WHEREAS, circumcision of young males has been a long-standing tradition among adherents to certain religions including Judaism, and Christians eventually adopted the practice, although it is unclear why; and

WHEREAS, it is also unclear why one million two hundred thousand circumcisions are performed in the United States each year–-more than in any other country when this operation is considered a medically unnecessary procedure; and

WHEREAS, the American Academy of Pediatrics, the American Academy of Family Practitioners, and the American Medical Association, have all published statements that do not support routine neonatal circumcisions; and

WHEREAS, although there are potential medical benefits, such as reduced incidence of urinary tract infections in circumcised male infants under one year of age and reduced risk of penile cancer in uncircumcised men, these risks are minimal–-fewer than one per cent of uncircumcised baby boys get such infections and penile cancer is quite rare; and

WHEREAS, on the other hand, potential adverse complications of circumcision are more likely and include bleeding, poor cosmetic results, adhesions, scarring of the urethral opening, infection, and, in very rare cases, penile amputation or death; and

WHEREAS, parents have chosen circumcision for their newborn sons so that their sons will "look" normal and for purposes of hygiene when, in fact, up to eighty-five per cent of the world's male population is not circumcised and, except in rare cases, hygiene is not an issue for most males; and

WHEREAS, in the United States, the cost of routine circumcisions ranges from $150,000,000 to $270,000,000 each year; and

WHEREAS, in certain states, such as Virginia, Medicaid still pays for circumcisions when the cost savings from not covering circumcisions could have paid for much of an infant's needed immunizations; and

WHEREAS, sixteen states--Arizona, California, Florida, Idaho, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Oregon, Utah, and Washington already have disallowed Medicaid coverage of circumcision; and

WHEREAS, in recent years, routine circumcision seems to be declining in popularity; in California, only one-third of male newborns are currently undergoing the procedure; and

WHEREAS, newborn circumcision is not recommended by any major American, foreign, or international medical organization, is medically unnecessary and defined as an elective procedure by the Centers for Medicare and Medicaid, and is not cost-effective; and

WHEREAS, Medicaid is mandated to pay only for medically necessary care and not for elective care and removing circumcision from Medicaid coverage will improve Hawaii's Medicaid program by making the cost savings available to cover other Medicaid needs; now, therefore,

BE IT RESOLVED by the House of Representatives of the Twenty-third Legislature of the State of Hawaii, Regular Session of 2006, that the Director of Human Services is requested to expedite the adoption of rules in accordance with chapter 91, Hawaii Revised Statutes, and to obtain any federal waivers, if necessary, to disallow Medicaid coverage for routine circumcision for newborn male infants in Hawaii; and

BE IT FURTHER RESOLVED that the Director of Human Services is requested to calculate the resulting cost savings and formulate a plan to reallocate those cost savings to other Medicaid needs; and

BE IT FURTHER RESOLVED that the Director of Human Services is requested to submit its plan to the Legislature not later than twenty days prior to the convening of the Regular Session of 2007; and

BE IT FURTHER RESOLVED that certified copies of this Resolution be transmitted to the Director of Human Services who, in turn, is requested to distribute copies to all health care providers in Hawaii who perform circumcision procedures reimbursed by Medicaid, the Director of Health, and the President of the Hawaii Health Systems Corporation.

Report Title:

Circumcision; Disallow Medicaid Coverage; Cost-Savings Report