When health care reform finally limped past the finish line on Capitol Hill, the compromises littering the final bill left many activists disillusioned, but some hoped that action on the state level could keep the progressive reform movement moving forward. On reproductive rights, however, it looks like the states are taking the lead in pushing back a woman's right to choose.

This year, amid a resurgence of right-wing activism, hundreds of bills targeting abortion have been introduced in state legislatures around the country, many of which will deeply impact the rights of poor women of color. Several conservative states have passed laws to block coverage of abortion under the insurance exchanges established under the overhaul-portending a tightening of abortion access even if it is privately financed.

Oklahoma lawmakers have passed several controversial bills, including constitutionally dubious measures that would subject women to the psychological torment of having an ultrasound and hearing a description of the fetus before undergoing an abortion.

The seeds of the current backlash, the New York Times reports, were sown with a 2007 Supreme Court decision on partial-birth abortions that chipped away at the legal framework for legal abortion under Roe v. Wade. It's all adding up:

About 370 state bills regulating abortion were introduced in 2010, compared with about 350 in each of the previous five years, and 250 a year in the early 1990s, according to the Guttmacher Institute, a research organization that supports abortion rights. At least 24 of this year's bills have passed, and the final total may reach the high of 2005, when states passed 34 laws, said Elizabeth Nash, a public policy associate at the institute....

The assault on abortion rights will be felt most acutely among poor women. On RH Reality Check, Pamela Merritt dissects the cruel psychological manipulation underlying Missouri's Abortion Restriction Bill:

The Abortion Restriction bill requires abortion clinics to post signs that promise state-backed assistance should a woman carry a child to term and assistance in caring for that child once born. These promised services include health care, housing, transportation, food, clothing, education, and job training. Given the fact that the Missouri legislature slashed funding to most of the programs that would have provided those services, those claims and promises aren't worth the poster-board they will be printed on.

By tying the refusal of an abortion to social services, Missouri masks its punishment of poor women as a "reward" for keeping an unwanted pregnancy. Adding insult to injury, they've also betrayed the same promise by tearing apart the safety net that should be available to all women, regardless of how they choose to exercise their reproductive rights.

Missouri is a microcosm for a slow-burning crisis in reproductive health that targets poor communities and communities of color, in which abortion has become more prevalent in recent years.

According to Raising Women's Voices, while the federal subsidies and Medicaid expansions will broaden women's access to the mainstream health care system, the new benefits come at the expense of reproductive health for the most vulnerable:

• Women on Medicaid and those who will become eligible for Medicaid in 2014 will not be able to use their coverage for abortion services in most cases, except in the circumstances stated above, or if they live in one of the 17 states that use state-only dollars to provide abortion coverage under Medicaid.
• Low-income women receiving care at Community Health Centers still will not be able to receive federally-subsidized abortion services, making it more difficult for CHCs to provide this care.
• New funding for ineffective abstinence-only sex education. Title V, the federal abstinence-only-until-marriage program is resuscitated and given $50 million a year for five years.

Additionally, immigrants, regardless of legal status, will continue to face discriminatory restrictions under the pending health reforms. This includes a five-year mandatory wait to qualify for federal Medicaid services for green card holders, along with a total ban for undocumented women.

The health care system is at the cusp of major changes in the coming years, delivering a mix of help and hurt. But for the women whose reproductive health needs have always been ignored in Washington, the biggest change they'll see could be from bad to worse.