The fate of a bill allowing employers in Missouri to refuse to provide health insurance coverage for contraception, sterilization or abortion is in the hands of Gov. Jay Nixon, who over the years has managed to sidestep taking a stand on abortion legislation.
Two anti-abortion bills have been sent to the desk of the Democratic governor during his first term, and both times he took no action. Instead of signing or vetoing the bills, on both occasions he let a constitutional deadline pass that allowed them to became law without his signatures.
This time, however, the issue could have implications on the national stage. That's because the Missouri bill is a direct response to a policy by the Obama administration that requires employers to provide health insurance coverage for contraceptives to employees.
After a backlash, President Barack Obama modified that policy to require insurers -- not religious employers -- to bear the responsibility of covering contraception.
But the change did little to dissuade Missouri Republicans, who on the legislative session's final day overwhelmingly approved a bill that states no employer or health plan provider can be compelled to provide coverage of abortion, contraception or sterilization if doing so violates their religious or moral convictions.
The bill also authorizes the state attorney general to file suit in state or federal court to defend the rights granted in the legislation.
"This bill is about religious freedom and moral convictions," said Rep. Sandy Crawford, a Buffalo Republican who sponsored the legislation in the House. "This is about sending a message to the federal government that we don't like things rammed down our throat."
Mike Hoey, executive director of the Missouri Catholic Conference, said the bill was his organization's top legislative priority this year.
"This is not intended as a war on women or making birth control inaccessible to women," Hoey said. "That's not the point. The point is that people with moral objections shouldn't have to pay for it."
When asked about the issue in February, Nixon questioned the need for such legislation, since "we already have a strong religious and moral exemption on the books here in Missouri."
Since then, however, the governor has remained quiet on the issue. When contacted last week, a spokesman for Nixon would say only that the governor was in the early stages of reviewing all the legislation passed by the General Assembly this year.
The last day for the governor to act is July 14.
Michelle Trupiano, public affairs manager for Planned Parenthood of Kansas and Mid-Missouri, said that in addition to making it harder for women to access contraception, the bill would put insurance companies on a collision course with lawsuits.
"It's going to put insurance companies in a position where they have to be in violation of either state or federal law no matter what they do," Trupiano said.
The federal policy already includes an expansive refusal exemption, she noted, which allows churches and houses of worship to refuse to provide birth control for their employees.
Hoey said Catholics understand that the religious liberty argument cannot trump public health concerns.
However, "I don't think contraceptives for contraceptive purposes rises to the level of overriding an employer's religious liberty," he said.
"Contraceptives, sterilization and abortion -- these things are not health care, really," Hoey said. "No one is going to die because they have to go somewhere else to buy their birth control pills. Pregnancy is not a disease."
Abortion and sterilization have nothing to do with the federal mandate, said Elizabeth Nash, state issues manager for the reproductive health research organization the Guttmacher Institute. It pertains solely to contraception.
"What I find ironic is that when you provide access to contraception, you reduce unintended pregnancies and abortions," Nash said. "Not providing these services makes no sense from a health perspective."
Deciding when to become a parent is "about the most important decision a person will make," Nash added. "Making sure the women, her partner and her family are healthy and ready to become parents is incredibly important. If we consider pregnancy health care, then we must remember contraception health care as well."
Cost is often a factor that prevents many women from using more effective contraceptives, Trupiano argued. A lot of women choose the birth control pill over other types of contraception not because it is the best method for them, she said, but because it is the only method they can afford.
"Birth control is basic health care, and women should have access to it regardless of where they work," she said. "Nobody is forcing anyone to take birth control or contraception."
Much of the Missouri bill's impact will be determined by the outcome of several lawsuits already making their way through federal courts, Nash said. Most importantly, the U.S. Supreme Court is supposed to issue its ruling on the federal health care law this month, a decision that could render the entire debate moot.
Dozens of Catholic institutions have sued the Obama administration to block the contraception mandate.
Trupiano said Planned Parenthood and its supporters have asked the governor to veto the measure and "will be pushing hard for a veto over the next several weeks."
But Hoey said he was confident the governor would sign the bill, especially in a year he is running for re-election.
"I don't think Jay Nixon is like President Obama," he said. "I think he's more in touch with Midwestern values."