State Exchange Accountability Act

State Exchange Accountability Act - Amends the Patient Protection and Affordable Care Act to require a state to reimburse the federal government for the amount of establishment or early innovator grants the state received to operate a health care exchange if it operated an exchange in 2014 but subsequently elected to provide for enrollment in qualified health plans solely through the federal health care exchange.

Requires that: (1) reimbursement be made in full within 10 years of such election, pursuant to an agreement with the Department of Health and Human Services (HHS); and (2) in case of failure to enter such an agreement, the Secretary of HHS shall reduce the state's Medicaid funding for 10 fiscal years in an aggregate amount equal to the reimbursement amount.

[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 2339 Introduced in Senate (IS)]

113th CONGRESS
  2d Session
                                S. 2339

  To amend the Patient Protection and Affordable Care Act to require 
 States with failed American Health Benefit Exchanges to reimburse the 
     Federal Government for amounts provided under grants for the 
             establishment and operation of such Exchanges.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                              May 14, 2014

Mr. Barrasso (for himself, Mr. Hatch, Mr. Enzi, Mr. McCain, Mr. Coburn, 
and Mr. Chambliss) introduced the following bill; which was read twice 
                and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
  To amend the Patient Protection and Affordable Care Act to require 
 States with failed American Health Benefit Exchanges to reimburse the 
     Federal Government for amounts provided under grants for the 
             establishment and operation of such Exchanges.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``State Exchange Accountability Act''.

SEC. 2. REIMBURSING THE FEDERAL GOVERNMENT FOR FAILED STATE EXCHANGE 
              GRANTS.

    Section 1311(a) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18031(a)) is amended by adding at the end the following:
            ``(6) Reimbursement in the case of failed exchanges.--
                    ``(A) In general.--In the case of a State that has 
                received one or more establishment or early innovator 
                grants under this subsection and which operated a 
                State-based Exchange in program year 2014, if such 
                State subsequently elects to provide solely for the 
                enrollment of its residents in qualified health plans 
                through the Federally Facilitated Exchange, such State 
                shall reimburse the Federal Government for the 
                aggregate amounts provided to the State under such 
                grant or grants.
                    ``(B) Reimbursement agreements.--Reimbursement 
                shall be provided to the Federal Government by a State 
                under this paragraph pursuant to the terms of an 
                agreement entered into by the State and the Department 
                of Health and Human Services that, at a minimum, shall 
                require that--
                            ``(i) such reimbursement be made, in full, 
                        within the 10-year period beginning on the date 
                        on which the State makes the election described 
                        in paragraph (1); and
                            ``(ii) that the State make an annual 
                        payment in an amount equal to 10 percent of the 
                        total amount provided to the State under the 
                        grant or grants awarded to the State under this 
                        subsection.
                    ``(C) No reduction in amount.--The Federal 
                Government shall not reduce the amount of the 
                reimbursement required to be provided by a State under 
                this paragraph.
                    ``(D) Failure to enter into agreement.--In the case 
                of a State described in subparagraph (A) that fails to 
                enter into an agreement under subparagraph (B), the 
                Secretary shall reduce the amount to be paid to the 
                State under title XIX of the Social Security Act for 
                each of the 10 fiscal years beginning with the first 
                fiscal year that begins after the date of the election 
                described in subparagraph (A) by the State. The amount 
                of each such reduction shall be uniform and shall in 
                the aggregate equal the total amount of the 
                reimbursement required under this paragraph.
                    ``(E) Deficit reduction.--Amounts paid by a State 
                under this section shall be placed in the General Fund 
                of the Treasury to be used for deficit reduction.''.
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