IB 

Union Calendar No. 27 

116TH CONGRESS 

1ST SESSION H. R. 1385 

[Report No. 116–49] 

To amend the Patient Protection and Affordable Care Act to preserve the 

option of States to implement health care marketplaces, and for other 

purposes. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 27, 2019 

Mr. KIM (for himself and Mr. FITZPATRICK) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

MAY 3, 2019 

Additional sponsors: Ms. SCHAKOWSKY, Mrs. WATSON COLEMAN, Ms. BLUNT

ROCHESTER, Mr. PALLONE, Mr. RUSH, Mrs. DINGELL, Mr. RUIZ, Ms. 

ESHOO, Mr. KENNEDY, Ms. MATSUI, Mr. VAN DREW, Ms. CLARKE of 

New York, Ms. HOULAHAN, Ms. SCANLON, Ms. MCCOLLUM, and Ms. 

MUCARSEL-POWELL

MAY 3, 2019 

Reported with an amendment, committed to the Committee of the Whole 

House on the State of the Union, and ordered to be printed 

[Strike out all after the enacting clause and insert the part printed in italic] 

[For text of introduced bill, see copy of bill as introduced on February 27, 2019] 


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•HR 1385 RH

A BILL 

To amend the Patient Protection and Affordable Care Act 

to preserve the option of States to implement health 

care marketplaces, and for other purposes. 


pamtmann on DSKBFK8HB2PROD with BILLS
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•HR 1385 RH

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘State Allowance for a 

5 Variety of Exchanges Act’’ or the ‘‘SAVE Act’’. 

6 SEC. 2. PRESERVING STATE OPTION TO IMPLEMENT 

7 HEALTH CARE MARKETPLACES. 

8 (a) IN GENERAL.—Section 1311 of the Patient Protec9 tion and Affordable Care Act (42 U.S.C. 18031) is amend10 ed— 

11 (1) in subsection (a)— 

12 (A) in paragraph (4)(B), by striking 

13 ‘‘under this subsection’’ and inserting ‘‘under 

14 this paragraph or paragraph (1)’’; and 

15 (B) by adding at the end the following new 

16 paragraph: 

17 ‘‘(6) ADDITIONAL PLANNING AND ESTABLISH18 MENT GRANTS.— 

19 ‘‘(A) IN GENERAL.—There shall be appro20 priated to the Secretary, out of any moneys in 

21 the Treasury not otherwise appropriated, 

22 $200,000,000 to award grants to eligible States 

23 for the uses described in paragraph (3). 

24 ‘‘(B) DURATION AND RENEWABILITY.—A 

25 grant awarded under subparagraph (A) shall be 


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•HR 1385 RH

1 for a period of two years and may not be re2 newed. 

3 ‘‘(C) LIMITATION.—A grant may not be 

4 awarded under subparagraph (A) after December 

5 31, 2022. 

6 ‘‘(D) ELIGIBLE STATE DEFINED.—For pur7 poses of this paragraph, the term ‘eligible State’ 

8 means a State that, as of the date of the enact9 ment of this paragraph, is not operating an Ex10 change (other than an Exchange described in sec11 tion 155.200(f) of title 45, Code of Federal Regu12 lations).’’; and 

13 (2) in subsection (d)(5)(A)— 

14 (A) by striking ‘‘OPERATIONS.—In estab15 lishing an Exchange under this section’’ and in16 serting ‘‘OPERATIONS.— 

17 ‘‘(i) IN GENERAL.—In establishing an 

18 Exchange under this section (other than in 

19 establishing an Exchange pursuant to a 

20 grant awarded under subsection (a)(6))’’; 

21 and 

22 (B) by adding at the end the following: 

23 ‘‘(ii) ADDITIONAL PLANNING AND ES24 TABLISHMENT GRANTS.—In establishing an 

25 Exchange pursuant to a grant awarded 


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•HR 1385 RH

1 under subsection (a)(6), the State shall en2 sure that such Exchange is self-sustaining 

3 beginning on January 1, 2024, including 

4 allowing the Exchange to charge assessments 

5 or user fees to participating health insur6 ance issuers, or to otherwise generate fund7 ing, to support its operations.’’. 

8 (b) CLARIFICATION REGARDING FAILURE TO ESTAB9 LISH EXCHANGE OR IMPLEMENT REQUIREMENTS.—Section 

10 1321(c) of the Patient Protection and Affordable Care Act 

11 (42 U.S.C. 18041(c)) is amended— 

12 (1) in paragraph (1), by striking ‘‘If’’ and in13 serting ‘‘Subject to paragraph (3), if’’; and 

14 (2) by adding at the end the following new para15 graph: 

16 ‘‘(3) CLARIFICATION.—This subsection shall not 

17 apply in the case of a State that elects to apply the 

18 requirements described in subsection (a) and satisfies 

19 the requirement described in subsection (b) on or after 

20 January 1, 2014.’’. 


pamtmann on DSKBFK8HB2PROD with BILLS
Union Calendar No. 27 

116TH CONGRESS 

1ST SESSION H. R. 1385 

[Report No. 116–49] 

A BILL 

To amend the Patient Protection and Affordable 

purposes. plement health care marketplaces, and for other Care Act to preserve the option of States to imMAY 3, 2019 

Reported with an amendment, committed to the Comand ordered to be printed mittee of the Whole House on the State of the Union, 


pamtmann on DSKBFK8HB2PROD with BILLS