I 

116TH CONGRESS 

1ST SESSION H. R. 1385 

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 

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. 

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 

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


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1 SEC. 2. PRESERVING STATE OPTION TO IMPLEMENT 

2 HEALTH CARE MARKETPLACES. 

3 (a) IN GENERAL.—Section 1311 of the Patient Pro4 tection and Affordable Care Act (42 U.S.C. 18031) is 

5 amended— 

6 (1) in subsection (a)— 

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

8 ‘‘under this subsection’’ and inserting ‘‘under 

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

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

11 paragraph: 

12 ‘‘(6) ADDITIONAL PLANNING AND ESTABLISH13 MENT GRANTS.— 

14 ‘‘(A) IN GENERAL.—There shall be appro15 priated to the Secretary, out of any moneys in 

16 the Treasury not otherwise appropriated, 

17 $200,000,000 to award grants to eligible States 

18 for the uses described in paragraph (3). 

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

20 grant awarded under subparagraph (A) shall be 

21 for a period of two years and may not be re22 newed. 

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

24 awarded under subparagraph (A) after Decem25 ber 31, 2022. 


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1 ‘‘(D) ELIGIBLE STATE DEFINED.—For 

2 purposes of this paragraph, the term ‘eligible 

3 State’ means a State that, as of the date of the 

4 enactment of this paragraph, is not operating 

5 an Exchange.’’; and 

6 (2) in subsection (d)(5)(A)— 

7 (A) by striking ‘‘In establishing an Ex8 change under this section’’ and inserting ‘‘(i) IN

9 GENERAL.—In establishing an Exchange under 

10 this section (other than in establishing an Ex11 change pursuant to subsection (a)(6))’’; and 

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

13 ‘‘(ii) ADDITIONAL PLANNING AND ES14 TABLISHMENT GRANTS.—In establishing 

15 an Exchange pursuant to subsection 

16 (a)(6), the State shall ensure that such 

17 Exchange is self-sustaining beginning on 

18 January 1, 2024, including allowing the 

19 Exchange to charge assessments or user 

20 fees to participating health insurance 

21 issuers, or to otherwise generate funding, 

22 to support its operations.’’. 

23 (b) CLARIFICATION REGARDING FAILURE TO ESTAB24 LISH EXCHANGE OR IMPLEMENT REQUIREMENTS.—SecVerDate Sep 11 2014 18:09 Mar 11, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1385.IH H1385

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1 tion 1321(c) of the Patient Protection and Affordable 

2 Care Act (42 U.S.C. 18041(c)) is amended— 

3 (1) in paragraph (1), by striking ‘‘If’’ and in4 serting ‘‘Subject to paragraph (3), if’’; and 

5 (2) by adding at the end the following new 

6 paragraph: 

7 ‘‘(3) CLARIFICATION.—This subsection shall 

8 not apply in the case of a State that elects to apply 

9 the requirements described in subsection (a) and 

10 satisfies the requirement described in subsection (b) 

11 on or after January 1, 2014.’’. 

Æ 


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