At the first anniversary of health care reform legislation, an unprecedented attack is spreading across the nation to restrict or even ban insurance coverage of abortion for millions of women. Legislators committed to ending legal abortion, backed by the U.S. Conference of Catholic Bishops and Christian Right “family values” organizations, have targeted the state insurance exchanges that are being set up as part of the Affordable Care Act.

Five states have already passed bills to prohibit coverage of abortion on their exchanges except in dire circumstances such as to save the woman’s life. Twenty-two more states are considering similar bills; nearly half of those are also considering making it illegal for all private plans to cover abortion. House Republicans passed two bills to restrict coverage—HR 3 (the “No Taxpayer Funding for Abortion Act”) and HR 358 (the “Protect Life Act”)—as soon as Congress convened in January.

An estimated 14.5 million women who are insured by their mid-sized and large employers would be affected by these new restrictions, according to the Employee Benefits Research Institute. Contrast that to the fact that about 80 percent of private plans now cover pregnancy termination. (This is in addition to women whose coverage for abortion is already restricted to the narrow cases of incest, rape, or life endangerment: women who receive Medicaid, federal workers, the military, the American Indian health service, women in federal prisons, and even Peace Corps volunteers.)

This effort may be more devastating to women’s reproductive health care than the hundreds of individual state laws now on the books—or it may be a pivotal moment of change in the bitter battle over abortion.

Narrow attacks on reproductive rights, whether from the Catholic or Protestant right, ignore the full range of issues that are involved in an unintentional pregnancy, including poverty, discrimination, abuse and violence, lack of jobs and health care, and—underlying it all—the effects of racism and sexism. They ignore the serious health issues that can affect a pregnancy and a woman’s life. They ignore the realities of young women and men who have no information or inaccurate information about sexuality, poor role models, and limited options for the future. They target abortion rather than the conditions that lead to unintended pregnancies.

There are many of us who want to change that mindset. While opponents of comprehensive reproductive health care want to control women’s decision-making, we talk about the importance of options and resources in the lives of women, families, and communities; while they demand “no taxpayer funding for abortion,” we explain that ample funding restrictions are already in place; while they stigmatize women who seek to end a pregnancy, we assert that abortion is an integral part of comprehensive reproductive health care and that one in three women will have an abortion procedure at some point in her life; while they demean women who choose abortion, we make it clear that forcing women to continue an unwanted pregnancy is wrong; while they rail against abortion, we elevate the discussion to consider the moral complexities of decisions about bearing children.

This a largely pro-choice country at heart—even those who have reservations about abortion are firmly and consistently in favor of options that include family planning, contraception, and sexuality education, and in favor of women making decisions with dignity and minimal governmental interference. Insurance coverage for pregnancy termination has had a low profile until now because it was not threatened. Now that it is, it’s critical to understand that insurance helps to guarantee access to reproductive health care services and—from a moral perspective—enables a woman to make a decision about childbearing according to her conscience, not according to what the government says is acceptable.

Progress in expanding health care coverage to millions of Americans and doing away with injustices in the system is long overdue and should be celebrated. But victory at the expense of women’s comprehensive reproductive health care is no victory at all.