There are many things that correlate with health status. Age is the greatest factor. Older is less healthy. Education is another. Poorly educated people have lower health status than more highly educated people. Wealth is also correlated with health. Lower income people have higher rates of obesity, diabetes, hypertension, high cholesterol, heart disease, strokes, and dementia, to name just a few conditions. In addition to income and education, other factors that affect health status include marital status, family structure, school quality, neighborhood quality, air quality, housing quality, nutrition quality, and possibly hundreds of other variables. These are called the social determinants of health (SDoH).
A question that public health advocates and social scientists want to discover is which of these SDoH correlations are mere associations and which are causal. It is obvious why health status declines with age but why does health status rise with education? Would free college make Americans healthier? Probably. How about income? Would giving away free money to poor people make Americans healthier? Maybe not. If so, would the benefits persist past the first several years and then regress back to the mean once the newness had wears off? Probably, but nobody knows.
Left-leaning advocates for the poor research these types of questions to bolster their argument for increasing social safety net spending. Most would welcome turning the United States into a Welfare State. A more immediate goal of left-of-center policymakers is to discover which interventions – both medical and nonmedical – positively affect the social determinants of health. For example, some states are looking at whether housing for the homeless would reduce Medicaid costs and by how much. One of the biggest medical expenses for homeless people is emergency room visits, and hospital stays. Past research has found that people who are housing insecure have longer hospital length of stay since they have nowhere to go and nobody to care for them when discharged. Comparable results are claimed for people who are food insecure. That is, meals on wheels for old, poor, sick people are correlated with lower medical spending. But does that mean that a program to provide meals delivered or old, poor people would save money for Medicare and Medicaid? Possibly not but the target population would have to be chosen carefully.
State Medicaid officials want access to federal matching funds for selected nonmedical interventions. They argue that some non-medical interventions are money-saving investments that reduce Medicaid costs and therefore should be partly covered by the federal government. Many Medicaid officials believe they can reduce or slow Medicaid spending if they can identify health-related social needs (HRSN), including nonmedical interventions that positively affect the social determinants of health.
Are there nonmedical interventions that reduce medical sending? Probably. Whether or not these are amenable to policy interventions is another question entirely. I am skeptical that there are any silver bullet nonmedical programs that really reduce Medicaid spending more than they cost when broadly applied. That sounds too much like the chorus of people who used to say (and still argue) that prevention saves money. It does not. There are only a handful of preventive medical services that are actually money saving. Most have positive costs per life-year saved. If the vast majority of preventive medical interventions do not save money when broadly applied, it is even less likely that non-medical interventions would save money if applied broadly.
The Trump Administration agrees with me (or perhaps, I agree with the Trump Administration). The following is from Health Affairs:
In early March 2025, the Centers for Medicare and Medicaid Services (CMS) under the Trump administration abruptly rescinded its multiyear guidance framework on health-related social needs (HRSN), eliminating a long-evolving roadmap for states seeking to address social determinants of health (SDoH) through Medicaid programs.
The rescinded CMS guidance provided critical regulatory clarity for health care organizations and managed care plans making these investments. Its removal creates uncertainty that will chill innovation and prevent scaling of cost-effective interventions that can reduce downstream health care costs.
Basically, the Trump Administration saw HRSN guidance as unlikely to reduce spending and likely to do the opposite. States are still free to invest their own funds into these types of programs, just without clear guidance explaining which ones the federal government will help pay for.
Read more at Health Affairs: Rescinding Health-Related Social Needs Guidance Undermines Trump’s Own Economic Goals