Paul Ryan and Mitt Romney have been campaigning on Medicare–claiming that people over 55 and current Medicare recipients will be unaffected by their proposed conversion of Medicare from a universal comprehensive defined benefit to a variously-defined premium support program.

I’m not wild about these proposals—which certainly do not shield current seniors and near-retirees from ill-effects. In repealing health reform, Romney and Ryan would re-open the prescription drug donut hole and remove other benefits included in the Affordable Care Act, The New York Times reports that this would also raise average Medicare premiums by an average of $342 a year over the next decade, $577/year by 2022.

I’m far more concerned about what Romney and Ryan’s proposals would do to low-income elderly or disabled people, especially the nine million “dual-eligibles” who rely on both Medicare and Medicaid. This is the poorest, sickest, and most complex segment of the Medicare population. These vulnerable men and women account for about one-third of Medicare’s total costs. They also seem out of sight, out of mind, in this year’s campaign debate.

Paul Ryan campaigned in Florida by visiting the Villages, a rather upscale 25,000-acre retirement location whose website brags about residents’ high incomes and the area’s 29 executive golf courses. I wish Ryan would get out of the Villages, and visit some of Florida’s 400,000 dual-eligible seniors. His proposals to bloc grant and deeply cut Medicaid would hurt this population, would hurt state governments, and would inevitably hurt Medicare, too.

More from me, here in the Daily Beast.

[Cross-posted at The Reality-based Community]

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Harold Pollack is the Helen Ross Professor at the School of Social Service Administration at the University of Chicago.