Senator Mitch McConnell (R-KY) obviously understands deal making. In his attempt to unite the Senate GOP behind a replacement for Obamacare, he gave a little bit to a lot of people, and a lot to Sen. Ted Cruz (R-TX). But there’s one group he hasn’t given anything to: women.

The proposed ACA replacement, called the Better Care Reconciliation Act, doesn’t offer much improvement over the House GOP’s proposal, which was called the American Health Care Act and which, according to polling, was about as popular as a fart in an elevator. Approval for that bill hovered in the mid-teens. And when the Senate took its turn at crafting legislation, enough Republicans were spooked that McConnell bailed on even allowing a vote.

But, at this juncture, what the public thinks matters much less to McConnell than what his colleagues think. Without them, he doesn’t have a health care bill at all; he’s got seven years over broken promises, and six wasted months of gridlock that produced no major legislative accomplishments. And all President Trump can do while he waits to deliver the health care reform he promised is wait at his desk, screaming at DVR’ed episodes of Fox and Friends and tweeting about how his 39-year-old son is a very good boy.

In other words, McConnell needs a win. And so, for now, he is reaching away from the aisle, deep into the fetid water collecting in a swamp that isn’t drained. When he introduced a second version of his health care legislation, he largely capitulated to the far-right members of his caucus, the ones who held their breath and stamped their feet and demanded more people get the right to purchase shittier health care. He gave Cruz his special “skinny” insurance plans, plans people can buy that don’t cover pesky expensive extras that normal people don’t need, like childbirth or emergency services or mental health treatment and substance abuse disorders. Insurance is cheaper, you see, if it doesn’t do anything. Now all Ted Cruz needs to do is to pose in a flight suit before a Mission Accomplished banner.

But McConnell also tried to sow consensus among his fractured caucus. He threw a lot of money behind opioid research, recovery, and care to win over senators from states suffering through the opioid epidemic. And he gave little morsels to others he was trying to appease, like Alaska’s Lisa Murkowski, an on-the-fence senator who is getting a specially-crafted provision to help stabilize her state’s very unstable individual insurance market.

Here are things that McConnell didn’t to the BCRA, lest he endanger his narrow majority. He didn’t ease up on the draconian Medicaid cuts and didn’t eliminate the provision that Planned Parenthood be defunded, even as several of his female caucus members, including Murkowski, said they were worried about just that.

On top of that, the Cruz amendment, much like Cruz himself, is a veritable middle finger to women. The Texas senator’s “skinny plans” could force women to purchase more expensive plans than men simply to have their desire to have or not have children be considered part of their “healthcare.”

Conservatives insist that this is fine since people shouldn’t have to pay for insurance coverage they don’t need. But this approach treats being a woman as something fancy and extra, akin to being talked into getting the heated leather seats by the chatty car dealer.

It ignores the fact that the entire concept of insurance is based on collectively pooling money in case an expensive ailment befalls one who has contributed. A man may feel slighted for having to pay into a pool that covers care of the tangled tubes that often reside in the female pelvic region, but female taxpayers pay for things they largely don’t use all the time. Women don’t generally need prostate cancer screenings, but can’t opt out of insurance policies that cover them.

Besides, by my count, no male senator could possibly exist if, at some point, a woman hadn’t grown him and birthed him, often at great physical expense. It seems that partaking in an insurance plan that covers maternity care for future mothers is the closest thing a man could do to getting his mother back for that massive rain check she wrote him with her body. Simone de Beauvior would roll over in her grave if she weren’t busy burrowing further away from the earth’s wacky surface.

Women’s health advocates have made it impossible for senators to ignore them in the last months. They’ve lit up their phone lines, showed up at town halls, and marched, over and over. They’ve written letters and emails and pithy columns about how bad Republicans are at this. They’ve confronted their senators with calm, empathetic reason, they’ve gone viral, they’ve been shared and liked and upvoted. Last week, they stopped by Sen. Dean Heller’s (R-NV) office in full Handmaid’s Tale regalia, hoping to sway him from “undecided” to “no.” McConnell knows exactly how women feel about his Obamacare replacement.

But to quote Mitch McConnell: nevertheless, he persisted.

McConnell will carry on in this uphill battle against moral decency and popular opinion. If he succeeds, he may score a career-defining legislative win, but one that proves incredibly unpopular. If he fails, he could shred his reputation as an effective leader heading into 2018. A vote on the bill will reportedly occur in a matter of weeks. Legally enshrining femaleness as an expensive medical condition seems like a risky move. But hey, ignoring women has gotten the GOP the White House, the Senate, and the House, so maybe they know something I, a lowly woman, do not.