I 
113TH CONGRESS 
2D SESSION 
H. R. 4677 
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 HOUSE OF REPRESENTATIVES 
MAY 19, 2014 
Mr. REED (for himself, Mr. SCALISE, Ms. JENKINS, Mrs. BLACK, and Mr. 
TIBERI) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce 
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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘State Exchange Ac-
countability Act’’. 
VerDate Mar 15 2010 
01:34 May 28, 2014
Jkt 039200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4677.IH
H4677
smartinez on DSK6TPTVN1PROD with BILLS
SEC. 2. REIMBURSING THE FEDERAL GOVERNMENT FOR 
FAILED STATE EXCHANGE GRANTS. 
Section 1311(a) of the Patient Protection and Af-
fordable Care Act (42 U.S.C. 18031(a)) is amended by 
adding at the end the following: 
‘‘(6) REIMBURSEMENT IN THE CASE OF FAILED 
EXCHANGES.— 
‘‘(A) IN GENERAL.—In the case of a State 
that has received one or more establishment or 
early innovator grants under this subsection 
and which operated a State-based Exchange in 
program year 2014, if such State subsequently 
elects to provide solely for the enrollment of its 
residents in qualified health plans through the 
Federally Facilitated Exchange, such State 
shall reimburse the Federal Government for the 
aggregate amounts provided to the State under 
such grant or grants. 
‘‘(B) REIMBURSEMENT
AGREEMENTS.— 
Reimbursement shall be provided to the Federal 
Government by a State under this paragraph 
pursuant to the terms of an agreement entered 
into by the State and the Department of Health 
and Human Services that, at a minimum, shall 
require that— 
VerDate Mar 15 2010 
01:34 May 28, 2014
Jkt 039200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4677.IH
H4677
smartinez on DSK6TPTVN1PROD with BILLS
‘‘(i) such reimbursement be made, in 
full, within the 10-year period beginning 
on the date on which the State makes the 
election described in paragraph (1); and 
‘‘(ii) that the State make an annual 
payment in an amount equal to 10 percent 
of the total amount provided to the State 
under the grant or grants awarded to the 
State under this subsection. 
‘‘(C) NO
REDUCTION
IN
AMOUNT.—The 
Federal Government shall not reduce the 
amount of the reimbursement required to be 
provided by a State under this paragraph. 
‘‘(D) FAILURE
TO
ENTER
INTO
AGREE-
MENT.—In the case of a State described in sub-
paragraph (A) that fails to enter into an agree-
ment under subparagraph (B), the Secretary 
shall reduce the amount to be paid to the State 
under title XIX of the Social Security Act for 
each of the 10 fiscal years beginning with the 
first fiscal year that begins after the date of the 
election described in subparagraph (A) by the 
State. The amount of each such reduction shall 
be uniform and shall in the aggregate equal the 
VerDate Mar 15 2010 
01:34 May 28, 2014
Jkt 039200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4677.IH
H4677
smartinez on DSK6TPTVN1PROD with BILLS
total amount of the reimbursement required 
under this paragraph. 
‘‘(E) DEFICIT REDUCTION.—Amounts paid 
by a State under this section shall be placed in 
the General Fund of the Treasury to be used 
for deficit reduction.’’. 
Æ 
VerDate Mar 15 2010 
01:34 May 28, 2014
Jkt 039200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6301
E:\BILLS\H4677.IH
H4677
smartinez on DSK6TPTVN1PROD with BILLS