The latest Republican effort to repeal and replace the Affordable Care Act has died without a vote in the U.S,. Senate, but the roughly 240,000 Ohioans who purchase health insurance through the ACA marketplace will still face new and daunting challenges to maintain coverage. With open enrollment for 2018 set to begin soon, the Trump administration is cutting funds for the navigators who have helped people sort through their options and slashing the time frames to sign up for insurance. Buyers also face higher premiums, though as ideastream health reporter Marlene Harris-Taylor points out, federal subsidies will ease the financial hit for lower-wage workers.