Circumcision debate hits state

MIKE STOBBE
Staff Writer

Charlotte homemaker Beth Long started lobbying against circumcision after her firstborn son bled for five days following the procedure.

Now she's part of a small but determined group of North Carolinians trying to convince the state to stop paying for Medicaid circumcisions.

"I'm amazed they can get away with this -- spend almost $2 million a year to do a cosmetic surgery not endorsed by any medical board in the world," Long said.

This week, the N.C. Senate is to consider a spending plan that would curtail Medicaid funding for circumcision in this state.

Long and her allies say the state shouldn't spend money on a procedure that's medically unnecessary when legislators are considering cutting home care for the disabled and dental care for low-income families.

But advocates for funding Medicaid circumcisions -- including some doctors and Medicaid parents -- say they fear that boys from low-income families will be stigmatized because they look different.

The issue is complex, even for legislators like state Sen. William Purcell, D-Laurinburg, a pediatrician who has performed thousands of circumcisions over the years.

"I don't know what the final decision will be," he said.

State almost cut funding

North Carolina's legislators briefly eliminated Medicaid funding for circumcisions last fall. The Medicaid program stopped paying doctors for routine newborn circumcision claims Nov. 1. But Medicaid resumed paying Jan. 1, after a backlash from physicians, some Medicaid patients -- and Gov. Mike Easley.

Easley heard about the funding cut from Dr. Sandy Easley of Washington, N.C., his brother and a legislative liaison for a state association of obstetricians and gynecologists.

"I called my closest contact in state government, my brother," Sandy Easley recalled. "He was quite surprised this had happened, and got his people to look into it."

Gov. Easley wouldn't comment for this article. A spokeswoman, Cari Boyce, said Easley brought it to the attention of N.C. Secretary of Health and Human Services Carmen Hooker Odom, who worked with legislators to restore the funding.

Victoria Brown of Walstonburg, who wrote to Gov. Easley about circumcision, got a Dec. 20 reply that said in part:

"My vision of North Carolina has always been of a unified North Carolina, not a state divided by social and class lines. People should not be indelibly branded as economically disadvantaged because their parents could not afford this simple procedure when they were born. I believe Medicaid funding for this procedure is money well spent."

Boyce said the letter, sent on official stationery, wasn't approved by Easley and doesn't reflect his opinion. "We have an auto-pen. Someone had the letter signed and sent out."

For, against circumcision

Circumcision is a surgical procedure to remove the foreskin from a young boy's penis, usually done in under 10 minutes. It's been practiced by Jews and Muslims for thousands of years, but didn't become common in this country until the 20th century.

Doctors advocated it as hygienic, because circumcision prevents accumulation of secretions under the foreskin.

In 1870, only 5 percent of U.S. male newborns were circumcised. By 1900, it was 25 percent, and by 1980, it was 85 percent, according to the International Coalition for Genital Integrity, an anti-circumcision group.

Then, percentages began dropping. In 2000, it was down to about 55 percent. One factor was a greater influx of immigrants from cultures where circumcision isn't commonplace.

Also, many doctors stopped making medical arguments for it. In 1999, the American Academy of Pediatrics said it would no longer recommend circumcision.

Meanwhile, an anti-circumcision movement started about 20 years ago, mainly in California.

In North Carolina, a loose-knit movement formed about 10 years ago, said Amber Craig, N.C. director for the National Organization of Circumcision Information Resource Centers (NOCIRC).

Today, about 30 people across the state regularly participate in parent education and lobbying efforts. The group includes parents and a few doctors.

Last month, 112 people signed a letter opposing Medicaid circumcisions that was addressed to Easley and the General Assembly and published as a full-page ad in a weekly Raleigh newspaper.

In South Carolina, Medicaid officials say they haven't seen funding for circumcisions challenged. S.C. Medicaid spends $650,000 yearly on the procedure.

A small dent

N.C. Medicaid spends about $2 million a year on circumcisions, including state and federal money. In contrast, state officials plan to spend around $14 billion overall in the next fiscal year.

"It's small potatoes," said state Rep. Connie Wilson, R-Mecklenburg.

Each year, about 52 percent of N.C. Medicaid male newborns are circumcised. In South Carolina, it's 71 percent.

A study last year by NOCIRC's Craig and others found a higher proportion of Medicaid newborns were circumcised in states that paid $60 or more for the procedure.

North Carolina's Medicaid program pays $123.73 for a standard circumcision performed in a hospital. S.C. Medicaid pays $65.16.

Dr. Kenneth Baker, a Monroe obstetrician with NOCIRC, said colleagues have talked about Medicaid circumcision as a quick, dependable source of income.

"It's very simple. If you do four or five, it's an easy thousand dollars a day," Baker said. "They (some doctors) were very upset about losing that."

Easley and other physicians disputed that claim.

"I think that's ludicrous," Easley said. "It's not an economic issue. It's an issue of fairness."

Medicaid officials say funding circumcision is not as crucial as maintaining other services.

"Anything not medically necessary is an expense we should not have," said Nina Yeager, the state's Medicaid director.

Wilson said the outcome may not depend on medical arguments.

"I use circumcision as an example of the way the political process works," she said. "If you can't cut circumcisions, what can you cut?"