The Gazette offers audio versions of articles using Instaread. Some words may be mispronounced.

Iowa Republican U.S. Sens. Chuck Grassley and Joni Ernst on Thursday voted to advance a GOP health care proposal built around expanded health savings accounts, positioning it as a patient-driven alternative to extending the Affordable Care Act’s enhanced premium tax credits — which are set to expire at the end of the month.

But Democrats — who rejected the measure, which required 60 votes to advance, by a vote of 51-48 — and health policy analysts warn the plan would expose families to sharply higher premiums beginning in January.

The Senate on Thursday also rejected a Democratic bill to extend the subsidies for three years, essentially guaranteeing that millions of Americans will see a steep

See Full Page