Senate Majority Leader Mitch McConnell (R-Ky.) (J. Scott Applewhite/Associated Press)

The fate of the American health-care system now rests with a group of allegedly “moderate” senators, who are getting ready to approve a bill to repeal the Affordable Care Act, a repeal bill so monumental in its cruelty that they feel they have no choice but to draft it in secret, not let the public know what it does, hold not a single hearing or committee markup, slip it in a brown paper package to the Congressional Budget Office, then push it through to a vote before the July 4th recess before the inevitable backlash gets too loud.

“We aren’t stupid,” one GOP Senate aide told Caitlin Owens — they know what would happen if they made their bill public. Even Republican senators who aren’t part of the 13-member working group crafting the bill haven’t been told exactly what’s in it.

Today, we learned that in a break with long-standing precedent, “Senate officials are cracking down on media access, informing reporters on Tuesday that they will no longer be allowed to film or record audio of interviews in the Senate side hallways of the Capitol without special permission.” Everyone assumes that it’s so those senators can avoid having to appear on camera being asked uncomfortable questions about a bill that is as likely to be as popular as Ebola. As Julie Rovner of Kaiser Health News tweeted about the secrecy with which this bill is being advanced, “I have covered every major health bill in Congress since 1986. Have NEVER seen anything like this.”

This is how a party acts when it is ashamed of what it is about to do to the American people. Yet all it would take to stop this abomination is for three Republicans to stand up to their party’s leaders and say, “No — I won’t do this to my constituents.” With only a 52-48 majority in the Senate, that would kill the bill. But right now, it’s looking as though this Coward Caucus is going to be unable to muster the necessary courage.

The Post's Libby Casey explains how television crews work in the Senate and how the rules are enforced. (Libby Casey,McKenna Ewen / The Washington Post)

To understand the magnitude of what they’re doing, let’s focus on Medicaid, because it was supposed to be a sticking point on which some senators wouldn’t budge, particularly those whose states accepted the ACA’s expansion of the program. But according to various reports, the moderates have already caved.

Take Sen. Shelley Moore Capito of West Virginia, a state where more than 175,000 people have gotten insurance thanks to the Medicaid expansion. For a while, Capito made noises about she wanted to preserve the expansion to protect her constituents. “I mean, we can’t just drop them off and wish them good luck,” she said. But no more.

Last week The Hill reported that Capito now supports eliminating the expansion after all — just doing it over seven years instead of the three years that the House bill required. The Charleston Gazette-Mail in Capito’s home state noted that Capito had said she didn’t want to drop all those West Virginians off a cliff, but “Instead, she would drop them off a cliff on the installment plan — around 25,000 per year for seven years.”

President Trump on June 13 said Republican efforts to overhaul the U.S. health-care system will result in a "phenomenal bill" and "fantastic" outcome. Trump was hosting several Republican senators at the White House. (The Washington Post)

Or how about Ohio Sen. Rob Portman? In his state, 700,000 people gained insurance as a result of the Medicaid expansion. He drafted a letter to Majority Leader Mitch McConnell (R-Ky.) stating his opposition to the House bill because it didn’t protect those who gained insurance from the expansion. Now Portman also wants to phase out the expansion over seven years.

What about Sen. Susan Collins, supposedly the most moderate Republican in the Senate? While Maine hasn’t accepted the expansion due to the resistance of America’s Worst Governor™, Paul LePage, Collins has said that she would like to see her state accept the expansion (with some provisions that make it more uncomfortable for recipients, just so those poors don’t get the idea that they should accept it without shame). But we’ve been through this dance with Collins before — Democrats hope she’ll be a vote for moderation; she talks about how she wants to find a compromise; and in the end she votes with the GOP on every important bill.

It’s important to know that the Medicaid question isn’t just about the millions who would lose coverage if the expansion is eliminated. Paige Winfield Cunningham reports today that Senate Republicans are considering even deeper cuts to Medicaid than the $880 billion the House bill slashed out of the program. They’d pay for the slower elimination of the expansion by cutting money out of the existing program, so they could get rid of all of the ACA’s tax increases — which mostly affected the wealthy. In other words, they want to cut Medicaid to give a tax break to rich people.

Just as critical, they want to end Medicaid’s status as an entitlement, meaning that the program wouldn’t cover everyone who’s eligible. States would get a chunk of money to spend, and if more people turned out to need coverage, tough luck for them. The states would be offered “flexibility,” which in practice would mean permission to kick people off the program and cut back on benefits. And don’t think this is just about poor people — over half of Medicaid dollars go to the elderly and disabled. That means that they aren’t just undoing the ACA; they’re making things substantially worse for tens of millions of America’s most vulnerable citizens than they were even before the ACA passed.

And they’re hoping they can do all this before anyone realizes what they’re up to, making this an act of both unconscionable heartlessness and epic cowardice. Their efforts to hide what they’re doing show that they are still capable of feeling some measure of shame. But it might not be enough to stop them.