Democrats in the US Senate have unveiled plans to overhaul health insurance after setbacks under the Trump administration. They propose a three-year extension of the increased tax credits for insurance premiums from the Affordable Care Act, which are set to expire at the end of 2025. Those credits, introduced in the American Rescue Plan of 2021 and the Inflation Reduction Act of 2022, allowed millions of people to sign up for insurance through the ACA's marketplaces. The Senate rejected two proposals to address the rising cost of insurance, although both received majorities, but fell short of the required number. Republicans have rejected an extension in the One Big Beautiful Bill Act, criticizing it as maintaining the status quo without reform. The bipartisan agreement on health care, including changes to drug broker practices and hospital billing, does not include an extension of these concessions. States such as Rhode Island, Illinois, Mississippi and Maine are expected to see significant increases in commercial insurance premiums in 2026, for example by double-digit percentages or an average of 24% in Maine. Without the extension of concessions, millions are at risk of insurance increases and loss of insurance.