---
kind: "diff"
citation: "H.R. 1385"
bill: "116-hr-1385"
heading: "State Allowance for a Variety of Exchanges Act"
from: "ih"
from_label: "Introduced in House"
to: "rh"
to_label: "Reported in House"
sections_amended: 1
sections_added: 0
sections_removed: 0
url: "https://uscodex.org/bills/116/hr/1385/changes/rh"
---

# H.R. 1385 — what changed

H.R. 1385, State Allowance for a Variety of Exchanges Act — 1 section amended between Introduced in House and Reported in House.

Edits are marked `<del>struck</del>` and `<ins>inserted</ins>`.

## Sec. 2 Preserving State option to implement health care marketplaces

- (a) In general— Section 1311 of the Patient Protection and Affordable Care Act (42 U.S.C. 18031) is amended—
  - (1) in subsection (a)—
    - (A) in paragraph (4)(B), by striking “under this subsection” and inserting “under this paragraph or paragraph (1)”; and
    - (B) by adding at the end the following new paragraph:
      - “(6) Additional planning and establishment grants
      - “(A) In general—There shall be appropriated to the Secretary, out of any moneys in the Treasury not otherwise appropriated, $200,000,000 to award grants to eligible States for the uses described in paragraph (3).
      - “(B) Duration and renewability—A grant awarded under subparagraph (A) shall be for a period of two years and may not be renewed.
      - “(C) Limitation—A grant may not be awarded under subparagraph (A) after December 31, 2022.
      - “(D) Eligible State defined—For purposes of this paragraph, the term eligible State means a State that, as of the date of the enactment of this paragraph, is not operating an <del>Exchange.”</del><ins>Exchange (other than an Exchange described in section 155.200(f) of title 45, Code of Federal Regulations).”</ins>
  - (2) in subsection (d)(5)(A)—
    - (A) by striking <del>“In </del><ins>“operations.—In </ins>establishing an Exchange under this section” and <del>inserting “(i) In general.—In establishing an Exchange under this section (other than in establishing an Exchange pursuant to subsection (a)(6))”; and</del><ins>inserting</ins>
      - <ins>“(i) In general—In establishing an Exchange under this section (other than in establishing an Exchange pursuant to a grant awarded under subsection (a)(6))”</ins>
    - (B) by adding at the end the following:
      - “(ii) Additional planning and establishment grants—In establishing an Exchange pursuant to <ins>a grant awarded under </ins>subsection (a)(6), the State shall ensure that such Exchange is self-sustaining beginning on January 1, 2024, including allowing the Exchange to charge assessments or user fees to participating health insurance issuers, or to otherwise generate funding, to support its operations.”
- (b) Clarification regarding failure To establish Exchange or implement requirements— Section 1321(c) of the Patient Protection and Affordable Care Act (42 U.S.C. 18041(c)) is amended—
  - (1) in paragraph (1), by striking “If” and inserting “Subject to paragraph (3), if”; and
  - (2) by adding at the end the following new paragraph:
    - “(3) Clarification—This subsection shall not apply in the case of a State that elects to apply the requirements described in subsection (a) and satisfies the requirement described in subsection (b) on or after January 1, 2014.”