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BY LISA LEVENSTEIN

During her confirmation hearings, Supreme Court nominee Sonia Sotomayor described the 1973 decision in Roe v. Wade as "settled law." Yet down the hall from the Supreme Court questioning, anti-abortion legislators have been attempting to unsettle the Roe v. Wade decision by using health care reform as an opportunity to restrict abortion.

Roe v. Wade defined abortion as a medical procedure, granting women the right to choose whether to terminate their pregnancies in consultation with their physicians. However, if anti-abortion legislators have their way, any success in redesigning our health care system will bring with it new restrictions on women's right to choose.

Congress first flexed its political muscle on the abortion question in 1976, when it passed the Hyde Amendment forbidding Medicaid from using federal money to pay for most abortion services, essentially eliminating the right to choose for the thousands of poor women who could not afford to pay for the procedure. The current attempts to reform the health care system have provided antiabortion legislators with an opportunity to extend these restrictions even further.

The health care plan under consideration in Washington involves the creation of a National Health Insurance Exchange and the provision of subsidies for those who need help purchasing insurance. According to a 2002 survey by the Guttmacher Institute, nearly 90 percent of private insurers currently cover abortion. At issue is whether the private insurers who participate in the exchange will be able to continue to provide such funding.

Antiabortion lawmakers have answered the question with a definitive no. Last month, 19 antiabortion Democrats in the House sent a letter to Speaker Nancy Pelosi expressing their refusal to "support any health care reform proposal unless it explicitly excludes abortion from the scope of a government-defined or subsidized health-insurance plan."

More recently, three Republican senators submitted an amendment to the Senate Health, Education, Labor and Pensions Committee extending the Hyde Amendment to any health care coverage purchased in the exchange. The amendment banned federal support not only for health care providers who offer abortion services but also for insurance plans that cover the procedure. Although the amendment was defeated, antiabortion advocates have clearly signaled that they view health care reform as an opportunity to use the congressional power of the purse to impose further restrictions on women's right to choose.

Meanwhile, abortion rights advocates have largely remained under the radar. While denying Republican claims that health care reform "would result in the greatest expansion of abortion since Roe v. Wade," they have not publicly campaigned for legislators to overturn the Hyde Amendment or to include abortion in the much-discussed "public option." When questioned last week on "Fox News Sunday," Peter R. Orszag, the White House budget director, refused to promise that "no taxpayer money will go to pay for abortions," yet he described the matter as "controversial" and unsettled, and did not offer a robust defense of abortion rights. At stake is our understanding of abortion not merely as an abstract right but as a fundamental component of women's health and safety. With fewer and fewer medical schools training students in abortions and clinics closing down in face of extreme antiabortion violence, conservatives are gaining ground in their efforts to define abortion not as a medical procedure or an essential element of women's equality but as an immoral and shameful practice.

Unless every woman has access to abortion as part of her health care plan there is no real choice; and without choice, the law is no longer settled.

Lisa Levenstein teaches U.S. women's history at UNCG. She is the author of "A Movement Without Marches: African American Women and the Politics of Poverty in Postwar Philadelphia" (2009).