II 

113TH CONGRESS 

2D SESSION S. 2339 

To amend the Patient Protection and Affordable Care Act to require States 

with failed American Health Benefit Exchanges to reimburse the Federal 

Government for amounts provided under grants for the establishment 

and operation of such Exchanges. 

IN THE SENATE OF THE UNITED STATES 

MAY 14, 2014 

Mr. BARRASSO (for himself, Mr. HATCH, Mr. ENZI, Mr. MCCAIN, Mr. 

COBURN, and Mr. CHAMBLISS) introduced the following bill; which was 

read twice and referred to the Committee on Finance 

A BILL 

To amend the Patient Protection and Affordable Care Act 

to require States with failed American Health Benefit 

Exchanges to reimburse the Federal Government for 

amounts provided under grants for the establishment 

and operation of such Exchanges. 

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 Exchange Ac5 countability Act’’. 

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1 SEC. 2. REIMBURSING THE FEDERAL GOVERNMENT FOR 

2 FAILED STATE EXCHANGE GRANTS. 

3 Section 1311(a) of the Patient Protection and Af4 fordable Care Act (42 U.S.C. 18031(a)) is amended by 

5 adding at the end the following: 

6 ‘‘(6) REIMBURSEMENT IN THE CASE OF FAILED

7 EXCHANGES.— 

8 ‘‘(A) IN GENERAL.—In the case of a State 

9 that has received one or more establishment or 

10 early innovator grants under this subsection 

11 and which operated a State-based Exchange in 

12 program year 2014, if such State subsequently 

13 elects to provide solely for the enrollment of its 

14 residents in qualified health plans through the 

15 Federally Facilitated Exchange, such State 

16 shall reimburse the Federal Government for the 

17 aggregate amounts provided to the State under 

18 such grant or grants. 

19 ‘‘(B) REIMBURSEMENT AGREEMENTS.— 

20 Reimbursement shall be provided to the Federal 

21 Government by a State under this paragraph 

22 pursuant to the terms of an agreement entered 

23 into by the State and the Department of Health 

24 and Human Services that, at a minimum, shall 

25 require that— 

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1 ‘‘(i) such reimbursement be made, in 

2 full, within the 10-year period beginning 

3 on the date on which the State makes the 

4 election described in paragraph (1); and 

5 ‘‘(ii) that the State make an annual 

6 payment in an amount equal to 10 percent 

7 of the total amount provided to the State 

8 under the grant or grants awarded to the 

9 State under this subsection. 

10 ‘‘(C) NO REDUCTION IN AMOUNT.—The 

11 Federal Government shall not reduce the 

12 amount of the reimbursement required to be 

13 provided by a State under this paragraph. 

14 ‘‘(D) FAILURE TO ENTER INTO AGREE15 MENT.—In the case of a State described in sub16 paragraph (A) that fails to enter into an agree17 ment under subparagraph (B), the Secretary 

18 shall reduce the amount to be paid to the State 

19 under title XIX of the Social Security Act for 

20 each of the 10 fiscal years beginning with the 

21 first fiscal year that begins after the date of the 

22 election described in subparagraph (A) by the 

23 State. The amount of each such reduction shall 

24 be uniform and shall in the aggregate equal the 

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1 total amount of the reimbursement required 

2 under this paragraph. 

3 ‘‘(E) DEFICIT REDUCTION.—Amounts paid 

4 by a State under this section shall be placed in 

5 the General Fund of the Treasury to be used 

6 for deficit reduction.’’. 

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