Colorado has become the 18th American state to drop medically unnecessary circumcision from the schedule of medical benefits under the Medicaid program. The decision comes as a result of a campaign by human rights and child protection advocates to protect baby boys from genital cutting, and in response to the budgetary crisis affecting so many American public authorities. When there is little enough funds available for necessary medical procedures, it makes little sense to waste valuable health dollars on unnecessary and harmful operations that the recipients do not want.

Gillian Longley, a registered nurse in Louisville, looks at the change in Medicaid policy as a critical moment for public education surrounding the issue. She said that until recently, new parents were remarkably ill-informed of the pros and cons of circumcision. “Doctors were not giving them the information they needed to make a decision,” she said. “The usual ethical requirements for informed consent were overlooked. Circumcision was a cultural habit that was accepted as normal.”

Colorado lawmakers had to cut hundreds of millions from state spending to balance the budget this year. Halting Medicaid coverage for circumcision is increasingly common across the country and is a relatively easy choice because there is no medical justification for the procedure. “The medical reasons are not convincing either way,” said Dr. Susan Pharo, director of Medicaid and External Pediatric. Research has found a “tiny” benefit in terms of circumcision reducing the frequency of urinary tract infections in the first year of life, Pharo said, “but the numbers are so low it’s not significant.” Some research has found a slight decrease in the transmission of HIV and sexually transmitted diseases among circumcised men in sub-Saharan Africa, “but that’s not really applicable here,” Pharo said, “and the evidence is not strong either way.”

The risks of the procedure include relatively rare incidence of complications such as bleeding and infection and, more commonly, “poor cosmetic effect,” said Dr. Sarah Pilarowski, pediatrician at Cherry Creek Pediatrics. “We do have a lot of baby boys going in later for revisions,” she said. The No. 1 risk is pain. “We try to minimize it,” Pilarowski said, but penile nerve blocks don’t always work and numbing creams “are not 100 percent.”

In fact, the greatest risk of circumcision, experienced by all victims, is the loss of the foreskin, a normal body part that plays a significant role in sexual experience. As Gillian Longley comments, “This is a normal body part,” said Longley. “We are doing our sons a favor to support them to stay whole.” Pilarowski speculates that the changes in Medicaid policies will spark changes in private insurance coverage. “Everyone is looking to cut costs,” she said. “It’s very possible other insurance companies will follow suit.”

Source:  Diane Cameron, Unkindest cut: Medicaid won’t cover circumcision in Colorado, Health Policy Solutions, 21 June 2011

Further information about Medicaid coverage of circumcision in the United States