I don’t think Cost Sharing Reduction (CSR) subsidies will ever be appropriated. I have a hard time lining up the policy and political incentives in a way that have 60 Senators agreeing to vote on it. I think the politics don’t line up as the policy foundations are changing.
My friend in Chicago was complaining about a huge premium hike. After prodding from me, he found a Cigna bronze plan costing him $7.50.
— Harris Meyer (@MHHmeyer) November 3, 2017
If there is no CSR deal by December, then the expectation of what the baseline subsidized Exchange plans should look like and what the cheaper/inferior versions should cost will change. And those changes are not occurring just in Blue States. The changes are happening in Red States. The changes are happening in big cities. The changes are happening in little hamlets.
The fundamental expectations of what the ACA delivers is changing now because CSR has not been appropriated. That reality will proceed as the politics catch up to it.