By Katie Kerwin McCrimmon
A bill that would have restored Medicaid funding for circumcisions 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.
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.
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 agains 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.”
Correction: An earlier version of this story incorrectly stated that the Senate Bill 12-090 passed in the House Appropriations Committee. That was incorrect. Committee members voted 8-to-4 to kill the bill.
Those doctors who think carving and off the flesh of children to reflect as billboards of another’s beliefs is criminal. And deserving my disgust come every March 30 -National Doctor Appreciation Day. Blessings on that rightfully see genital cutting as a Human Rights violation.
http://www.jewsagainstcircumcision.com says it all. BTW, please tell Rep. Schaefer that it’s not the foreskin that causes pregnancy.
Good! My tax dollars shouldn’t have to pay for a procedure that I am morally opposed to.
Common sense prevails! Awesome!! Now to outlaw all non-therapeutic infant circ …
Ms. Shafer’s absurd comment that circumcision might lessen teen sexual activity and pregnancy is just the latest in ridiculous justifications for unnecessary genital alteration. It may seem she was being flippant, but I take her at her word that she means it. Her comment is resonant of the reasons given for circumcision by advocates in the 19th Century, who knew that it lessened sexual sensation, although not desire. It failed as a “cure” for masturbation and it certainly is no “cure” for teenage pregnancy. As to HIV and the Gates Foundation, such an argument just shows that even the smartest folks in one area can be completely deluded by bad science in another. In fact, rather than lessening HIV in Africa, there are reports that circumcision is encouraging irresponsible behavior. Newly circumcised men believe they are now immune to acquiring HIV and are not using condoms – a sure fire way to get HIV eventually. Funny, despite the highest circumcision rate in the industrialized world, the U.S. has the highest HIV rate and one of the highest, if not the highest, rates of teen pregnancy. In short, the proponents of Medicaid funding for a cultural ritual have shown their bias and lack of knowledge. Congratulations to those who voted against this irresponsible measure and saved the taxpayers dollars that will be better spent on child nutrition programs and other real necessities for which there are not nearly enough funds.
Thank god Colorado didn’t pass this bill. If you want to damage your child’s sexuality, you should at least have to pay for it yourself. What about that one woman who voted for the bill because she thought men having their full sexual sensations would lead to more teen pregnancies? Wow. Scary to think someone with those dangerous beliefs is in a position of authority.
Sen. Schafer’s proposal, that baby boys should have part of their genitals cut off (at public expense) to curb their sexuality in their teenage years, is interesting.
She follows in the footsteps of John Harvey Kellogg, whose advocacy of circumcision to prevent, “cure” or punish masturbation (successful only at the last of those) is what led to its widespread adoption in the USA.
Her proposal just underlines what circumcision has always been about – power and control.
If circumision were a medical procedure, there would be a diagnosis of defect or disease, and a record of less-destructive remedies attempted before jumping to the last-resort of amputation.
A couple of things disturb me in this article that is otherwise good news.
One is that a grown woman who appears in many ways to support equality is pondering the efficacy of sexual oppression. Cutting off body parts from all men in order to control their behavior, REALLY!? This is the kind of excuse they give when they cut the labia or clitoris from little girls. (you know, that “mutilation” that Americans like to be so abhorred by?)
The other is that while this issue is about MEDICAL SERVICES to be or not to be paid for by the taxpayers, Ms. Aguilar defends this payment while saying: “People make this decision based on religious and cultural reasons.” <—-That is NOT MEDICINE.