IB 
Union Calendar No. 27 
116TH CONGRESS 
1ST SESSION H. R. 1385 
[Report No. 116–49] 
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 HOUSE OF REPRESENTATIVES 
FEBRUARY 27, 2019 
Mr. KIM (for himself and Mr. FITZPATRICK) introduced the following bill; 
which was referred to the Committee on Energy and Commerce 
MAY 3, 2019 
Additional sponsors: Ms. SCHAKOWSKY, Mrs. WATSON COLEMAN, Ms. BLUNT 
ROCHESTER, Mr. PALLONE, Mr. RUSH, Mrs. DINGELL, Mr. RUIZ, Ms. 
ESHOO, Mr. KENNEDY, Ms. MATSUI, Mr. VAN DREW, Ms. CLARKE of 
New York, Ms. HOULAHAN, Ms. SCANLON, Ms. MCCOLLUM, and Ms. 
MUCARSEL-POWELL 
MAY 3, 2019 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on February 27, 2019] 
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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. 
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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’’ or the ‘‘SAVE Act’’. 
SEC. 2. PRESERVING STATE OPTION TO IMPLEMENT 
HEALTH CARE MARKETPLACES. 
(a) IN GENERAL.—Section 1311 of the Patient Protec-
tion and Affordable Care Act (42 U.S.C. 18031) is amend-
ed— 
(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, 
$200,000,000 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 
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for a period of two years and may not be re-
newed. 
‘‘(C) LIMITATION.—A grant may not be 
awarded under subparagraph (A) after December 
31, 2022. 
‘‘(D) ELIGIBLE STATE DEFINED.—For pur-
poses of this paragraph, the term ‘eligible State’ 
means a State that, as of the date of the enact-
ment of this paragraph, is not operating an Ex-
change (other than an Exchange described in sec-
tion 155.200(f) of title 45, Code of Federal Regu-
lations).’’; 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 pursuant to a 
grant 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 pursuant to a grant awarded 
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under subsection (a)(6), the State shall en-
sure that such Exchange is self-sustaining 
beginning on January 1, 2024, including 
allowing the Exchange to charge assessments 
or user fees to participating health insur-
ance issuers, or to otherwise generate fund-
ing, to support its operations.’’. 
(b) CLARIFICATION REGARDING FAILURE TO ESTAB-
LISH EXCHANGE OR IMPLEMENT REQUIREMENTS.—Section 
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 para-
graph: 
‘‘(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.’’. 
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Union Calendar No. 27 
116TH CONGRESS 
1ST SESSION 
H. R. 1385 
[Report No. 116–49] 
A BILL 
To amend the Patient Protection and Affordable 
Care Act to preserve the option of States to im-
plement health care marketplaces, and for other 
purposes. 
MAY 3, 2019 
Reported with an amendment, committed to the Com-
mittee of the Whole House on the State of the Union, 
and ordered to be printed 
VerDate Sep 11 2014 
20:32 May 03, 2019
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PO 00000
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