Medicaid provides health care for both the poorest Americans and for the most vulnerable of America’s elderly. Presently, with nearly a quarter of our children born to poverty, Medicaid is a critically important program for children’s health. Moreover, the vast majority of nursing home residents rely on Medicaid to pay for their care in the last years of life.  Although important details have not been provided, it seems evident Governor Romney’s proposed plan for Medicaid would drastically reduce needed funding and replace its governance with a hodge-podge of state programs.

Specifically, he proposes replacing the current Medicaid system with block grants to the states, but funded at tremendously lower levels. Over the next decade, the block grant trick would gut federal outlays for what Medicaid now covers by $810 billion. According to analysis by the Center for Budget & Policy Priorities, these slashes would add up to a 34 percent cut in the anticipated budget by 2022 and ever larger cuts in succeeding years. Governor Romney offers nothing to offset these devastating reductions.  States would need to cut the number of recipients, reduce medical coverage, or ration health care to the elderly and to the poorest of Americans, including children. Analysis last year by the Urban Institute of a similar radical scheme, concluded that such cuts would deprive more than 14 million Americans of health care coverage, including a disproportionate number of children.

To put this in perspective, more than one-third of all the births in America are now provided for by Medicaid. As a pro-life Democrat I worry what cutting such support for pregnancies, deliveries, and pre- and post-natal care would mean, particularly when so many other desperately necessary programs for America’s poor are also on the chopping block.

Today about 20 million of America’s children live at or below the poverty line. As mentioned before, that’s more than one in five of our kids. Our country guarantees Medicare for wealthy retirees. Surely we can make a similar promise to our poorest children. Investing in their health is a savvy investment in our country’s future. Has Governor Romney considered even the long-term dollar cost to our nation that would result from his reductions? But isn’t this more importantly a moral question? Don’t we want to ensure every child a fair start in life and the health to succeed?

In fact, we all need Medicaid. Medicaid provides a health care safety net for us all amidst the vulnerabilities of life, as many of trickle down’s “new poor” can attest who tumbled from the middle class thanks to earlier versions of Republican top down economic ideology. Medicaid is there for us and our families if we lose our job, if our spouse abandons us, or if we’re disabled or become critically ill and our private insurance or savings aren’t enough to cover the costs. It is also the federal program that provides vital health care for many of America’s most profoundly disabled citizens including the vast majority of those who are institutionalized.

How the various states might juggle expenditures in response to Romney’s proposed reductions is uncertain as they struggle with determining which portions of Medicaid recipients would bear the brunt of the impact. Nevertheless, what does seem certain is that our middle class elderly would especially be hit very hard by Romney’s plan. Currently, about two-thirds of all nursing home care is paid for by Medicaid and for hospice care it’s even higher. Those percentages are expected to rise in coming years. The number of Americans over age 65 will double by 2030 to about 71 million. As the Boomer generation makes its way from early golden years to later years of assisted living, nursing homes, and hospices—the importance of what is now paid for by Medicaid will balloon.

Middle class elderly begin transitioning to Medicaid reliance almost immediately on entering nursing into home care. The typical cost of nursing home care is more than $75,000 a year and tops $100,000 in many regions.  Such costs very quickly run through retirement nest eggs until the elderly are poor enough to qualify for Medicaid. In most circumstances, it takes only a few months of nursing home care before savings are exhausted enough to qualify for Medicaid. Medicaid is the final healthcare safety net for the vast majority of America’s elderly both in and out of nursing homes.

So, what would Romney’s changes to Medicaid mean for middle class Americans’ last years?  The picture is frightening. Our nation’s elderly would need to rely more on charity or burden their families — and by all estimates neither charities nor family resources are sufficient to cope with the need. Greater rationing pressures (rationing panels?) would result in regard to nursing home residents, nursing care, and end of life medical care. Those pressures on families, on charities, and on the quality and availability of care will surely play out in worrisomely in end of life moral issues.

Governor Romney’s plan is policy extremism at its worst. Where is his moral reflection on what this portends? His plan will have devastating consequences for the middle class elderly, for the poor, and most poignantly for poor children. Indeed, Governor Romney proposes many deep cuts in programs for the most vulnerable of Americans — in housing, education, food stamps, and so on, but what he proposes for Medicaid is by far the cruelest.

Schneck is national co-chairman of Catholics for Obama.