Tax Dollar Funding of Medically Unnecessary

Tax Dollar Funding of Medically Unnecessary

Circumcisions Through Medicaid

(Summary)

Prepared by John W. Travis, M.D., M.P.H., George Denniston, M.D., M.P.H., Rio Cruz, Ph.D,

J. Steven Svoboda, Esq. and Amber Craig, M.A. for the

International Coalition for Genital Integrity

www.icgi.org, PO Box 8462, Santa Cruz, CA 95061 1-831-423-6105 info@icgi.org

Overview

United States taxpayers currently fund more than 25% of all routine non-therapeutic infant circumcisions performed in this country. The American Medical Association, the American Academy of Pediatrics, and the American College of Obstetrics and Gynecology consider routine circumcision of male infants to be a medically unnecessary procedure performed for cosmetic, social, or religious reasons, and these organizations do not recommend it as a routine medical procedure.

Worldwide circumcision of the male or female genitals is rare. Routine circumcision is not performed in Europe, Australia, most of Asia, Latin America, or in South America. Eighty-five percent of the world’s male population and ninety-eight percent of the world’s female population are not circumcised. The United States is the only country in the world that circumcises a majority of male infants for non-religious reasons. Non-religious infant circumcision in the United States persists because of medical misinformation, physician ignorance, cultural tradition, personal motive and/or financial incentive. Although circumcision is commonly performed on male infants in the United States, this medical procedure is rarely performed for actual medical reasons.

The International Coalition for Genital Integrity (ICGI), along with two of its member organizations, Attorneys for the Rights of the Child (ARC) and Doctors Opposing Circumcision (DOC), commenced in 1999 a survey of each state’s Medicaid programs to determine if tax dollars were used to support elective, non-therapeutic circumcision (the removal of healthy, normal tissue from the penis of newborn males) for clients enrolled in their program. The state Medicaid programs in California, Oregon, North Dakota, Nevada, Mississippi, and Washington have policies against funding circumcision unless there is a demonstrated medical need. Consequently, virtually no routine non-therapeutic circumcisions are funded with tax dollars in these states, saving taxpayers millions of dollars. Many taxpayers oppose the use of public tax dollars to fund a non-medical procedure, especially when the numerous health needs of Medicaid children go unmet because of limited public health care funds.

Summary of Medicaid Spending

According to data supplied by HCIA-Sachs for 1999, Medicaid paid for 310,403 circumcisions in the United States. The current 1999 AAP Circumcision Policy Statement states, "It is estimated that 1.2 million newborn males are circumcised in the United States annually at a cost of between $150 and $270 million. These figures are conservative, not taking into account facility fees, fees used to correct complications, etc. The United States taxpayers are currently funding more than 25% of all medically unnecessary newborn circumcisions through the Medicaid program at an estimated cost to US taxpayers of $39 to $70 million a year. In the southern region of the United States, the Medicaid program funds more than 40% of all newborn circumcisions.

The AAP also states that circumcision is extremely painful and therefore it is "essential" that pain relief be provided, and this new mandate will increase circumcision costs. Considering that the US government funds more than 25% of all circumcisions, the current level of expenditure in the United States for circumcision is alarming, especially when routine infant circumcision is not recommended by any medical organization in the United States. In their position statements, both the AAP and the AMA highlight the fact that "a number of medical societies in the developed world have published statements that do not recommend routine circumcision of male newborns."

STATES	FEE	RATE
CT, DC, MO, NJ, NY, VT, CO	under $50	20%
KS, MN, MN, MI, SD, TX, WI, WY	$50 - $60	28%
AL, AK, DE, FL, GA, ID, IL, IN, KY, LA, MA, MT, NH, NM, NC, OH, OK, PN, SC	over $60	38%

Circumcision rates are double in states that pay more for the procedure.

This survey accounted for 181,292 Medicaid covered circumcisions, costing taxpayers a minimum of $20,255,217 in 1999. According to HCIA-Sachs there were a total of 310,403 Medicaid paid circumcisions in 1999 performed in hospitals. From this, we can extrapolate minimum nation-wide Medicaid payments of $34,680,406 for 1999.

Conclusion

The United States Medicaid program currently funds more than 25% of all routine infant circumcisions performed in the United States (1999) despite recent policy statements by the American Academy of Pediatrics and the American Medical Association that do not recommend this procedure. Many American taxpayers are increasingly concerned that the US Federal and State governments continue to fund this non-therapeutic elective procedure when currently many economically deprived children’s health-care needs go unmet. Many states provide inadequate coverage in health care services to poor children, and currently seek additional health care cuts in Medicaid; while the promotion and performance of non-therapeutic circumcision continues unabated.

Forty-four states and the District of Columbia provided the requested information to either the International Coalition for Genital Integrity (ICGI) or Attorneys for the Rights of the Child (ARC). Despite numerous letters, phone calls, and faxes, over a period of several months, six states failed to comply with this request: Arkansas, Hawaii, Maryland, Nebraska, Rhode Island, and Tennessee.

California, Mississippi, Nevada, North Dakota, Oregon and Washington have already discontinued circumcision funding, saving their state taxpayers millions of dollars. Other states’ HMO plans have discontinued coverage for circumcision for Medicaid recipients (such as Oklahoma), and many state Medicaid agencies and legislatures are currently looking into whether or not they will continue to provide coverage for routine "non-therapeutic" circumcisions. There is currently a bill under consideration in the Michigan legislature to cease Medicaid funding for circumcisions.

In 1999, 43% of parents chose not to have their male infant circumcised. Many Americans are now opposed to routine infant circumcision, as is evident in the proliferation of organizations in America devoted to ending this practice. Their concerns are supported by numerous national medical organizations in the United States and worldwide who deem this traumatic and diminishing genital surgery on male infants to be unwarranted.

Tax paying US citizens who are morally, ethically, and culturally opposed to the non-therapeutic routine circumcision of male children should not have to pay for medically unnecessary circumcisions. Medicaid pays for 25.9% of these circumcisions annually, at a cost to US taxpayers of a minimum of $35 million a year. Medicaid should not utilize taxpayer dollars to fund procedures that are not recognized by the overall medical community as offering a significant health benefit, regardless of the current standard of practice in medicine, or of the cultural or religious preference of the parent requesting this non-therapeutic, elective procedure. Tax dollars that fund Medicaid programs should be directed solely to necessary medical services desperately needed by all children in the United States and not wasted on medically unnecessary circumcisions of male children.