As the presidential campaign unfolds, the differences in approaches to Medicare by President Barack Obama and Republican nominee Mitt Romney have taken center stage. But what is getting far less scrutiny: Romney's plans for Medicaid. He would convert the health care program for the poor, disabled and elderly into a block grant to the states and sharply reduce funding over time. Middle-class Americans should be especially wary, since it's Medicaid, not Medicare, that covers nursing home care for aged and infirm parents and grandparents. Without Medicaid's safety net, it isn't clear what those Americans would do, and Romney doesn't have any good answers.

It's an understandable confusion. People think that since Medicare covers medical services for people over 65, it also pays for nursing home care for elderly people. Medicaid is thought of as a poverty program that provides medical coverage to poor families. But Medicaid is the program that provides long-term care to the elderly and disabled, which accounts for 31 percent of the program's $400 billion annual federal and state spending. Most of the nation's 1.8 million nursing home residents, including more than 77,000 Floridians, rely on Medicaid to pay their bills.

Medicaid's nursing home beneficiaries are not necessarily poor people. During their working years they may have lived productive middle-class lives until becoming infirm and quickly exhausting their assets. No matter how assiduously families save for retirement, there aren't many who could long afford the steep costs of a residential nursing home that can run an average of $80,000 a year. Without Medicaid's essential safety net, members of this vulnerable population would be on their own or might be forced to live with relatives ill equipped to care for their intensive needs.

There is an irony to Romney running mate Paul Ryan's applause line at the Republican National Convention last month that "the truest measure of any society is how it treats those who cannot defend or care for themselves." It was Ryan who authored the plan to convert Medicaid from a strong federal-state entitlement to a block grant program to the states that Romney has incorporated into his campaign. The plan, passed as a budget blueprint by the Republican-controlled House, would gut Medicaid's safety net and focus instead on cutting funds. The nonprofit Center for Budget and Policy Priorities says Medicaid funding would decline by one-third by 2022 under Ryan's plan.

To make up the difference, states that are already struggling under Medicaid's rising costs would have to add substantial state money to the program or — more likely — utilize the new flexibility Romney promises to pare back eligibility, reimbursements and enrollment. Estimates are that states would drop between 14 million and 27 million people from Medicaid by 2021, according to the Urban Institute. In addition, Romney's promise to repeal President Barack Obama's health care reform law would impact Medicaid by eliminating expanded coverage of home and community-based services that help seniors live at home. This fits the you-are-on-your-own agenda of the Republican presidential ticket far more neatly than Ryan's rhetoric about caring for those who can't care for themselves.

Medicaid is a lifeline for poor children and families but also for the nation's middle class whose elderly and disabled loved ones rely on it for long-term care. The Romney/Ryan plan would decimate the program, and that should be on every voter's mind come November.