Medicaid Circumcision Funding Bill Dies in Colorado House

Posted on 05 May 2012.

By Katie Kerwin McCrimmon

A bill that would have restored funding for Medicaid circumcision in Colorado died Friday.

The measure squeaked through a hearing in the House Health and Environment Committee on Thursday, then died in Appropriations Friday morning.

Opponents, who included health professionals, budget hawks and anti-circumcision activists told health committee members on Thursday that circumcision is cosmetic and potentially harmful, and taxpayers should not fund it.

Proponents for the bill argued that funding for circumcision for babies on Medicaid is a social justice issue. In general, insurance companies pay for the procedure for insured Colorado babies even though the American Academy of Pediatrics does not deem circumcisions to be “medically necessary.” Meanwhile, low-income parents who want their babies circumcised are being put on waiting lists for the procedure until parents can prove they’ve paid in advance.

Sen. Irene Aguilar, D-Denver, an internal medicine doctor for Denver Health, testified on behalf of restoring public funding for circumcision. Last year, Colorado lawmakers decided to save money and cut funding for Medicaid circumcisions. They were following the lead of 17 other states. Proponents wanted taxpayers to once again pay for the procedures for parents who choose to have their infants circumcised. Doctors like Aguilar and hospitals like Denver Health would be the financial beneficiaries of the Medicaid payments proposed in this bill.

Fiscal analysts estimated that covering the procedures again would cost the state about $195,000 next year and $230,000 the year after that.

“As a physician, I don’t try to influence parents one way or the other,” Aguilar said. “People make this decision based on religious and cultural reasons.”

She said that there is some evidence that infant boys who don’t get circumcised have higher rates of urinary tract infections and that adult men who are uncircumcised and live in poverty tend to have increased rates of HPV, which can lead to higher rates of cervical cancer in female partners. However the American Academy of Pediatrics has stated in their 2012 Circumcision Policy Statement that circumcision is not likely to have any effect on cervical cancer rates in women.

Only one other doctor testified on behalf of circumcision. The rest of the witnesses opposed public funding for the procedure for a variety of reasons.

They included Dr. Jennifer Johnson, a family physician who works with Medicaid and uninsured patients at Clinica Family Health Services.

“I’ve done at least 100 circumcisions and just recently decided to stop,” Johnson testified.

Rep. Janak Joshi, R-Colorado Springs and Rep. Kay Schafer, D-Wheat Ridge. Joshi, a retired doctor, voted against the restoring circumcision. He said circumcision is uncommon in India and he’s never seen infections due to lack of circumcision. Schafer supported the bill. She asked a witness whether circumcision could help decrease teen pregnancy rates.

She said she and her husband, who is Jewish, decided not to circumcise their own son, who is now 4. She said she was concerned when she researched the issue and found that removing the foreskin from a boy’s penis damages numerous nerve endings. While circumcision is traditional in the Jewish community, Johnson said her husband was open to new research about the potential harms from circumcision.

If boys or men decide to remove the foreskin as adults, then they can make that decision, Johnson said. But she decided that as a physician, she should no longer do a procedure that is “potentially harmful.”

“This is not a necessary procedure,” Johnson said. “It’s a healthy, normal body part. There are a lot of medical needs in our population. We have no business using limited health care dollars on a medically unnecessary cosmetic procedure.”

One lawmaker, Rep. Sue Schafer, D-Wheat Ridge, elicited laughter in the hearing room when she asked Dr. Johnson if circumcision might help reduce teen pregnancy rates and teen sexual activity by reducing nerve sensation in boys’ penises.

“I’m wondering if there’s a risk of more sexual activity, more male irresponsibility” for uncircumcised boys, Schafer asked.

Johnson answered that teen pregnancy is certainly a problem, but said circumcision won’t halt teen sexual activity.

“Circumcision is not a cure for behavior. That’s about education,” she said.

She and others also testified that cutting off infant babies’ body parts is not the way to prevent urinary tract infections. She said she’s treated plenty of babies for infections and antibiotics are an easy answer.

“You don’t cut off part of a healthy penis to treat urinary tract infections,” Johnson said.

While circumcision is an ancient tradition in some religions, circumcision opponents said it became popular in the U.S. as a method to prevent masturbation among boys. Later, fathers wanted their sons to look like them.

“Frankly that’s cosmetic surgery…and I strongly urge you to vote against it,” said Dr. Matt Mason, a physician from Telluride. He was skeptical about cost estimates and said circumcision is now rare in Western Europe, Canada and New Zealand.

Supporters and opponents differed sharply on whether circumcision helps prevent HIV infection.

Dr. Jeremiah Bartley spoke on behalf of the Colorado chapter of the American College of Obstetrics and Gynecology.

He said new research is showing that circumcision helps stop the spread of certain viruses, especially HIV in Africa. He said the Bill and Melinda Gates Foundation has found beneficial effects of circumcision for adult African men and is now promoting the procedure.

Bartley said opponents to circumcision have spread a great deal of “misinformation.”

Ultimately, Bartley said coverage for the poor is an issue of fairness.

“It’s allowed under Medicaid. Those that are the most poor among us should have that option.”