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Case Studies 9 MISSOURI The state of Missouri closely mirrors North Carolina in political and demographic characteristics. Both states have historically been represented in the U.S. Senate by both Democrats and Republicans and have elected governors from both parties. Both currently have Republican-controlled state legislatures. As reflected by voting data, large urban centers in both states, such as St. Louis and Raleigh, are home to diverse and liberal populations, whereas rural areas are comprised of more conservative and religious residents (Politico, 2012). The states have nearly identical median annual incomes, uninsured rates, and high school graduation rates (approximately $45,000, 12% and 87% respectively) (Census.gov, 2015). These similarities make Missouri a good candidate to compare to North Carolina. Missouri lawmakers have already attempted to pass legislation that would allow birth control to be purchased over the counter, in a political environment similar to what NC lawmakers would face. The states faced near identical situations in terms of unintended pregnancy, teen pregnancy, and public costs of unintended pregnancy. In 2010, 51% of Missouri pregnancies and 54% of North Carolina pregnancies were unintended (Kost, 2010). The teen pregnancy rates were 54 and 53 for every 1,000 women in Missouri and North Carolina respectively (Kost, 2010). Missouri publicly funded 72.2% of unplanned births, compared to 74.8% in North Carolina (Sonfield, 2010). In the 2015-2016 legislative session, the Missouri House passed HB 1679, which would have allowed Missouri pharmacists to prescribe birth control pills. The primary sponsor, Republican representative Sheila Solon, called the legislation the “ultimate pro-life bill,” saying it would reduce abortion rates by reducing unintended pregnancies. The bill passed the House on April 26th by a vote of 97-50. There were 57 Republican and 40 Democratic yes votes, and 49 Republican and 1 Democratic nay votes (“Project Vote Smart”, 2016). The bill was sent to the Senate, where it was referred to the Veterans Affairs and Health committee (HB 1679, 2016). However, the Senate committee did not take action on the bill before the legislature adjourned three weeks later (“2016 Dates of Interest”, 2016). Therefore, the bill failed for the session. POLITICS Representative Solon introduced the bill in December 2015. It was referred to the Emerging Issues Committee, where it underwent a public hearing. The American Congress of Obstetricians and Gynecologists -- Missouri Section, Family Health Council, Teen Pregnancy & Prevention Partnership, and Planned Parenthood Advocates of Missouri all testified on behalf of the bill (Committee Bill Summary, 2016). The Missouri Academy of Family Physicians also testified; while they did not take a position on the bill itself, they stated that do not believe pharmacists are adequately trained to make a meaningful contribution to prescription decisions (Associated Press, 2016). No groups testified in opposition to the bill (Committee Bill Summary, 2016). In committee, one amendment was adopted. The amendment removed the bill’s inclusion of birth control patches, after anti-abortion groups expressed concerns about safety (Donaldson, 2016). Another amendment was circulated but not voted on or adopted, which would have stated that notwithstanding any laws to the contrary, pharmacies must not sell emergency contraceptives over-the-counter (4359H02.1H, 2016). The bill passed the Emerging Issues Committee unanimously in February 2016. It was then referred to the House Select Committee on General Laws, where it passed 7-2 at the beginning of April.