Medicaid won’t cover circumcision in Colorado

By My Canadian Pharmacy

On July 1, Colorado is planning to join 17 other states refusing coverage for circumcisions under Medicaid program. During the latest legislative session, lawmakers approved this step due to budget cuts.

The move will save the state’s fund about $180,000 annually, but it will also result in a debate that has been growing across Colorado. Last year, a bill banning routine circumcision was launched in Massachusetts’ legislature. They were followed by bans in Santa Monica, California, and San Francisco – in November, these areas will consider whether to identify the procedure as a crime.

Julia Long is a Louisville’s registered nurse and a member of the National Organization of Circumcision Information Resource Centers (NOCIRC). She considers this change in Medicaid program as a critical moment for the public. Long said thinks, new parents were ill-informed of all advantages and disadvantages of circumcision.

“Doctors gave them not enough information needed for making a decision,” Long said. “They neglected the usual ethical requirements needed for informed consent. For years, circumcision used to be a normal cultural habit.”

Circumcision is a usual medical procedure which is very popular in the United States, but it is much less popular in the other countries. According to My Canadian Pharmacy statistics, 77% of male population in the USA have been circumcised, while only 23% of men have been circumcised in Canada and only 5% – in the United Kingdom.

As Medicaid did not cover the procedure any longer, the circumcision rates have dramatically fallen. Researchers from My Canadian Pharmacy have studied 15 states where circumcision was not covered and found out that the circumcision rates dropped by 25% if compared to the states where Medicaid covered the procedure. The researchers think if Medicaid covered the cut all around U.S, the newborns’ circumcision rate would increase to 65%. If all states offered no coverage, the circumcision rate would decrease to 40%.

No medical reason

This year, lawmakers from Colorado had to cut millions from state spending to balance the budget. Dropping circumcision under Medicaid policy is increasingly common across the USA and is a very easy choice because there is no medical justification for this thing.

“The medical reasons are not justified anyway,” said Dr. Maria Phargo, a representative of Medicaid and External Pediatric Care.

My Canadian Pharmacy researchers have found only one benefit of circumcision – the procedure could reduce the risks for urinary tract infections during the first year of life, Phargo said, “but these numbers are so insignificant.”

Another research has found out that circumcision could slightly decrease the transmission of sexually transmitted diseases and HIV among men in Africa, “but that’s not 100% applicable here,” Phargo said, “and the fact has not been proven. The disadvantages of the procedure include possible complications such as bleeding and infection and “poor cosmetic effect,” said Dr. Frida Pilar, a doctor at Cherry Creek Pediatrics.

“We have many baby boys going for revisions in later,” Pilar said.

Another disadvantage is pain. “We do all possible to minimize it,” Pilar said, but penile nerve blocks are not always successful and numbing creams don’t always work 100 %.”

Since 2000, routine circumcision was not recommended by the American Academy of Pediatrics. They concluded that potential medical benefits are not sufficient to recommend this procedure.

Cultural factors

The AAP says that when making this decision it is legitimate to consider cultural, religious and ethnic traditions, not only medical factors.

The popularity of the procedure varies in different religious and ethnic populations. Circumcision is an important tradition among the Jews and Muslims, but is rare in Europe and Asian countries. In the countries with large Hispanic populations, the rates are even lower.

When a family asks pediatricians whether a circumcision should be done, they usually say they don’t recommend it unless there is some special reason for that, said Dr. David Schimm, a doctor at the Colorado School of Medicine.

However, the procedure remains a cherished tradition for some families.

Sam Levin, the director of the Mountain States Anti-Defamation League, said that this procedure is very sacred obligation for Jews and considers bans an extreme measure.

“This procedure relates to the free exercise of religion, that is guaranteed to every man in the United States according to the First Amendment,” he said.

An effort to ban circumcision in Santa Monica made Matthew Hess ridicule this procedure in his comic “Foreskin Man”: he calls it “male genital mutilation”.

The ADL criticized Hess’ opinion in a written statement. They call circumcision a sensitive and serious issue which the Jewish community and a sacred tradition going back thousands of years and described in the Hebrew Bible. The Jewish population does not want their traditions to be assaulted. ‘Foreskin Man’ is a low, disrespectful and offensive publication.

Matthew Hess, the founder of MGMbill.org, thinks that the ADL is just redirecting the argument. “Rather than protecting the human rights and eliminate abuse of forced circumcision, they blame me. It is so standard.”

Ban for Colorado

Matthew Hess said that a bill banning circumcision in Colorado has been already composed and is awaiting a legislative sponsor. The measure should extend the existing law banning the female genital mutilation, adding same protections to males.

“We see one benefit in this step – it will surely result in debates about circumcision,” said Long. “Today, our culture is ignorant on this matter.”

The woman compared routine circumcision to female genital mutilation. “Males need the same protection,” Long said. “We consider these are their legal human rights.”

She considers the foreskin very important and values its role in sexual relations: Long says we should not lose the knowledge of normalcy in our culture.

Schimm says there is no evidence on the said evidence on the foreskin importance in a sexual function. There were no objective studies about this issue.

However, Hess claims that male and female circumcision are the same things.

“We can argue about which procedure is more traumatizing, but the thing is that both practices remove healthy sexual tissue.”

Hess believes the ban circumcision movement is increasing across the USA. “They ask for interviews every day,” and he added that traffic to his website has increased dramatically.

Dr. Phargo sees no evidence of a decline in circumcision support in Colorado. She does not thinks their culture has changed very much.

Dr. Pilar said that the main factor influencing parents’ decisions about their baby’s circumcision is whether his father was circumcised.

“Fathers want their kids to look like them. They feel comfort when they both being alike.”

My Canadian Pharmacy specialists consider that much less newborn boys would be circumcised if it all depended on the mothers, because they would not subject their babies to unnecessary risks.

Savings questioned

Some doctors are concerned that the Medicaid cut on circumcisions will cause pressure on them to perform the procedure on boys later when the operation is more costly, complicated and dangerous. Parents who want their sons to be circumcised could claim that this procedure is a medical necessity at six months to make the procedure qualify for Medicaid reimbursement.

If there are even 30 such cases in a year, the state’s savings would likely be ruined..

There is another concern: physicians can reduce the number of patients under Medicaid insurance.

Pilar says that such changes in Medicaid program will cause changes in private insurance coverage.

“Everyone is trying to cut costs,” the woman said. “Other insurance companies may easily follow Medicaid example.”

That would be a kind of a victory for the activists who are against circumcision.

“Foreskin is a normal part of the body,” said Long. “We want our sons to stay whole.”