Star-Tribune (Minneapolis). Thursday, 1 September 2005.
Star-Tribune (Minneapolis). Thursday, 1 September 2005.
The state of Minnesota is quietly getting out of the business of paying for three controversial treatments that affect the sex lives or sex organs of low-income patients.
Starting today, the state will no longer cover routine circumcisions, unless required by religious practice,
under its insurance plans for 670,000 low-income Minnesotans, according to the 
Department of Human Services.
It's also dropping coverage of Viagra and other impotence drugs.
And last month, it completely stopped paying for sex-change operations.
Each of the three changes in coverage may face legal problems.
The Legislature voted to end the payments with little fanfare during the special session in July. Supporters say they were no brainers
at a time when legislators desperately needed to cut costs without doing serious harm to the programs: MinnesotaCare, Medical Assistance and General Assistance Medical Care.
Even state officials admit that the new rules may be challenged by civil liberties groups and activists, and in one case would require a federal agency to reverse its policy.
But at least one Stillwater woman hopes the changes will spur a sea change in Minnesota, to help turn the tide against what she considers an unnecessary and barbaric procedure.
In recent years, about 10,000 baby boys have been circumcised each year at state expense, at an average cost of $54, according to the Human Services Department. That's 10,000 too many to Cindy Tregilgas, a Stillwater financial manager and mother of two sons. For several years, as a volunteer for NoCirc, the National Organization of Circumcision Information Resource Centers, she had lobbied the Legislature to stop circumcision. This year, her testimony helped change the policy, making Minnesota the 16th state to do so.
At a House hearing in March, she said: I have come here today not to ask for money, but instead to show you where money can be saved.
She argued that taxpayer dollars were wasted on a cosmetic procedure.
While she opposes circumcision on moral grounds, she said, the money argument was especially persuasive. Frankly if it's ten dollars to spend on something that's totally unnecessary and can cause harm vs. spending on necessary medical services for low-income people, it's a no-brainer,
she said.
The bill's sponsor, Rep. Jim Abeler, R-Anoka, a chiropractor and father of six boys, agreed. There's no medical indication, [and] we're looking for ways to save some money,
he said. However, he added two exemptions, to allow payment if it's medically necessary or part of someone's religious practice.
Circumcision is practiced by Jews and Muslims, but he said neither group asked for the exemption. I thought it seemed reasonable,
he said.
Assistant Human Services Commissioner Brian Osberg, who oversees the state health plans, acknowledged that the religious exemption might pose problems. We have not determined exactly how we're going to process that exception,
he said.
Its legality was questioned by Charles Samuelson, executive director of the American Civil Liberties Union of Minnesota, who wondered how the state could base payments on a patient's religion. It just doesn't make sense,
he said. My guess is that if it was challenged, they would be hard pressed to keep that exception.
Abeler, the sponsor, said he included it as a show of respect to other religions, and doesn't believe it affects many people. So if it's an issue, there wouldn't be a big fight,
he said.
In any case, Tregilgas hopes this is just the beginning. Now, most private insurers cover routine circumcision in Minnesota. In other states, she said, private insurers have followed the government's lead. I think it will take some time. But I do think that over time, [fewer] insurance companies are going to cover it.
About 2,000 men got impotence drugs last year courtesy of the state's Medicaid program, at a cost of roughly $7 a pill (up to six a month), state officials say.
It seemed like a natural place to save money, said Suzy Geroux, administrator for the House Health Policy and Finance committee. For the past seven years, Minnesota has covered impotence drugs under pressure from the federal government. In 1998, the Clinton administration issued a directive warning that states could lose federal funds if the drugs weren't covered under Medicaid.
With the change in political winds, state officials say this is the time to challenge that policy. It's really an interpretation of the law,
Osberg said. Although the ban kicks in today, the state hasn't obtained federal permission to implement the change. Officials say they plan to submit that request later this month.
loophole
Minnesota has tried to end Medicaid payments for sex-change operations for 10 years. But activists have challenged the restrictions in court. As a result, two to three people a year have had their sex-change operations paid for by state programs, at a total cost of about $15,000 in state funds, officials say. The new law, which took effect Aug. 1, completely closes the loophole,
Geroux said.
State lawyers say they expect court challenges to continue. Phil Duran, a lawyer for OutFront Minnesota, an advocacy group, says he's appealing the department's denials to five patients awaiting sex-change surgery. It's certainly our position that this is not about saving money,
he said. This is about imposing a [penalty] on politically unpopular people.
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