Speaker Paul Ryan is struggling to corral his caucus, but gamers are hilariously trolling the GOP. (More)

“I’m not sure where all this goes tomorrow”

The latest deal seems to involve repealing the Affordable Care Act’s essential benefits package:

Key to the deal, they report, are changes to the law that would eliminate the Affordable Care Act’s “essential health benefits,” a list of 10 categories of procedure that all insurance plans offered to individuals or small businesses must cover. The 10 are, in the words of Healthcare.gov:

• Outpatient care without a hospital admission, known as ambulatory patient services
• Emergency services
• Hospitalization
• Pregnancy, maternity, and newborn care
• Mental health and substance use disorder services, including counseling and psychotherapy
• Prescription drugs
• Rehabilitative and habilitative services and devices, which help people with injuries and disabilities to recover
• Laboratory services
• Preventive care, wellness services, and chronic disease management
• Pediatric services, including oral and vision care for children

These provisions set a baseline, mandating that all offered plans meet a certain threshold. They can’t skimp out and not cover big things like emergency room visits or pregnancy or mental health. Particularly for previously undercovered areas like mental health and addiction services, which plans didn’t have to cover before the ACA, this provision was a huge deal.

Yes, premiums can be lower if the insurance doesn’t have to cover most medical expenses. On the other hand, then all your premiums buy is an insurance card. That may make hardliners in the Freedom Caucus happy, but it’s turning away moderates:

Ryan summoned more than a dozen members of the moderate Tuesday Group to his office late Wednesday in an apparent bid to curb further defections. One participant, who spoke on the condition of anonymity to describe the private meeting, said Ryan and other House leaders described the potential deal with the Freedom Caucus, which would strip essential health benefits but leave other ACA mandates, such as those dealing with preexisting conditions and coverage of adult dependents, in place.

“People got to say their piece and react to the proposal. It’s safe to say people had concerns about stripping out essential health benefits, especially at this late hour,” the Tuesday Group member said. “I think they’re short [of votes], and I think they’re considerably short. … I’m not sure where all this goes tomorrow.”

And even if Speaker Ryan can cobble together enough votes to pass that bill, it may fail in the Senate:

Democrats, meanwhile, said amending the bill in the Senate would affect procedure, and increase the amount of votes Republicans would need in that chamber. Currently, Republicans intend to pass the plan through budget reconciliation, a process with little room for changes that only requires a simple majority to pass.

Repealing regulations such as the ten essential services is not usually considered “budgetary,” so it could violate the Byrd Rule that allows budget reconciliation on a simple majority vote. But Freedom Caucus member Rep. David Brat says Senate Republicans should overrule the parliamentarian and pass the bill on a simple majority anyway. Coz rules are for losers …

“Can we roll to not see it?”

And that brings us to the hilarious Twitter hashtag #GOPDnD, where roleplaying gamers lampooned Republicans:

Which is pretty much how Republicans want to treat the Byrd Rule….

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Photo Credit: Associated Press

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Good day and good nuts