In backloading reductions in federal spending on Medicare to gradual erosion of “premium support” over time, while “grandfathering” benefits for Americans 55 or older, the Ryan Budget treats this program much more gently than Medicaid, which is “block-granted” and flat-funded immediately, aside from Ryan’s proposed cancellation of the Medicaid expansion provided for in the Affordable Care Act of 2010.

So old folks do better than young folks under Ryan’s tender care, right?

Well, not exactly. As Joan McCarter usefully reminds us at Daily Kos today, Medicaid is the ultimate safety net for lower-income seniors, paying for Medicare premiums for some and for long-term care for virtually all of modest means. More than two-thirds of America’s nursing home residents–two-thirds–are having their basic needs met by Medicaid. So with federal Medicaid funding being cut an estimated one-third over the next decade if Ryan gets his way (not cuts likely to be offset by the typically Republican leadership in the states most affected, who are already whining they can’t afford their current costs), and Romney apparently even more inclined to aggressively follow the block, cap and dump approach, it’s going to get tough fast for lower-income seniors.

This includes a lot of people who have fallen out of the middle-class and lost most of their assets as they grew older and sicker. So in general, if Romney/Ryan win this election, and get a Republican-controlled Congress eager to enact some version of the Romney/Ryan budget plans, then we may soon see revolutionary changes in how people reach the end of their lives in this country. It won’t be pretty.

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Ed Kilgore is a political columnist for New York and managing editor at the Democratic Strategist website. He was a contributing writer at the Washington Monthly from January 2012 until November 2015, and was the principal contributor to the Political Animal blog.