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Case Studies 10 The bill was then debated by the full House. Representative Solon forcefully advocated for it, using several arguments: • She stated that since half of all Missouri births are covered by Medicaid, the bill is fiscally prudent. She estimated savings to Medicaid of between $47 and $95 million per year, by reducing unplanned pregnancy by 10% to 20% among Medicaid-eligible women, and said that this was “an extremely conservative estimate.” • She argued that the bill would reduce abortions by reducing the rate of unintended pregnancy. • She said that the bill “let women have control over their own health issues”(Mo. House Floor Debate, 2016). In sum, she stated that the bill was a “pro-life, pro-woman, common-sense approach to bringing down escalating Medicaid costs.” Opposition to the bill centered around the risk of blood clots, with some legislators arguing that the pills were dangerous enough that they should require a doctor’s supervision (ibid). Representative Solon had several counters to this objection: • That the risk of blood clots is extremely low, and that the risk of a blood clot is four times higher while pregnant and twenty times higher after giving birth than when taking oral contraceptives; • That pharmacists will be well-trained, and will administer a risk assessment just as a doctor would; • That the American Congress of Obstetricians and Gynecologists - Missouri Section supported the bill; • And, notably, that legislators should place more trust in women. Rep. Solon said that “studies have shown that women are actually pretty smart, amazingly… when women do a risk assessment [for oral contraceptives] with their doctor, they agree with their doctor 95% of the time.” She went on to note that the 5% of the time women disagreed with their doctor about oral contraceptives, it was because the woman was more conservative than the doctor, deciding that oral contraceptives were too high-risk even with a doctor’s clearance. She said that legislators should “give women a little credit here, I believe that with the pharmacist they can take the risk assessment… and [let] women have control over their own health issues” (ibid). The bill passed the House on April 26th, and was sent to the Senate, where it was referred to the Veterans’ Affairs and Health subcommittee. However, this committee did not take action on the bill before the legislature adjourned on May 13th (HB 1679, 2016). In subsequent days, Representative Solon distributed the bill’s text as an amendment to a number of other health- related House bills (Missouri State Medical Association). Some of these amendments were not taken up, but she succeeded in at least two cases; the amendment passed the House on HCS SB 635, an omnibus health care bill, by a vote of 90-45 (Journal of the House, April 27 2016) and on HCS SB 864, a pharmacy regulation (Journal of the House, May 6 2016). However, both bills then went to conference committees. In SB 635 the amendment was removed from the final bill (S.B. 635, 2016), and in SB 864 the bill never left conference (S.B. 864, 2016). It is unclear why the Senate resisted passing this policy; unfortunately, there is no documentation of conference committee proceedings, which leaves many questions unanswered.