,,ii  #aafth ,,congress  #ast ,session  
,s4 #adjj  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,may #i1       
#bjai,mr4 ,menendez 7for himself1 ,mr4  
,casey1 and ,mr4 ,booker7 introduced the
 following bill2 which was read twice   
and referred to the ,committee on       
,health1 ,education1 ,labor1 and        
,pensions  ,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 #b 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 ,exchange4  2 and  
7#b7 in subsection 7d77#e77;,a7-- 7,a7  
by striking ,in establishing an         
,exchange under this section and        
inserting the following3  7i7 ,in       
general ,in establishing an ,exchange   

under this section 7other than in       
establishing an ,exchange pursuant to   
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 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