The fast-approaching expiration of federal subsidies for people buying healthcare on the Affordable Care Act (ACA) marketplace appears all but guaranteed after Senate Republicans declined to include an extension of the tax credits in their health care proposal and then blocked a competing Democratic bill that would have extended them on Thursday.

The subsidies, which are set to expire at the end of the year, were at the center of the impasse that shut down the government for the longest period in U.S. history this fall. Democrats refused to pass President Donald Trump’s spending bill until they were extended, and Republicans dug in, spreading false claims about what Democrats were demanding , even as polls showed most people blamed Trump and his party for the shutdown.

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