House GOP leaders: Speaker John Boehner, Rep. Paul Ryan,

Rep. Jeb Hensarling, Rep. Eric Cantor and Rep. Cathy McMorris Rodgers. (Jonathan Ernst/Reuters)

House GOP leaders: Speaker John Boehner, Rep. Paul Ryan,

Rep. Jeb Hensarling, Rep. Eric Cantor and Rep. Cathy McMorris Rodgers. (Jonathan Ernst/Reuters)

While the House Republicans gear up for Wednesday's Affordable Care Act repeal vote, the public face of their temper tantrum, behind the scenes they're challenging the rule-making for the law, all to make sure that as few people as possible actually get health insurance through the law. While Republican governors are vowing to not expand Medicaid and to not set up health insurance exchanges in their states, Republicans in Congress are trying to keep the federal government from providing financial assistance to low-income people on the exchanges it sets up.

Republicans say a strict reading of the the law only allows the subsidies to be provided in states that set up their own exchanges, not in the federal exchanges. The White House and the IRS (which is writing the rules for the subsidies) argue that the intent of the law is clear: The subsidies are get insurance for anyone who doesn't qualify for Medicaid and who can't afford the full price of premiums.



The dispute has huge practical implications. The Congressional Budget Office predicts that 23 million uninsured people will gain coverage through exchanges and that all but five million of them will qualify for subsidies, averaging more than $6,000 a year per person. Subsidies, in the form of tax credits, will be available to people with incomes from the poverty level up to four times that amount ($23,050 to $92,200 for a family of four).

Republicans don't want any people who can't afford health insurance now to have it. Period. No Medicaid, no help getting insurance. They've introduced legislation in the House to nullify the rule the IRS created for the subsidies, and if they are defeated there, Republicans governors could very well sue over this issue.

This is how they fight back, how they make sure that the law, even if implemented, fails. They're sabotaging it by trying to keep as many people as possible uninsured, to keep health care costs for the entire nation as high as possible. Just for politics. If that means people have to continue to die because they don't have insurance, so be it.