Lawmakers reconsider circumcision for babies on Medicaid

By Katie Kerwin McCrimmon

Circumcisions for low-income babies could once again be covered in Colorado after a bill seeking to restore funding moved forward Tuesday in the Senate.

Circumcision has become a polarizing issue in Colorado after the legislature last year voted to make Colorado the 18th state to ban Medicaid funding for the procedure. The state stopped paying for routine circumcisions last July.

Cost is not the primary point of contention. Circumcisions which cost about $200 to $400 each for low-income babies add up to a relatively small tab according to state fiscal analysts: about $195,000 next year and $230,000 the year after that.

Instead, activists on both sides are battling over whether the ancient practice of cutting an infant boys foreskin from the head of his penis is healthy. Opponents argue that the procedure is medically unnecessary, and elsewhere in the country, foes are trying to ban it altogether. Supporters believe circumcision should be a personal choice. They say it has health benefits including reduction of urinary tract infections in babies and prevention of HIV and AIDS among adults.

Debate over circumcision taps into deeply held personal and religious beliefs that often spark fights between new parents, medical professionals and lawmakers.

Sen. Joyce Foster, D-Denver, was alarmed to learn last summer that funding for circumcisions had been cut from Colorados Medicaid budget last year. So, this year, she introduced Senate Bill 12-90,which would restore the funding.

Its a fairness issue. Its a prevention issue. Its a social justice issue, Foster said. Ive always cared about low-income people. Ive worked my whole life in that arena. When a person is on Medicaid and they dont have the ability to make the same decisions that I do, thats unfair.

Foster also happens to be Jewish and her husband is the influential retired Temple Emanuel rabbi, Steven Foster. Ritual male circumcision is a fundamental tradition in Jewish culture.

Foster said her own religious views and those of her husband have nothing to do with her support for Medicaid funding of circumcision. She said traditional Jewish families typically dont opt for circumcisions in a hospital. Rather a religious leader called a mohel performs the circumcision either at home or in a temple when the baby is about eight days old.

This bill will have absolutely nothing to do with the Jewish community of Colorado, she said.

Mohels dont get reimbursement from Medicaid and Foster said that if a family cant pay for a religious circumcision, the community helps.

Foster said opponents of circumcision who are seeking to ban the procedure altogether would be abridging religious rights, not only for Jews, but also for others.

Some people dont want anybody to have it. That would be an attack not only on Jews, but on Christianity, which is based on Judaism, and on the Muslim community. If their goal is to infringe on my rights, thats where I take issue, Foster said.

With respect to babies on Medicaid, Foster said she is most persuaded by the medical evidence.

She said treatment of infant urinary tract infections in Colorado cost about $3.4 million from 2009-2010 when she says 147 baby boys had to be hospitalized. She also cited the work of the Bill and Melinda Gates Foundation, which is supporting circumcision in Africa to prevent the spread of HIV.

At an earlier hearing, Gillian Longley, a registered nurse from Louisville, was among those who testified against public funding for circumcision. She described routine circumcision of newborn boys as elective, non-therapeutic, cosmetic surgery.

It is neither medically necessary nor cost effective, Longley said.

Lawmakers in the Senate last week nixed an amendment that would have added funding for Medicaid circumcisions to the budget bill, known as the long bill. But, on Tuesday, the Senate Appropriations Committee voted to move the bill forward. Now it goes to the full Senate; then if it passes, on to the House.