I 
117TH CONGRESS 
1ST SESSION H. R. 1896 
To amend title I of the Patient Protection and Affordable Care Act to 
provide for additional grants for States to conduct activities related 
to establishing American Health Benefit Exchanges. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 16, 2021 
Mr. KIM of New Jersey (for himself and Mr. FITZPATRICK) introduced the 
following bill; which was referred to the Committee on Energy and Commerce 
A BILL 
To amend title I of the Patient Protection and Affordable 
Care Act to provide for additional grants for States 
to conduct activities related to establishing American 
Health Benefit 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 Allowance for 
a Variety of Exchanges Act of 2021’’ or the ‘‘SAVE Act 
of 2021’’. 
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SEC. 2. 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)— 
(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 
million 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 2 years and may not be renewed. 
‘‘(C) LIMITATION.—A grant may not be 
awarded under subparagraph (A) after Decem-
ber 31, 2024. 
‘‘(D) ELIGIBLE
STATE
DEFINED.—For 
purposes of this paragraph, the term ‘eligible 
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State’ means a State that, as of January 1, 
2019, was not operating an Exchange (other 
than 
an 
Exchange 
described 
in 
section 
155.200(f) of title 45, Code of Federal Regula-
tions).’’; and 
(2) in subsection (d)(5)(A)— 
(A) by striking ‘‘OPERATIONS.—In estab-
lishing an Exchange under this section’’ and in-
serting ‘‘OPERATIONS.— 
‘‘(i) IN GENERAL.—In establishing an 
Exchange under this section (other than in 
establishing an Exchange with respect to 
which a grant is awarded under subsection 
(a)(6))’’; and 
(B) by adding at the end the following: 
‘‘(ii) ADDITIONAL PLANNING AND ES-
TABLISHMENT
GRANTS.—In establishing 
an Exchange with respect to which a grant 
is awarded under subsection (a)(6), the 
State shall ensure that such Exchange is 
self-sustaining beginning on January 1, 
2026, including allowing the Exchange to 
charge assessments or user fees to partici-
pating health insurance issuers, or to oth-
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erwise generate funding, to support its op-
erations.’’. 
(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)) is amended— 
(1) in paragraph (1), by striking ‘‘If’’ and in-
serting ‘‘Subject to paragraph (3), if’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(3) 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.’’. 
Æ 
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