On January 28th, 2025, on behalf of Attorneys for the Rights of the Child, Steven Svoboda submitted feedback to the New Hampshire House Health, Human Rights, and Elderly Affairs Committee regarding a bill that was currently pending and on which testimony was heard the next day: HB94-FN (“Relative to Coverage of Circumcision under the State Medicaid Plan”).
I am the founder in 1997 and Executive Director of Attorneys for the Rights of the Child (ARC), a non-profit primarily aimed at educating the public (including New Hampshire’s residents and voters) about the lack of medical necessity for and the harm of male circumcision. I have published more than forty-five peer-reviewed articles about genital cutting. In 2001, I put the issue of male circumcision as a human rights violation in the official United Nations record for the first time. In 2002, I received a Human Rights Award for this work. In 2013, I unofficially won a debate about whether male circumcision is ethical and legal with an epidemiologist and member of the American Academy of Pediatrics (AAP) Circumcision Task Force.
I urge you to approve HB94-FN, Relative to Coverage of Circumcision under the State Medicaid Plan. The taxpayers of New Hampshire should not use scarce public funds to pay for a procedure that is not medically necessary and has a complication rate on healthy baby boys of over 10%. HB1683-FN from 2024 had the same text as this current bill. HB1683-FN was narrowly defeated, 184 to 191.
Some commentators have expressed an admirable though misguided concern that HB1683-FN might deprive relatively low-income people of a circumcision for their child. This is not a genuine shortcoming of the bill, since male circumcision is a cosmetic procedure lacking any genuine documented medical benefit and carrying a risk of harm and complications. It is contrary to the public interest to pay for it to be done to anyone regardless of their economic status. Moreover, it is unlawful to use Medicaid to pay for unnecessary medical services. Ending Medicaid coverage of male circumcision will prevent the wasting of scarce health care resources. and will free up public funds to serve actual medical needs of New Hampshire’s residents.
False arguments for “equity” are sometimes made claiming that people on Medicaid should not be “discriminated” against by not being allowed to pay for the circumcision of their boy using public funds. I started my legal career working in Massachusetts in legal services for people below the poverty line. Based on my second-hand familiarity with the serious impact on every aspect of the lives of my clients, folks on Medicaid are concerned on a daily basis with (among many other things) putting food on the table, finding or keeping employment, keeping utilities turned on, avoiding eviction from their homes. Never once in all my years working with Medicaid recipients did I hear that they wished to have performed on their sons at state expense a medical procedure that does not even confer any actual benefit on its recipients but carries risks and loss of functional tissue.
As Rep. Read testified when HB-1683-FN was being considered last year, foreskin amputation “really has no business being paid for by the taxpayers,” since it is not a medical procedure. Rep. Read quoted the National Institutes of Health as saying: “…consequently, the prevention of sexually transmitted infections cannot rationally be interpreted as a benefit of circumcision.”
Currently, physicians bill Medicaid for the procedure despite the above-mentioned lack of medical necessity, using false diagnoses such as “newborn boys” (which is not a proper diagnosis) or “phimosis” when the procedure is performed later in childhood. Such billing is either reckless and/or appears to constitute Medicaid fraud.
Physicians in the U.S. portray it as medicine but insofar as it is virtually never medically necessary, and parents usually elect it for personal, cultural, and/or religious reasons, it is a cultural practice cloaked as medicine.
J. Steven Svoboda, M.S., J.D.