,,ii  #aacth ,,congress  #b;d ,session  
,s4 #bcci  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #ad1 #bjad
 ,mr4 ,barrasso 7for himself1 ,mr4      
,hatch1 ,mr4 ,enzi1 ,mr4 ,mc,cain1 ,mr4 
,coburn1 and ,mr4 ,chambliss7 introduced
 the following bill2 which was read     
twice and referred to the ,committee on 
,finance  ,a ,,bill  ,to amend the      
,patient ,protection and ,affordable    
,care ,act to require ,states with      
failed ,american ,health ,benefit       
,exchanges to reimburse the ,federal    
,government for amounts provided under  
grants for the establishment and        
operation of such ,exchanges4  #a4      
,short title  ,this ,act may be cited as
 the ,state ,exchange ,accountability   
,act4  #b4 ,reimbursing the ,federal    
,government for failed ,state ,exchange 
grants ,section #acaa7;a7 of the        
,patient ,protection and ,affordable    
,care ,act 7#db ,u4,s4,c4 #ahjca7;a77 is
 amended by adding at the end the       
following3  7#f7 ,reimbursement in the  

case of failed ,exchanges  7,a7 ,in     
general ,in the case of a ,state that   
has received one or more establishment  
or early innovator grants under this    
subsection and which operated a         
,state-based ,exchange in program year  
#bjad1 if such ,state subsequently      
elects to provide solely for the        
enrollment of its residents in qualified
 health plans through the ,federally    
,facilitated ,exchange1 such ,state     
shall reimburse the ,federal ,government
 for the aggregate amounts provided to  
the ,state under such grant or grants4  
7,b7 ,reimbursement agreements          
,reimbursement shall be provided to the 
,federal ,government by a ,state under  
this paragraph pursuant to the terms of 
an agreement entered into by the ,state 
and the ,department of ,health and      
,human ,services that1 at a minimum1    
shall require that-- 7i7 such           
reimbursement be made1 in full1 within  
the #aj-year period beginning on the    
date on which the ,state makes the      

election described in paragraph 7#a72   
and  7ii7 that the ,state make an annual
 payment in an amount equal to #aj      
percent of the total amount provided to 
the ,state under the grant or grants    
awarded to the ,state under this        
subsection4  7,c7 ,no reduction in      
amount ,the ,federal ,government shall  
not reduce the amount of the            
reimbursement required to be provided by
 a ,state under this paragraph4  7,d7   
,failure to enter into agreement ,in the
 case of a ,state described in          
subparagraph 7,a7 that fails to enter   
into an agreement under subparagraph    
7,b71 the ,secretary shall reduce the   
amount to be paid to the ,state under   
title ,,xix of the ,social ,security    
,act for each of the #aj fiscal years   
beginning with the first fiscal year    
that begins after the date of the       
election described in subparagraph 7,a7 
by the ,state4 ,the amount of each such 
reduction shall be uniform and shall in 
the aggregate equal the total amount of 

the reimbursement required under this   
paragraph4  7,e7 ,deficit reduction     
,amounts paid by a ,state under this    
section shall be placed in the ,general 
,fund of the ,treasury to be used for   
deficit reduction4  4