SAVE Act of 2021
Bill: S.1623 | Sponsor: Sen. Menendez, Robert (D-NJ)
Policy area: Health

Summary:
State Allowance for a Variety of Exchanges Act of 2021 or the SAVE Act of 2021
This bill allows the Department of Health and Human Services to award grants to support the establishment of state-based health insurance exchanges in those states that have not already elected to do so. A state that receives a grant must ensure that the resulting exchange is self-sustaining by 2026.

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 Representatives 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''.

SEC. 2. PRESERVING STATE OPTION TO IMPLEMENT HEALTH CARE MARKETPLACES.

    (a) In General.--Section 1311 of the Patient Protection 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 establishment grants.--
                    ``(A) In general.--There shall be appropriated 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 2 years 
                and may not be renewed.
                    ``(C) Limitation.--A grant may not be awarded under 
                subparagraph (A) after December 31, 2024.
                    ``(D) Eligible state defined.--For purposes of this 
                paragraph, the term `eligible 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 Regulations, as 
                in effect on such date).''; and
            (2) in subsection (d)(5)(A)--
                    (A) by striking ``operations.--In establishing an 
                Exchange under this section'' and inserting 
                ``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 
                        establishment 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 participating 
                        health insurance issuers, or to otherwise 
                        generate funding, to support its operations.''.
    (b) Clarification Regarding Failure To Establish 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 inserting 
        ``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.''.
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