II 

116TH CONGRESS 

1ST SESSION S. 1400 

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 SENATE OF THE UNITED STATES 

MAY 9, 2019 

Mr. MENENDEZ (for himself, Mr. CASEY, and Mr. BOOKER) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

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 2 years and may not be renewed. 

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

23 awarded under subparagraph (A) after Decem24 ber 31, 2022. 

25 ‘‘(D) ELIGIBLE STATE DEFINED.—For 

26 purposes of this paragraph, the term ‘eligible 


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

2 enactment of this paragraph, is not operating 

3 an Exchange.’’; and 

4 (2) in subsection (d)(5)(A)— 

5 (A) by striking ‘‘In establishing an Ex6 change under this section’’ and inserting the 

7 following: 

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

9 Exchange under this section (other than in 

10 establishing an Exchange pursuant to sub11 section (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 04:19 May 17, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1400.IS S1400

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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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