Caption contest: Why are these men laughing?

It’s hard to beat the original caption to this image:

Speaker of the House Paul Ryan (R-WI) (3rd L) shares a laugh with Republican members of Congress after signing legislation to repeal the Affordable Care Act, also known as Obamacare, and to cut off federal funding of Planned Parenthood during an enrollment ceremony in the Rayburn Room at the U.S. Capitol January 7, 2016 in Washington, DC. 

What could create more glee among Paul Ryan and his maniacs than taking healthcare away from millions of people? Bet you can think of a few things. Go!