,,ib  ,union ,calendar ,no4 #bg  #aafth 
,,congress  #ast ,session  ,h4 ,r4 #ache
  ,report ,no4 #aaf-di  ,,in ,,the      
,,house ,,of ,,representatives          
,february #bg1 #bjai ,mr4 ,kim 7for     
himself and ,mr4 ,fitzpatrick7          
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce  ,may #c1 #bjai           
,additional sponsors3 ,ms4 ,schakowsky1 
,mrs4 ,watson ,coleman1 ,ms4 ,blunt     
,rochester1 ,mr4 ,pallone1 ,mr4 ,rush1  
,mrs4 ,dingell1 ,mr4 ,ruiz1 ,ms4 ,eshoo1
 ,mr4 ,kennedy1 ,ms4 ,matsui1 ,mr4 ,van 
,drew1 ,ms4 ,clarke of ,new ,york1 ,ms4 
,houlahan1 ,ms4 ,scanlon1 ,ms4          
,mc,collum1 and ,ms4 ,mucarsel-,powell  
,may #c1 #bjai ,reported with an        
amendment1 committed to the ,committee  
of the ,whole ,house on the ,state of   
the ,union1 and ordered to be printed   
,strike out all after the enacting      
clause and insert the part printed in   
italic ,for text of introduced bill1 see
 copy of bill as introduced on ,february

 #bg1 #bjai  ,a ,,bill  ,to amend the   
,patient ,protection and ,affordable    
,care ,act to preserve the option of    
,states to implement health care        
marketplaces1 and for other purposes4   
#a4 ,short title ,this ,act may be cited
 as the ,state ,allowance for a ,variety
 of ,exchanges ,act or the ,,save ,act4 
#b4 ,preserving ,state option to        
implement health care marketplaces  7a7 
,in general ,section #acaa of the       
,patient ,protection and ,affordable    
,care ,act 7#db ,u4,s4,c4 #ahjca7 is    
amended--  7#a7 in subsection 7a7-- 7,a7
 in paragraph 7#d77;,b71 by striking    
under this subsection and inserting     
under this paragraph or paragraph 7#a72 
and  7,b7 by adding at the end the      
following new paragraph3  7#f7          
,additional planning and establishment  
grants  7,a7 ,in general ,there shall be
 appropriated to the ,secretary1 out of 
any moneys in the ,treasury not         
otherwise appropriated1 #bjj1jjj1jjj to 
award grants to eligible ,states for the

 uses described in paragraph 7#c74  7,b7
 ,duration and renewability ,a grant    
awarded under subparagraph 7,a7 shall be
 for a period of two years and may not  
be renewed4  7,c7 ,limitation ,a grant  
may not be awarded under subparagraph   
7,a7 after ,december #ca1 #bjbb4  7,d7  
,eligible ,state defined ,for purposes  
of this paragraph1 the term eligible    
,state means a ,state that1 as of the   
date of the enactment of this paragraph1
 is not operating an ,exchange 7other   
than an ,exchange described in section  
#aee4bjj7;f7 of title #de1 ,code of     
,federal ,regulations74  2 and  7#b7 in 
subsection 7d77#e77;,a7--  7,a7 by      
striking operations4--,in establishing  
an ,exchange under this section and     
inserting operations4--  7i7 ,in general
 ,in establishing an ,exchange under    
this section 7other than in establishing
 an ,exchange pursuant to a grant       
awarded under subsection 7a77#f77  2 and
  7,b7 by adding at the end the         
following3  7ii7 ,additional planning   

and establishment grants ,in            
establishing an ,exchange pursuant to a 
grant awarded under subsection 7a77#f71 
the ,state shall ensure that such       
,exchange is self-sustaining beginning  
on ,january #a1 #bjbd1 including        
allowing the ,exchange to charge        
assessments or user fees to             
participating health insurance issuers1 
or to otherwise generate funding1 to    
support its operations4  4  7b7         
,clarification regarding failure ,to    
establish ,exchange or implement        
requirements ,section #acba7;c7 of the  
,patient ,protection and ,affordable    
,care ,act 7#db ,u4,s4,c4 #ahjda7;c77 is
 amended--  7#a7 in paragraph 7#a71 by  
striking ,if and inserting ,subject to  
paragraph 7#c71 if2 and  7#b7 by adding 
at the end the following new paragraph3 
7#c7 ,clarification ,this subsection    
shall not apply in the case of a ,state 
that elects to apply the requirements   
described in subsection 7a7 and         
satisfies the requirement described in  

subsection 7b7 on or after ,january #a1 
#bjad4  4  ,may #c1 #bjai ,reported with
 an amendment1 committed to the         
,committee of the ,whole ,house on the  
,state of the ,union1 and ordered to be 
printed