ Id. at 2.

³⁷⁴ Id. at 4.

³⁷⁵ Id. at 2.

³⁷⁶ Id. at 3-4.

³⁷⁷ Ctr. for Medicare & Medicaid Serv., Fast Facts, supra note 62.

³⁷⁸ Garfield et al., supra note 12, at 14 n.74 (citing Cornelia Hall et al., Food Insecurity and Health: Addressing Food Needs for Medicaid Enrollees as Part of COVID-19 Response Efforts, Kaiser Family Found. (Aug. 14, 2020), https://www.kff.org/report-section/food-insecurity-and-health-addressing-food-needs-for-medicaid-enrollees-as-part-of-covid-19-response-efforts-issue-brief/).

³⁷⁹ Status of State Medicaid Expansion Decisions: Interactive Map, Kaiser Fam. Found. (Nov. 9, 2022), https://www.kff.org/medicaid/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ [https://perma.cc/J43C-K4VJ ].

³⁸⁰ Id.

³⁸¹ Garfield et al., supra 12 at 16.

³⁸² Id.

³⁸³ 42 U.S.C.S. § 1396d(a)(13) (LexisNexis 2022).

³⁸⁴ Garfield et al., supra 12 at 16.

³⁸⁵ Id. at 15.

³⁸⁶ Id.

³⁸⁷ Including produce prescriptions within the definition of rehabilitative services would help patients who already suffer from a chronic disease; however, rehabilitative services would not cover patients who have not yet developed a disease.

³⁸⁸ Swartz, supra note 290, at 968 (discussing the need for substantial policy cohesion in order to adequately and consistently fund produce prescription programs).

³⁸⁹ Garfield et al., supra note 12, at 16.

³⁹⁰ See Ctr. for Medicare & Medicaid Serv., supra note 296, at 10.

³⁹¹ Garfield et al., supra note 12, at 21.

³⁹² Ctr. for Medicare & Medicaid Serv., supra note 296, at 10; Medicaid.gov, About Section 1115 Demonstrations, https://www.medicaid.gov/medicaid/section-1115-demonstrations/about-section-1115-demonstrations/index.html (last visited Oct. 25, 2022) [https://perma.cc/9T8K-FT47 ].

³⁹³ Id.

³⁹⁴ Id.

³⁹⁵ Garfield et al., supra note 12, at 4.

³⁹⁶ N.C. Dep’t of Health & Hum. Serv., Healthy Opportunities Pilots, https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/healthy-opportunities-pilots (last visited Oct. 25, 2022) [https://perma.cc/DGK4-HE9Q ].

³⁹⁷ MassHealth Medicaid and CHIP Section 1115 Demonstration, 118-119 (Ctr. for Medicare & Medicaid Serv. 2022) https://www.mass.gov/doc/masshealth-extension-approval/download [https://perma.cc/6ZTA-KMT8 ].

³⁹⁸ Garfield et al., supra note 12, at 21. (Section 1115 waivers allow states to test new approaches to Medicaid delivery).

³⁹⁹ Id.

⁴⁰⁰ Id.

⁴⁰¹ Id. at 22.

⁴⁰² Id. at 23.

⁴⁰³ Id. at 23.

⁴⁰⁴ Id. at 22-23.

⁴⁰⁵ Ctr. for Medicare & Medicaid Serv., Enrollment, supra note 22, at 3.

⁴⁰⁶ Feldstein, supra note 41, at 138-39.

⁴⁰⁷ The Children’s Health Insurance Program (CHIP), Health care.gov, https://www.healthcare.gov/medicaid-chip/childrens-health-insurance-program/ (last visited Oct. 24, 2022) [https://perma.cc/ADR3-6265 ].

⁴⁰⁸ 42 U.S.C.S. § 1397aa (LexisNexis 2022).

⁴⁰⁹ 42 U.S.C.S. §§ 1397aa-1397mm (LexisNexis 2022).

⁴¹⁰ 42 U.S.C.S. § 1397aa(a) (LexisNexis 2022).

⁴¹¹ See generally 42 U.S.C.S. § 1397bb (LexisNexis 2022).

⁴¹² 42 U.S.C.S. § 1397bb(b)(1) (LexisNexis 2022).

⁴¹³ See generally 42 U.S.C.S. § 1397dd (LexisNexis 2022).

⁴¹⁴ Financing, Medicaid.gov, https://www.medicaid.gov/chip/financing/index.html (last visited Oct. 24, 2022) [https://perma.cc/5V5F-RF9B ].

⁴¹⁵ 42 U.S.C.S. § 1397aa (LexisNexis 2022); CHIP State Program Information, Medicaid., https://www.medicaid.gov/chip/state-program-information/index.html gov (last visited Oct. 24, 2022) [https://perma.cc/AMB7-4TVH ]; Key CHIP design features, The Medicaid and CHIP Payment and Access Comm’n, https://www.macpac.gov/subtopic/key-design-features/ (last visited Oct. 24, 2022) [https://perma.cc/L894-NNV2 ].

⁴¹⁶ 42 U.S.C.S. § 1397cc (LexisNexis 2022).

⁴¹⁷ Id.

⁴¹⁸ 42 U.S.C.S. § 1397aa (LexisNexis 2022)

⁴¹⁹ Id.

⁴²⁰ Id.

⁴²¹ 42 U.S.C.S. § 1397jj (LexisNexis 2022).

⁴²² Id.

⁴²³ 42 U.S.C.S. § 1397jj(a)(24) (LexisNexis 2022).

⁴²⁴ 42 U.S.C.S. § 1397jj(a)(28) (LexisNexis 2022).

⁴²⁵ CMS Issues New Roadmap for States to Address the Social Determinants of Health to Improve Outcomes, Lower Costs, Support State Value-Based Care Strategies, Ctr. for Medicare & Medicaid Serv. (Jan. 7, 2021) https://www.cms.gov/newsroom/press-releases/cms-issues-new-roadmap-states-address-social-determinants-health-improve-outcomes-lower-costs [https://perma.cc/5QSC-YD4A ].

⁴²⁶ Id.

⁴²⁷ Garfield et al., supra note 12, at 19.

⁴²⁸ Id.

⁴²⁹ Chiquita Brooks-LaSure & Daniel Tsai, A Strategic Vision for Medicaid And The Children’s Health Insurance Program (CHIP), Health Aff. Blog (Nov. 16, 2021). https://www.healthaffairs.org/do/10.1377/forefront.20211115.537685/ [https://perma.cc/4F4G-JF3J ].

⁴³⁰ Letter from Anne Marie Costello, Acting Deputy Adm’r and Dir., Dep’t of Health & Hum. Servs. to State Health Official (Jan. 7, 2021).

⁴³¹ Ctr. for Medicare & Medicaid Serv., supra note 296, at 10, 19.

⁴³² Id. at 31-32.

⁴³³ See Garfield et al., supra note 12, at 14; Hennessee, supra 80, at 14, 17.

⁴³⁴ See, e.g., id. at 13-14 (describing the Gus Schumacher Nutrition Incentive Program).

⁴³⁵ The United States Department of Agriculture has historically focused heavily on agricultural and farming interests. While these interests are important, the focus of produce prescriptions is on the health care impacts of food rather than the agricultural impacts. The USDA should adapt its own policies to help American farmers to sustainably meet the increased fruit and vegetable demand from this policy.

⁴³⁶ Hennessee, supra note 80, at 14.

⁴³⁷ See Garfield, supra note 259, at 12.

⁴³⁸ Auvinen et al., supra note 181, at 11.

⁴³⁹ See, e.g., Neuberger, supra note 261, at 5-6.

⁴⁴⁰ Hennessee, supra note 80, at 17.

⁴⁴¹ Sunstein, supra note 83, at 80.

⁴⁴² Id.

⁴⁴³ Auvinen et al., supra note 181, at 1.

⁴⁴⁴ Susan L. Moffitt, Making Policy Public: Participatory Bureaucracy in American Democracy xii, 224 (Cambridge Univ. Press 2014).

⁴⁴⁵ White, supra note 103, at 366.

⁴⁴⁶ Rodriguez et al., supra note 78, at 9.

⁴⁴⁷ Feldstein, supra note 41, at 125.

⁴⁴⁸ Id. at 149.

⁴⁴⁹ Id. at 120.

⁴⁵⁰ Lee et al., supra note 212, at 7-81.

⁴⁵¹ Helena Bottemiller Evich, Bipartisan Nutrition Group Kicks off in House, Politico (Jan. 22, 2018), https://www.politico.com/story/2018/01/22/bipartisan-nutrition-group-kicks-off-in-house-354850 [https://perma.cc/Y9B2-Z7NJ].

⁴⁵² Press Release, Sen. Rob Portman, Portman, Wyden Introduce Bill to Help Lower Medicare Costs by Keeping Seniors Healthy, (Mar. 28, 2012), https://www.portman.senate.gov/newsroom/press-releases/portman-wyden-introduce-bill-help-lower-medicare-costs-keeping-seniors [https://perma.cc/UBX2-85LC ].

⁴⁵³ Garfield et al., supra note 12, at 4.

⁴⁵⁴ Press Release, USDA NIFA Invests $40M to Improve Dietary Health and Reduce Food Insecurity, (June 1, 2022), https://www.nifa.usda.gov/about-nifa/press-releases/usda-nifa-invests-40m-improve-dietary-health-reduce-food-insecurity [https://perma.cc/F77S-VDP6 ].

⁴⁵⁵ Garfield et al., supra note 12, at 16.

⁴⁵⁶ This is the economic concept known as substitution.

⁴⁵⁷ Hennessee, supra note 80, at 16.

⁴⁵⁸ Auvinen et al., supra note 181, at 10.

⁴⁵⁹ Hennessee, supra note 80, at 16.

⁴⁶⁰ Garfield et al., supra note 12, at 11.

⁴⁶¹ The section of this Article entitled “Funding” discusses current economic research and limitations.

⁴⁶² See Feldstein, supra note 41, at 112.

⁴⁶³ Hennessee, supra note 80, at 17.

⁴⁶⁴ Ctr. for Medicare & Medicaid Serv., supra note 296, at 10, 19. Garfield et al., supra note 12, at 16.

⁴⁶⁵ Garfield et al., supra note 12, at 19.

⁴⁶⁶ Id. at 17-18.

⁴⁶⁷ Tamara Dubowitz, Food Insecurity Among Veterans: Veterans’ Issues in Focus (Rand Corp. 2021) https://www.rand.org/pubs/perspectives/PEA1363-2.html [https://perma.cc/GB9Q-K9MQ ].

⁴⁶⁸ Garfield et al., supra note 12, at 18-19.

⁴⁶⁹ Id. at 15.

⁴⁷⁰ Hennessee, supra note 80, at 14. This would increase the demand for fruit and vegetables and therefore benefit the agricultural community.

⁴⁷¹ Karen Bishop, Veggie Rx: Using Food as Medicine: It’s Not Just About More Food: It’s About the Right Kind of Food, Better the Future (Nov. 10, 2020), https://betterthefuture.org/veggie-rx-using-food-as-medicine/ [https://perma.cc/NSM4-LLJR ]. Farmers markets have created similar incentive programs under SNAP such as “Double Up Food Bucks” programs where SNAP benefits have additional purchasing power.

⁴⁷² Id.

⁴⁷³ White, et al., supra note 103, at 366.

⁴⁷⁴ Rodriguez et al., supra note 78, at 7.

⁴⁷⁵ Hough, supra note 145, at 116.

⁴⁷⁶ Id.

⁴⁷⁷ Id.

⁴⁷⁸ Hennessee, supra note 80, at 15.

⁴⁷⁹ Swartz, supra note 290, at 966.

⁴⁸⁰ Cavanagh et al., supra note 15, at 2639.

⁴⁸¹ Id.

⁴⁸² Jones et al., supra note 183, at 4. This program included healthy traditional foods that fit well with the community.

⁴⁸³ Id.

⁴⁸⁴ Hennessee, supra note 80, at 15.

⁴⁸⁵ See generally Jennifer M. Taber et al., Why do People Avoid Medical Care? A Qualitative Study Using National Data, 30 J. Gen. Internal Med. 290-297. (2014)