,,ii  #aaf? ,,congress  #a/ ,session    
,s4 #adjj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #i1 #bjai,mr4     
,m55dez 7= himself1 ,mr4 ,casey1 & ,mr4 
,book]7 introduc$ ! foll[+ bill2 :i* 0  
read twice & ref]r$ to ! ,committee on  
,heal?1 ,education1 ,labor1 & ,p5sions  
,a ,,bill  ,to am5d ! ,pati5t           
,protection & ,af=dable ,c>e ,act to    
pres]ve ! option ( ,/ates to implem5t   
heal? c>e m>ketplaces1 & = o!r purposes4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,/ate ,all[ance = a ,v>iety (       
,ex*anges ,act or ! ,,save ,act4  #b4   
,pres]v+ ,/ate option to implem5t heal? 
c>e m>ketplaces  7a7 ,9 g5]al ,section  
#acaa ( ! ,pati5t ,protection &         
,af=dable ,c>e ,act 7#db ,u4,s4,c4      
#ahjca7 is am5d$-- 7#a7 9 subsection    
7a7-- 7,a7 9 p>agraph 7#d77;,b71 by     
/rik+ "u ?is subsection & ins]t+ "u ?is 
p>agraph or p>agraph 7#a72 &  7,b7 by   
add+ at ! end ! foll[+ new p>agraph3    
7#f7 ,additional plann+ & e/abli%m5t    
grants  7,a7 ,9 g5]al ,!re %all be      

appropriat$ to ! ,secret>y1 out ( any   
moneys 9 ! ,treasury n o!rwise          
appropriat$1 #bjj1jjj1jjj to aw>d grants
 to eligible ,/ates = ! uses describ$ 9 
p>agraph 7#c74  7,b7 ,duration &        
r5ewability ,a grant aw>d$ "u           
subp>agraph 7,a7 %all be = a p]iod ( #b 
ye>s & may n be r5ew$4  7,c7 ,limitation
 ,a grant may n be aw>d$ "u subp>agraph 
7,a7 aft] ,decemb] #ca1 #bjbb4  7,d7    
,eligible ,/ate def9$ ,= purposes ( ?is 
p>agraph1 ! t]m eligible ,/ate means a  
,/ate t1 z ( ! date ( ! enactm5t ( ?is  
p>agraph1 is n op]at+ an ,ex*ange4  2 & 
7#b7 9 subsection 7d77#e77;,a7-- 7,a7 by
 /rik+ ,9 e/abli%+ an ,ex*ange "u ?is   
section & ins]t+ ! foll[+3  7i7 ,9 g5]al
 ,9 e/abli%+ an ,ex*ange "u ?is section 
7o!r ?an 9 e/abli%+ an ,ex*ange pursuant
 to subsection 7a77#f77  2 &  7,b7 by   
add+ at ! end ! foll[+3  7ii7           
,additional plann+ & e/abli%m5t grants  
,9 e/abli%+ an ,ex*ange pursuant to     
subsection 7a77#f71 ! ,/ate %all ensure 
t su* ,ex*ange is self-su/a9+ beg9n+ on 

,janu>y #a1 #bjbd1 includ+ all[+ !      
,ex*ange to *>ge assessm5ts or us] fees 
to p>ticipat+ heal? insurance issu]s1 or
 to o!rwise g5]ate fund+1 to support its
 op]ations4  4  7b7 ,cl>ification reg>d+
 failure ,to e/abli% ,ex*ange or        
implem5t requirem5ts ,section #acba7;c7 
( ! ,pati5t ,protection & ,af=dable ,c>e
 ,act 7#db ,u4,s4,c4 #ahjda7;c77 is     
am5d$-- 7#a7 9 p>agraph 7#a71 by /rik+  
,if & ins]t+ ,subject to p>agraph 7#c71 
if2 &  7#b7 by add+ at ! end ! foll[+   
new p>agraph3  7#c7 ,cl>ification ,?is  
subsection %all n apply 9 ! case ( a    
,/ate t elects to apply ! requirem5ts   
describ$ 9 subsection 7a7 & satisfies ! 
requirem5t describ$ 9 subsection 7b7 on 
or aft] ,janu>y #a1 #bjad4  4