A nationwide debate about circumcisions for newborn boys, combined with cash-strapped public health budgets, has Colorado taking sides with 17 other states that no longer fund Medicaid coverage of the once widely accepted procedure.
For years, Colorado lawmakers considered doing away with funding for circumcisions under Medicaid — a move that would save the state $186,500 a year. Now facing a seismic budget shortfall estimated to be $1 billion at the beginning of this year, lawmakers finally approved the change, which takes effect July 1.
"We were just looking at virtually every option and trying to decide what was absolutely urgent now," said Republican Sen. Kent Lambert, a member of the budget-writing Joint Budget Committee. "I think 99 percent of it was completely economic."
The matter of circumcisions has gotten contentious in California, where San Francisco will be the first city to hold a public vote in November on whether to ban the practice.
Jewish and Muslim families are challenging that proposal in court, claiming it violates their right to practice their religion and decide what's best for their children. Supporters of the ballot initiative say male circumcision is a form of genital mutilation that parents should not be able to force on their children.
Matthew Hess, the president of the group behind the San Francisco proposal, called the Male Genital Mutilation Bill, applauded Colorado's move and said he hopes it will lead to a drop in the circumcision rate.
"That's a good thing, because paying someone to amputate a healthy functional body part from an unconsenting minor is not just a waste of taxpayer money — it's also a violation of human rights," he said.
South Carolina is one of the most recent states to eliminate Medicaid payments for circumcisions amid budget concerns. The change, which went into effect in February, was expected to save the state about $114,800 a year. States that also no longer fund circumcisions through Medicaid include Arizona, California, Florida, Maine and Louisiana.
Scott Levin, the regional director of the Mountain States office of the Anti-Defamation League, said Jews are unlikely to be affected by the defunding of Medicaid payments for circumcisions. For them, the procedure is not performed by a hospital physician, but a mohel — a specialist trained in Jewish ritual circumcision.
Levin said his group is more concerned about places like San Francisco that are trying to ban the procedure because Jewish people see the ritual as one of their religion's most sacred.
The World Health Organization reported that circumcisions are one of the most common procedures performed on newborn males in the United States, but the practice is not as common in the rest of the world. About 75 percent of baby boys in the U.S. are circumcised, compared to 30 percent elsewhere, the organization said. The figures refer to non-religious circumcisions.
Joanne Zahora, spokeswoman for the Colorado Department of Health Care Policy and Financing, which administers health care programs for low-income families, said the research her organization has seen shows that circumcisions are not medically necessary.
But the procedure retains its supporters. Although the topic never became heated during the Colorado budgetary debate, some lawmakers spoke in favor of keeping the Medicaid funding. Among them was Democratic Sen. Irene Aguilar, a primary care doctor at Denver Health.
"It's really a pretty inexpensive procedure to perform, and so it's just a little penny-wise and dollar-poor," she said.
Aguilar argued that circumcisions reduce the rates of urinary tract infections, penile cancer, and also lower the rates of cervical cancer for men's sexual partners. She also said she worried that doing away with funding for circumcisions would be discriminatory for Jewish and Muslim people on Medicaid.
Lambert, from Colorado's JBC, said the topic is sensitive for most, but the question lawmakers faced really was whether the government has the money to pay for the procedure.
"I think the general answer was no," Lambert said.