IB Union Calendar No. 27 116th CONGRESS 1st Session H. R. 1385 [Report No. 116–49] 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 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.

1. Short title This Act may be cited as the State Allowance for a Variety of Exchanges Act or the SAVE Act . 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 two years and may not be renewed. (C) Limitation A grant may not be awarded under subparagraph (A) after December 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 (other than an Exchange described in section 155.200(f) of title 45, Code of Federal Regulations). ; 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 pursuant to a grant awarded under subsection (a)(6)) ; and (B) by adding at the end the following: (ii) Additional planning and establishment grants In establishing an Exchange pursuant to a grant awarded under 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 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. .

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