THE effort to restore Medicaid funding for circumcisions in Colorado passed its first legislative hurdle last week, with a 6-3 vote of the State Senate Health and Human Services Committee.
The Feb. 2 vote approved Senate Bill 12-090, titled “Restore Medicaid Funding for Circumcision,” co-sponsored by Senators Joyce Foster and Irene Aguilar.
The bill moves next to the Senate Appropriations Committee where it must pass before being debated in the entire Senate. It will likely be a month or so before Appropriations puts the bill up for a vote.
Last week’s hearing included public testimony both for and against the funding restoration. Several witnesses took advantage of the opportunity to express their feelings, less about the funding itself than about the alleged pros and cons of male circumcision itself.
Although the State Legislature cut the Medicaid funding for the procedure shortly before the end of last summer’s legislative session primarily for budgetary reasons – as part of an extensive drive to cut state spending in light of Colorado’s distressed budget – last week’s hearing quickly became a verbal battle over whether parents have the right to impose circumcision on their male infants and whether circumcision is a helpful or harmful practice.
The debate pitted supporters of circumcision, primarily medical professionals, against supporters of the so-called “intactivist” movement which is waging a legislative and legal campaign to restrict public funding for, and sometimes even outlaw, the practice of circumcision.
Last week’s hearing at the State Capitol demonstrated that although unsuccessful last year in several efforts to ban circumcision outright in California, the intactivists have not given up the fight, which has clearly arrived on Colorado’s doorstep.
SPEAKING to the Intermountain Jewish News last week, before the committee vote, the bill’s co-sponsor, Sen. Joyce Foster, emphasized that she is convinced that Colorado’s ban on Medicaid funding for circumcisions puts infant males at risk.
Foster cited studies indicating that circumcised males have a significantly lower risk of contracting HIV-AIDS during their lifetime than uncircumcised males.
According to a recent study commissioned by the Bill and Melinda Gates Foundation, the spread of AIDS in Africa could be cut by as much as 60% if all males were circumcised.
The foundation is backing up its words with money, launching a campaign to make circumcisions available on a wide scale in Africa.
The World Health Organization agrees with the Gates numbers, although it hasn’t kept statistics for Western countries.
The WHO also says the procedure helps ward off penile cancer, male urinary tract infections and other conditions.
Likewise, Foster cited evidence of a “dramatic” reduction in incidence of urinary tract infections among males who are circumcised.
In fiscal terms, Foster insisted that the state will end up footing the bill for many of these cases of HIV-AIDS and urinary tract infections, since many Medicaid patients are likely to use emergency rooms at public expense, more than obliterating any savings accrued by withdrawing Medicaid funding for circumcision.
She called it shortsighted fiscal policy, noting that the 2010 figure for Colorado’s matching funds for Medicaid funding of circumcision came to some $186,500.
Foster indicated further that since Colorado withdrew state funding last July — the 17th state to do so — the number of Medicaid-dependent families who choose circumcision has already declined, suggesting that the funding cut is discouraging families who cannot afford to pay for circumcisions on their own.
In her view, Medicaid funding for circumcision is not only a prevention issue in medical terms, but a fairness issue in terms of parental rights.
“The fairness issue is a social justice issue,” she said. “This is a choice issue for parents.”
When introducing her bill before her colleagues last week, Foster emphasized that argument.
“This should be about the family’s decision. We need to trust parents to make the best decisions for their children. It’s about the family’s decision to have, or not have, a circumcision . . . not about if you can afford it and not about what the neighbor thinks.”
At the Capitol, Foster compared funding for circumcisions to funding for vaccinations – not to force such procedures on the unwilling but to make them available for the willing.
“There is no way that we are going to tell a family or an individual that you must have this, even though we know that it is in their best interest,” Foster said.
“We are hoping that people will choose to have this procedure because the science is on our side, but if they choose not to, it’s their decision.”
AS last week’s hearing began taking pro and con public testimony, the debate quickly turned into a discussion over statistics, with each side tossing numbers at the other.
Proponents of the restoration of funding argued a variety of points, including their opinion that cutting Medicaid funding discriminates against the poor and minorities.
The proponents included physicians who stressed that HIV-AIDS transmission rates, as well as rates of urinary tract infections, with potential complications to the liver and blood system, are significantly higher in populations of uncircumcised males than those who are circumcised.
Some researchers also believe that uncircumcised males are at higher risk of getting penile cancer.
They characterized opponents’ claims that circumcision itself results in high rates of infection as a myth, and denied that the pain of the procedure can be highly traumatic for infants, insisting that modern anesthetic methods make circumcision virtually painless for babies.
These witnesses frequently referred to Africa, where the infamous AIDS epidemic provided them with an epidemiological data base.
Opponents countered that figures used by WHO and the Gates Foundation are skewed, not taking into account such factors as risky sexual behavior, which they say has a much greater impact on AIDS transmission than circumcision.
If uncircumcised males had such a greater chance of contracting AIDS, they argued, then why doesn’t Europe, with its majority population of uncircumcised males, have a significantly higher rate of AIDS transmission than the US, with its majority population of circumcised males?
Opponents countered proponents’ claims that restoring funding for circumcision will save the state money in the long term by insisting that the actual costs for circumcision — due to the state paying for treatment of complications after the procedure — is much higher than the $186,500 matching funds sum.
They testified that circumcision results in diminished sexual sensitivity for males, comparing it to genital mutilation among young females in some Third World countries.
They took the stance that parental choice should be less important than the state’s guarantee of the infant’s rights.
If it is illegal to remove an adult’s body part without that person’s permission, they argued, then why is it legal to remove a body part from an infant?
Many of the opponents’ arguments strongly suggested that intactivists are really contending for a California-like circumcision ban in Colorado, rather than arguing a budgetary fine point.
State budgetary concerns were only marginally discussed at the hearing.
In the flurry of conflicting numbers and statistics, it was clear that the hearing was delving into technical territory that, even among many health professionals, remains unclear and in dispute.
When Sen. Aguilar, co-sponsor of the bill to restore funding, was challenged by a fellow committee member on the ambiguity of much of the evidence, Aguilar – a physician by profession — responded in terms limited to Medicaid funding.
“There actually are a number of procedures that Medicaid pays for, for which there is not evidence that there is benefit,” Aguilar said.
“One of them is mammograms between the ages of 40 and 50. I think that if we were scratching funding for mammograms between the ages of 40 and 50 we would hear a lot of outrage. Another test that Medicaid pays for that is not medically proven is PSA testing for prostate cancer.
“I would put circumcision in that same category. There is strong evidence that it may be helpful, but the evidence that it’s harmful is pretty limited.”
ALTHOUGH the issue of religious rights was not even brought up at last week’s Capitol hearing, it is undeniably part of the debate, said Foster — the wife of Rabbi Steven Foster, emeritus rabbi of Temple Emanuel — in her comments to the IJN.
Many Jews and Muslims, and some Christians, see circumcision as a religious obligation, or at least as a cultural tradition. The fact that there is a national movement to ban circumcision can rightfully be seen as an abridgement of their religious rights, Foster told the IJN.
She pointed out that the prominent intactivist Matthew Hess, the author of an unsuccessful bill to ban circumcisions in Santa Monica, Calif. last year, supports a similar ban in Colorado.
Hess — the creator of “Foreskin Man,” a comic book that vilifies circumcision and that many readers felt was anti-Semitic – recently told local media that Colorado activists are seeking a legislative sponsor for a bill that would add male circumcision to an existing law banning female genital mutilation.
Foster told the IJN that some of the “pushback” she has recently received on the Medicaid-circumcision issue has included some “pretty mean-spirited” messages and calls that she suspects are motivated by anti-Semitism.
“I respect their perspectives, but I don’t respect their discriminatory comments,” Foster said.
“I think the ultimate goal of some people is to ban circumcision, period. Whatever I can do to enlighten the community with regard to prevention and fairness, and ultimately with regard to reducing medical costs, I’ll do it.”
Foster’s counterstrategy to the efforts of intactivists is based on the idea that taking a public stance in favor of circumcision now – through a reversal of the Medicaid funding cut – might help stave off later efforts to ban it in Colorado.
“I am primarily arguing on the basis of health and fairness,” she says, “but because of the potential ban in San Francisco and Massachusetts last year, as well as such efforts in other states, perhaps this can serve as a prevention of a potential ban in Colorado.”
While most Jews aren’t directly affected by the cut in Medicaid funding — since Jews traditionally call upon the mohel to perform circumcisions rather than Medicaid-supported physicians — Foster feels there’s a larger issue at stake.
“I don’t think it will really affect Orthodox communities because of Halachah, but we have to look out for everyone, not just for the Jewish community. We care about all people and we care about people’s rights.”
Copyright © 2012 by the Intermountain Jewish News