H.R. 1385House116th Congress (2019-2021)In Committee

SAVE Act

Sponsored by Andy KimRep. Andy Kim (D-NJ)
Introduced February 27, 2019

AI-Generated Summary

Updated April 14, 2026 at 2:29 AM UTC

The SAVE Act changes the Affordable Care Act to keep the option for states to create their own health‑insurance marketplaces. It offers a limited pool of federal grants to states that have not yet set up an exchange, and sets rules for how those grants can be used and when they must be awarded.

Key Provisions

  • Adds a new grant program of up to $200 million for states that are not operating an exchange; grants are two‑year, non‑renewable, and must be awarded by Dec 31 2022.
  • Defines an “eligible state” as one without an exchange (except certain federally‑run exchanges).
  • States receiving a grant must make the exchange financially self‑sustaining by Jan 1 2024, including the ability to charge fees to insurers.
  • Adjusts ACA language to separate grant‑based exchange creation from other exchange‑establishment requirements.
  • Clarifies that the penalty for failing to establish an exchange does not apply to states that choose the grant option and meet the required conditions after Jan 1 2014.

Legislative Activity

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9 earlier actions
HouseCalendars Latest Action

Placed on the Union Calendar, Calendar No. 27.

May 3, 2019

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HouseIntro Referral

Introduced in House

February 27, 2019

HouseIntro Referral

Referred to the House Committee on Energy and Commerce.

February 27, 2019

HouseIntro Referral

Sponsor introductory remarks on measure. (CR H2275)

February 28, 2019

HouseCommittee

Referred to the Subcommittee on Health.

March 1, 2019

HouseCommittee

Subcommittee Consideration and Mark-up Session Held.

March 27, 2019

HouseCommittee

Forwarded by Subcommittee to Full Committee by Voice Vote .

March 27, 2019

HouseCommittee

Committee Consideration and Mark-up Session Held.

April 3, 2019

HouseCommittee

Ordered to be Reported (Amended) by the Yeas and Nays: 29 - 22.

April 3, 2019

HouseCommittee

Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 116-49.

May 3, 2019

HouseCalendars

Placed on the Union Calendar, Calendar No. 27.

May 3, 2019

Bill Text

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Reported in HouseIssued May 3, 2019

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Union Calendar No. 27

116th CONGRESS

1st Session

H. R. 1385

[Report No. 116–49]

IN THE HOUSE OF REPRESENTATIVES

February 27, 2019

Mr. Kim (for himself and Mr. Fitzpatrick) introduced the following bill; which was referred to the Committee on Energy and Commerce

May 3, 2019

Additional sponsors: Ms. Schakowsky, Mrs. Watson Coleman, Ms. Blunt Rochester, Mr. Pallone, Mr. Rush, Mrs. Dingell, Mr. Ruiz, Ms. Eshoo, Mr. Kennedy, Ms. Matsui, Mr. Van Drew, Ms. Clarke of New York, Ms. Houlahan, Ms. Scanlon, Ms. McCollum, and Ms. Mucarsel-Powell

May 3, 2019

Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed

Strike out all after the enacting clause and insert the part printed in italic

For text of introduced bill, see copy of bill as introduced on February 27, 2019


A BILL

To amend the Patient Protection and Affordable Care Act to preserve the option of States to implement health care marketplaces, and for other purposes.


1.

Short title

This Act may be cited as the State Allowance for a Variety of Exchanges Act or the SAVE Act.

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 Exchange (other than an Exchange described in section 155.200(f) of title 45, Code of Federal Regulations).

; and

(2)

in subsection (d)(5)(A)—

(A)

by striking operations.—In establishing an Exchange under this section and inserting

operations.—

(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))

; and

(B)

by adding at the end the following:

(ii)

Additional planning and establishment grants

In establishing an Exchange pursuant to a grant awarded under 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.

.

May 3, 2019

Reported with an amendment, committed to the Committee of the Whole House on the State of the Union, and ordered to be printed