While Paul Ryan's Medicare plan is getting all the headlines, his plan for Medicaid is every bit as dramatic. But because Medicaid helps the poor - who don't vote - rather than seniors - who do - it hasn't dominated the presidential race like Medicare has.

Ryan’s budget would turn Medicaid into block grants to the states. That’s not a new idea; Republican governors have been demanding that since at least the Reagan years, which is another reason the issue isn’t capturing the headlines right now.

But Ryan’s plan delivers: It would reduce growth in Medicaid spending by $۸۰۰ billion in a decade and repeal the Medicaid coverage expansion under the Democrats’ health care law.

All told, the CBO has estimated that the amount of money spent on Medicaid and the Children’s Health Insurance Program would plummet — from ۲ percent of GDP in ۲۰۱۱ to ۱.۲۵ percent in ۲۰۳۰ and then ۱ percent in ۲۰۵۰.

Block grants would give states vast freedom on how to spend the Medicaid money, without the current federal rules about who gets covered and what coverage they get. Medicaid would no longer be an entitlement for poor children, pregnant women, low - income disabled and elderly Americans in nursing homes.

That flexibility, and the hard cap on the federal contribution, is exactly what makes supporters of Ryan’s plan so enthusiastic.

“The idea that we can afford open - ended entitlement with an open federal checkbook — those days are over, ” said Nina Owcharenko, director of the Center for Health Policy Studies at The Heritage Foundation, who favors a much smaller program, as she put it, “a more focused safety net. ”

And that’s what has Democrats worried.

Ryan's "massive cuts,” Joe Biden said on the campaign trail this week, "could throw 19 million people in distress off of Medicaid, including 1 million seniors, roughly 75 percent of whom are women. How do they think these people in nursing homes are there? Who do they think pays for that? Seventy-five percent of those octogenarians, those elderly - I mean genuinely elderly - persons in homes, they're there because of Medicaid,” he said.