Medicare is not the only entitlement Rep. Paul RyanPaul RyanJuan Williams: McConnell won big by blocking Obama Republicans want to grease tracks for Trump This week: Government funding deadline looms MORE (R-Wis.) has big plans to reform.
Its sister program, Medicaid, would lose about three-quarters of its federal funding by 2050 under proposals from the Republican vice presidential candidate, according to federal budget auditors.
Medicaid provides healthcare for the poor and the disabled. Over 10 years, Ryan's budget plan would cut the program's budget by about $810 billion.
"It's a program that's very hard to simplify," said Matt Salo, executive director of the National Association of Medicaid Directors.
"It pays for 40 percent of the country's births and the majority of the nation's long-term care [for the elderly]. It's one of the most complex programs in the U.S. government — on the level of tax policy."
The program's beneficiaries also lack the political clout of seniors and their representatives in Washington who adamantly defend Medicare.
Medicaid functions as an open-ended entitlement, with the federal government paying more as the program grows.
Under Ryan's plan, that contribution would become a block grant, limiting the federal government's exposure and giving states much more license to say how their programs function and who can benefit.
Critics say the change would cripple Medicaid and roll back the coverage it provides vulnerable Americans.
Ryan's proposals for Medicaid have elicited criticism from Catholic leaders, who argued in 2011 that the poor deserve "special consideration" from anyone seeking to reform government entitlements.
Ryan, who is Catholic, has said his reforms are in line with church teachings.
The congressman’s plan to block grant Medicaid has long been on the wish list of GOP governors, who say the program places a heavy burden on state governments.
"This reform ends the misguided one-size-fits-all approach that has tied the hands of so many state governments," states the House's 2013 budget resolution, which Ryan authored as head of the Budget Committee.
"States will no longer be shackled by federally determined program requirements and enrollment criteria."
On Friday, Democratic staff in the House pushed back, warning Ryan’s plan would jeopardize healthcare for 60 million Americans, including 33 million children.
"The Ryan budget shreds the Medicaid safety net," stated a memo from Minority Staff on the Energy and Commerce Committee.
"Medicaid is currently structured to provide more help when states need it most: when unemployment increases and citizens lose insurance coverage," it continued.
"The Medicaid block grant … shifts all risks including future recessions, healthcare cost increases, and disasters to states and beneficiaries. The federal government would no longer be a partner responding to such changes."