The demise of health care is going to look something like “Murder on the Orient Express” — everyone in the GOP takes a stab at it in the middle of the night and in the end no one knows who did it. The first wave of protest in response to the outrageous House bill has ebbed completely, and this time after a U.S. Senate vote there will be no second chance. The time to fight back is now.

With complete control of the White House and Congress, the House GOP leadership proposed a truly terrible bill that had voters and major players everywhere (doctors, hospitals, insurers, etc.) up in arms. At first, the bill failed for lack of votes and then it was revived with a few inconsequential changes that left the number of people uncovered more or less the same. Lo and behold, it passed the House despite the prediction by the Congressional Budget Office that under the measure, 23 million Americans would ultimately lose coverage and those with pre-existing conditions would be worse off. President Donald Trump proudly held a Rose Garden ceremony just to celebrate that the House (not yet the Senate) had passed a bill.

In the Senate, the House bill hailed in the Rose Garden was broadly dismissed as more or less dead on arrival. The Senate, it was said, would start from scratch. But a funny thing happened on the way to the dustbin of history. The Senate bill to replace the House bill broadly dissed by the Senate disappeared behind of a curtain of obscurity, and leaks portend a bill a lot more like the House version than anyone thought possible.

But no one really knows. The new Senate bill was drafted behind closed doors, with no hearings, by an all-white group of men. On the chopping block, yet again: Medicaid, pre-existing conditions, minimum standards of coverage, subsidies for those who can’t pay and mental health coverage (including care for those with addictions) among other vital policies and programs. The bill also bars the use of federal funds to pay Planned Parenthood for family-planning services, screening tests and preventive care.

What do women have to lose? All that the Affordable Care Act guaranteed them — an end to denials of coverage for such “pre-existing conditions” as having previously given birth by Caesarean section; being pregnant at the time coverage is sought; surviving domestic violence and receiving treatment related to abuse, even after a sexual assault. The Affordable Care Act also bans charging women higher premiums than men of the same age and, for the first time, bars sex discrimination outright in federal health programs, in health programs receiving federal dollars and in the health insurance exchanges. The ban applies as well to private insurers receiving federal funds. These are game changers.

Further, under the Affordable Care Act, maternity coverage for all, typically excluded by individual market insurance plans (87 percent in 2009) is guaranteed. New plans must cover recommended preventive care, including contraception, domestic violence screenings, Pap tests and mammograms, without co-payments. The law also requires that employers with more than 50 employees provide breaks and a private place for nursing mothers to express breast milk, a beneficial move for mothers and children. All this is at risk now.

The national conversation is distracted every day by the president’s tweets lashing out in different directions, by committee hearings on the integrity of our elections, and by the fate of the Paris accord on fighting climate change, among other demands on the public’s attention. What is mostly ignored is what the Senate did behind closed doors to health care as we know it. One sixth of the nation’s economy is at stake. Massive tax cuts for the rich that depend on shrinking federal funding for health care are baked into the new health-care legislation, and the lives and health of millions hang in the balance.

Yet only a handful of people in the entire country — all operating from a few GOP Senate offices, has any idea what is going on. This situation is truly a travesty of democracy and a textbook case of perverting the legislative process. Blowing more smoke is the president, who having celebrated passage of the draconian House bill, now says the Senate bill, likely a bit milder, is “mean.” Maybe because it is clear the public doesn’t like it.

What is clear is how devastating the Senate’s approach is. It’s time to pull out all the stops. Call your senators. Plan a visit to their office in Washington, D.C., or at home in your state if possible. March with signs demanding universal affordable quality health care for all. In other words, raise hell. The train is hurtling down the tracks. Senate leader Mitch McConnell wants a vote before July 4 — before senators return home to outraged constituents. If the Senate gets away with this secretive process, there will be no end to the destruction of our safety net and indeed our democracy. Resist! JN

Nancy K. Kaufman is the CEO of the National Council of Jewish Women.

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