,i  #aac? ,,congress  #b;d ,session  ,h4
 ,r4 #dfgg  ,,9 ,,! ,,h\se ,,(          
,,repres5tatives  ,may #ai1 #bjad ,mr4  
,re$ 7= himself1 ,mr4 ,scalise1 ,ms4    
,j5k9s1 ,mrs4 ,black1 & ,mr4 ,tib]i7    
introduc$ ! foll[+ bill2 :i* 0 ref]r$ to
 ! ,committee on ,en]gy & ,comm]ce  ,a  
,,bill  ,to am5d ! ,pati5t ,protection &
 ,af=dable ,c>e ,act to require ,/ates )
 fail$ ,am]ican ,heal? ,b5efit ,ex*anges
 to reimburse ! ,f$]al ,gov]nm5t =      
am\nts provid$ "u grants = ! e/abli%m5t 
& op]ation ( su* ,ex*anges4  #a4 ,%ort  
title ,?is ,act may be cit$ z ! ,/ate   
,ex*ange ,acc\ntability ,act4  #b4      
,reimburs+ ! ,f$]al ,gov]nm5t = fail$   
,/ate ,ex*ange grants ,section #acaa7;a7
 ( ! ,pati5t ,protection & ,af=dable    
,c>e ,act 7#db ,u4,s4,c4 #ahjca7;a77 is 
am5d$ by add+ at ! end ! foll[+3  7#f7  
,reimbursem5t 9 ! case ( fail$ ,ex*anges
  7,a7 ,9 g5]al ,9 ! case ( a ,/ate t   
has receiv$ "o or m e/abli%m5t or e>ly  
innovator grants "u ?is subsection & :i*
 op]at$ a ,/ate-bas$ ,ex*ange 9 program 

ye> #bjad1 if su* ,/ate subsequ5tly     
elects to provide solely = ! enrollm5t (
 its resid5ts 9 qualifi$ heal? plans    
?r\gh ! ,f$]ally ,facilitat$ ,ex*ange1  
su* ,/ate %all reimburse ! ,f$]al       
,gov]nm5t = ! aggregate am\nts provid$  
to ! ,/ate "u su* grant or grants4  7,b7
 ,reimbursem5t agreem5ts ,reimbursem5t  
%all be provid$ to ! ,f$]al ,gov]nm5t by
 a ,/ate "u ?is p>agraph pursuant to !  
t]ms ( an agreem5t ent]$ into by ! ,/ate
 & ! ,dep>tm5t ( ,heal? & ,human        
,s]vices t1 at a m9imum1 %all require   
t--  7i7 su* reimbursem5t be made1 9    
full1 )9 ! #aj-ye> p]iod beg9n+ on !    
date on :i* ! ,/ate makes ! election    
describ$ 9 p>agraph 7#a72 &  7ii7 t !   
,/ate make an annual paym5t 9 an am\nt  
equal to #aj p]c5t ( ! total am\nt      
provid$ to ! ,/ate "u ! grant or grants 
aw>d$ to ! ,/ate "u ?is subsection4     
7,c7 ,no r$uction 9 am\nt ,! ,f$]al     
,gov]nm5t %all n r$uce ! am\nt ( !      
reimbursem5t requir$ to be provid$ by a 
,/ate "u ?is p>agraph4  7,d7 ,failure to

 ent] into agreem5t ,9 ! case ( a ,/ate 
describ$ 9 subp>agraph 7,a7 t fails to  
ent] into an agreem5t "u subp>agraph    
7,b71 ! ,secret>y %all r$uce ! am\nt to 
be paid to ! ,/ate "u title ,,xix ( !   
,social ,security ,act = ea* ( ! #aj    
fiscal ye>s beg9n+ ) ! fir/ fiscal ye> t
 beg9s aft] ! date ( ! election describ$
 9 subp>agraph 7,a7 by ! ,/ate4 ,! am\nt
 ( ea* su* r$uction %all be uni=m & %all
 9 ! aggregate equal ! total am\nt ( !  
reimbursem5t requir$ "u ?is p>agraph4   
7,e7 ,deficit r$uction ,am\nts paid by a
 ,/ate "u ?is section %all be plac$ 9 ! 
,g5]al ,fund ( ! ,treasury to be us$ =  
deficit r$uction4  4