A Paul Ryan vice presidency could have dire consequences for the poor and people with disabilities. Ryan’s plans to transform Medicare into a voucher system have been well-documented, but his proposed Medicaid reductions would cut even deeper. Between eliminating the Medicaid expansion in the Affordable Care Act and transforming the remainder of Medicaid into a capped block grant, the Ryan budget would deny health care coverage to 30 million people.

Whether Congress would enact such harsh cuts is an open question. Medicaid beneficiaries don’t possess the same political clout as senior citizens, but some elected officials may still cringe at the prospect of reducing services to their most vulnerable constituents.

The need to reform Medicaid is clear and I expect that beneficiaries like me will have to accept some reductions (on top of the reductions in personal care reimbursement we’ve already witnessed). But we would prefer not to hand the reins of power over to two men who seem to regard entitlements as abstractions disconnected from the lives of real people.