When the government shutdown ended last month without any solution for the looming expiration of Affordable Care Act subsidies, health care instantly became one of the most important issues in Congress for the rest of the year.

The clock has been ticking ever since. The subsidies are on track to expire on Dec. 31. The true deadline for Congress is even sooner, though. Next Thursday is the last day that both the Senate and House of Representatives will be in session before they go on recess through the end of the year.

Unless a bill to extend them is passed before then, the subsidies will run out. If that happens, health care premiums are expected to increase by $1,000 on average for the more than 20 million Americans who get their plans through the ACA, and nearly 4 million people will lose their health insurance entirely.

The only substantive thing that came out of the shutdown was a pledge from Republicans that the Senate would hold a vote on extending the subsidies at some point before the end of the year.

Democrats have maintained the position they’ve held since before the shutdown even began. They want a “clean” extension for the subsidies that keeps them in place for a few more years with no meaningful changes. The challenge has been on the Republican side, where there has been a vast divide within the party over the best approach to health care.

Over the last several weeks, there has been a flurry of behind-the-scenes negotiating within the GOP to decide what to offer up as an alternative to the Democrats’ plan. Some moderate Republicans in the Senate have said they’d support extending the subsidies for a limited time, as long as new restrictions were added to reduce the costs. But the bulk of the GOP — including President Trump and leadership in both chambers of Congress — has instead been pushing a variety of alternative plans that would allow the subsidies to expire and potentially make dramatic changes to how the Affordable Care Act works.

What happens next?

With time running thin, the Senate is scheduled to hold votes on two competing health care proposals on Thursday. One will be the Democrats’ plan to extend the subsidies for three years. The other is a bill written by conservative Republicans Bill Cassidy and Mike Crapo that would not extend the subsidies but would instead filter more money into Health Savings Accounts that people could tap into to cover their health care expenses.

The Cassidy-Crapo plan fits within Trump’s vision for health care, which he has expressed repeatedly in recent weeks.

“THE ONLY HEALTHCARE I WILL SUPPORT OR APPROVE IS SENDING THE MONEY DIRECTLY BACK TO THE PEOPLE, WITH NOTHING GOING TO THE BIG, FAT, RICH INSURANCE COMPANIES,” he wrote on Truth Social last month. Trump has warned Congress to “not waste your time and energy” on any health care proposal that doesn’t meet his criteria, though he hasn’t identified a specific bill that he’d support.

The specifics of either party’s Senate bill may not matter much, however. Both votes on Thursday are widely expected to fail. Democrats would need more than a dozen Republicans to join them for their bill to extend the subsidies to pass. So far only a few have even hinted that they might back the plan. Republican Senate Majority Leader John Thune described the vote on the Democrats’ bill as little more than a “political messaging exercise” that is “designed to fail.”

The Republicans’ bill will likely meet the same fate. Chuck Schumer, who leads Democrats in the Senate, called the proposal “dead on arrival” after it was unveiled on Tuesday.

Even if something does somehow pass through the Senate, it would still have to be approved by the House, where there is even more uncertainty about what happens next. Republican leaders in the House said Wednesday that they plan to hold votes on “a number” of health care bills next week, but the caucus hasn’t yet settled on a single proposal. During a closed-door meeting on Wednesday, House Speaker Mike Johnson presented his caucus with a list of nonspecific frameworks for health care, but there was reportedly deep disagreement among GOP members over what path they should ultimately take.

Rep. Hakeem Jeffries, the top Democrat in the House, has been working to use a procedural tactic known as a discharge petition to force a vote on the Democrats’ bill to extend the subsidies. That petition is currently stalled because no Republicans have been willing to sign it.

A few moderate House Republicans have reportedly said they may try to take the same route to force a vote on their own plan for a scaled-back extension of the subsidies, but that process hasn’t been put in motion yet.

With only six legislative days left in the year and so much still unsettled, some members of Congress have effectively given up hope that anything will get done in time to prevent the subsidies from expiring. Many are now reportedly viewing Jan. 30, the last day before government funding runs out again, as the “real deadline” to pass some sort of health care bill.