Fate of ‘game changer’ women’s health care bill in hands of Missouri Senate

A wide-ranging women’s health care bill that stalled in the House for months over concerns about expanding coverage for birth control is a step away from the governor’s desk — though dysfunction in the Senate could derail its chances of becoming law. 

The bill, an effort by a bipartisan group of five women lawmakers across the House and Senate, would be “a game changer” for women’s health, said state Rep. Melanie Stinnett, a Republican from Springfield.

With provisions focused on annual supply birth control, congenital syphilis, mammograms, STI treatment and rape test kits, the legislation is sponsored by Stinnett; state Sen. Elaine Gannon, a DeSoto Republican; State Rep. Tara Peters, a Rolla Republican; State Sen. Tracy McCreery, an Olivette Democrat; and state Rep. Patty Lewis, a Kansas City Democrat.

“We need to focus on women’s health, children’s health, babies’ health,” Gannon said. “We have to do whatever we can do to produce healthy people.”

Though it got its initial committee hearing in January, the House didn’t pass the bill and send it to the Senate until late April. The delay was caused by a number of Republicans expressing concerns that birth control could be used as an abortifacient, the bill’s sponsors said.

Since passing the House with approval from 60 Republicans and 45 Democrats, it has moved quickly in the Senate and was approved unanimously by the chamber’s emerging issues committee on Monday. 

“This bill was on life support several times as it moved its way forward,” Lewis said. “But no matter what side of the aisle you’re on, it’s politically advantageous to support women’s health care right now.”

The sponsors remain hopeful the bill can make it across the finish line before session ends on May 17.

But progress in the Senate is stalled as infighting between the Freedom Caucus and Senate Republican leadership has left the chamber with little to show as they run up against a deadline to pass the state budget.

Also hanging in limbo is a bill that would make it more difficult to pass citizen-led constitutional amendments, legislation Democrats have staunchly opposed, fearing it could inhibit an abortion rights proposal expected to land on the November ballot. 

The sponsors of the women’s health care bill argue that unlike other legislation, theirs should not be controversial and thus shouldn’t be a casualty of Senate gridlock. 

“If the supermajority knew how to govern, they could bulldoze anything through,” Lewis said.  “But they are too busy fighting amongst themselves and ultimately playing games with people’s lives.” 

Annual supply birth control

Peters said if there’s one thing she’s learned in her freshman term in the House, it’s that all it takes to mount a campaign to kill a bill is the word “abortion.”

The legislation, which would allow women on private insurance to pick up an annual supply of contraceptives rather than going to the pharmacy every few months, is already law in 26 states. Studies show this increase in access and continuity can help prevent unintended pregnancy. It does not apply to abortifacients.

Stinnett, who has a master’s degree in health care administration and who serves as vice chair of the House Healthcare Reform Committee, said several Republican colleagues had questions about hormonal contraceptives and whether drugs that induce abortions fall under the statute. 

“At every turn we either had to educate or deflate or talk against what wasn’t true,” Peters said, adding that some lawmakers were spreading inaccurate information that the bill had to do with abortion drugs.

After whipping the bill several times, Peters said she ultimately won over the needed support, finally moving the bill out of the House in late April, despite it receiving an initial House committee hearing in January.

Only the Missouri Insurance Coalition and America’s Health Insurance Plans and Blue Cross Blue Shield of Kansas City were present to testify in opposition of the birth control policy.

A recent survey released by The Right Time, a family planning initiative through the Missouri Family Health Council Inc., showed Missourians overwhelmingly support access to contraceptives, but some fear their lawmakers could pass laws limiting that availability.

Of the 1,000 Missourians polled between the ages of 18 and 35, 77% said they believed there should be access to annual supplies of birth control.

“I would have to dig pretty deep to find out when the last proactive sexual and reproductive health care legislation of a ‘women’s health type’ passed,” said Mandy Hagseth, the council’s director of policy and external affairs. “So it does not come often and it does not come easy.”

Hagseth previously told The Independent that in conversations with women around Missouri, the council learned that access to clinics, lack of consistent transportation and balancing work and children are often barriers to picking up their contraception consistently, which can create gaps in use and increase the chances of an unintended pregnancy. 

More than 373,000 Missouri women live in contraceptive deserts, which they define as a place where there’s not reasonable access to a full range of contraceptive methods, according to data compiled by Power to Decide. Most are in rural counties.

“The Senate has an opportunity to pass a really important, pro-active women’s health bill,” Hagseth said. “At a time that it’s woefully needed sort of generally and politically.”

Congenital syphilis testing

In 2022, Missouri recorded 81 congenital syphilis cases — the most in 30 years, the state health department said in an alert distributed earlier this year. 

From 2017 to 2021, congenital syphilis cases rose 219% across the country; in Missouri, they rose 593%, according to the Centers for Disease Control and Prevention. Between 2012 and 2015, one stillbirth from a congenital syphilis case was reported in Missouri. Since then, there’s been at least one infant death every year, with 18 deaths reported between 2016 and 2022, according to the Missouri Department of Health and Senior Services. 

Mothers can pass along congenital syphilis in utero at any point in pregnancy. But if caught before the baby passes through the birth canal, the disease is reversible in the womb.

For adults, the symptoms, if there are any, can include a rash on the palms of a person’s hands or on the soles of their feet, hair loss, swollen lymph nodes or sores. Often these symptoms go away on their own, even though they are still contagious.  If a mother is infected within four weeks of delivering their baby and doesn’t get treatment, the infant has a 40% chance of dying at birth or shortly after, according to the CDC.

Right now, only two syphilis tests are required in pregnancy: one in the first trimester and one at birth. The bill would also require a third trimester test for HIV and hepatitis C and hepatitis B, which can cause liver damage in infants.  

This legislation hopes to address this outbreak by adding additional optional testing for women around 28 weeks of pregnancy during their regularly-scheduled appointment. 

“Anything we can do to ensure that baby is born healthy, that’s what we need to be doing,” Gannon said.

Mammograms, STI treatment and forensic exams

McCreery said after she went in for a mammogram at the start of the year, she received a “weird form letter” that left her thinking she needed additional testing to ensure she didn’t have breast cancer. 

New federal regulations for mammograms are now at odds with Missouri’s statute, so this bill would update the language given to patients after a cancer screening to be less confusing, as the current language may cause unnecessary concern.

“We need to speak in clear, easy to understand terms when we’re communicating with somebody after they’ve had an exam like that,” McCreery said.

The bill also hopes to make treatment easier for trichomoniasis, an infection that’s more common in women then men. 

Under current state statute, if someone is diagnosed with gonorrhea and chlamydia, their doctor is allowed to also treat the patient’s sexual partner in a process called expedited partner therapy. Under this legislation, trichomoniasis would also be added to that list, and it would open the door for syphilis to also be added if federal guidelines change as syphilis rates rise.

The final piece of the legislation would smooth out a law passed in 2022 that requires survivors of rape or sexual assault be given the option to ask for a forensic exam.

Right now, speciality hospitals without emergency departments are not exempt from the statute, meaning survivors can be taken to health care providers without access to rape test kits. This statute would require that patients initially seen at specialty hospitals be transferred to a hospital with an emergency department equipped to do a forensic exam.

This story was originally published in the Missouri Independent