for tax credits under section 36B of the Internal 
Revenue Code of 1986, with the ability to opt out 
of such enrollment. 
(2) State investment in technology to improve 
data sharing and collection for the purposes of facili-
tating greater enrollment in health insurance cov-
erage in such markets. 
(3) Implementation of a State version of an in-
dividual mandate to be enrolled in health insurance 
coverage. 
(4) Feasibility studies to develop comprehensive 
and coherent State plan for increasing enrollment in 
the individual and small group market. 
(d) FUNDING.—For purposes of carrying out this 
section, there is hereby appropriated, out of any funds in 
the Treasury not otherwise appropriated, $200,000,000 
for each of the fiscal years 2020 through 2022. Such 
amount shall remain available until expended. 
SEC. 303. PRESERVING STATE OPTION TO IMPLEMENT 
HEALTH CARE MARKETPLACES. 
(a) IN GENERAL.—Section 1311 of the Patient Pro-
tection and Affordable Care Act (42 U.S.C. 18031) is 
amended— 
(1) in subsection (a)— 
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(A) in paragraph (4)(B), by striking 
‘‘under this subsection’’ and inserting ‘‘under 
this paragraph or paragraph (1)’’; and 
(B) by adding at the end the following new 
paragraph: 
‘‘(6) ADDITIONAL PLANNING AND ESTABLISH-
MENT GRANTS.— 
‘‘(A) IN GENERAL.—There shall be appro-
priated to the Secretary, out of any moneys in 
the 
Treasury 
not 
otherwise 
appropriated, 
$200,000,000 to award grants to eligible States 
for the uses described in paragraph (3). 
‘‘(B) DURATION AND RENEWABILITY.—A 
grant awarded under subparagraph (A) shall be 
for a period of two years and may not be re-
newed. 
‘‘(C) LIMITATION.—A grant may not be 
awarded under subparagraph (A) after Decem-
ber 31, 2022. 
‘‘(D) ELIGIBLE
STATE
DEFINED.—For 
purposes of this paragraph, the term ‘eligible 
State’ means a State that, as of the date of the 
enactment of this paragraph, is not operating 
an Exchange.’’; and 
(2) in subsection (d)(5)(A)— 
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(A) by striking ‘‘In establishing an Ex-
change under this section’’ and inserting ‘‘(i) IN 
GENERAL.—In establishing an Exchange under 
this section (other than in establishing an Ex-
change pursuant to subsection (a)(6))’’; and 
(B) by adding at the end the following: 
‘‘(ii) ADDITIONAL PLANNING AND ES-
TABLISHMENT
GRANTS.—In establishing 
an 
Exchange 
pursuant 
to 
subsection 
(a)(6), the State shall ensure that such 
Exchange is self-sustaining beginning on 
January 1, 2024, including allowing the 
Exchange to charge assessments or user 
fees to participating health insurance 
issuers, or to otherwise generate funding, 
to support its operations.’’. 
(b) CLARIFICATION REGARDING FAILURE TO ESTAB-
LISH EXCHANGE OR IMPLEMENT REQUIREMENTS.—Sec-
tion 1321(c) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18041(c)), as amended by section 
205, is further amended— 
(1) in paragraph (1), by striking ‘‘If’’ and in-
serting ‘‘Subject to paragraph (4), if’’; and 
(2) by adding at the end the following new 
paragraph: 
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‘‘(4) CLARIFICATION.—This subsection shall 
not apply in the case of a State that elects to apply 
the requirements described in subsection (a) and 
satisfies the requirement described in subsection (b) 
on or after January 1, 2014.’’. 
SEC. 
304. 
PROMOTE 
TRANSPARENCY 
AND 
ACCOUNT-
ABILITY IN THE ADMINISTRATION’S EXPENDI-
TURES OF EXCHANGE USER FEES. 
For each of plan years 2018, 2019, and 2020, not 
later than the date that is 3 months after the end of such 
plan year, the Secretary of Health and Human Services 
shall submit to the appropriate committees of Congress 
and make available to the public an annual report on the 
expenditure by the Department of Health and Human 
Services of user fees collected pursuant to section 156.50 
of title 45, Code of Federal Regulations (or any successor 
regulations). Each such report for a plan year shall in-
clude a detailed accounting of the amount of such user 
fees collected during such plan year and of the amount 
of such expenditures used during such plan year for the 
federally facilitated Exchange operated pursuant to sec-
tion 1321(c) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18041(c)) on outreach and enroll-
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ment 
activities, 
navigators, 
maintenance 
of 
Healthcare.gov, and operation of call centers. 
Æ 
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