Rep. Paul Ryan says in his WSJ op-ed that his Medicaid reform is actually welfare reform. Matthew Yglesias responds:

In other words, people are supposed to think Medicaid is that “bad” kind of government spending, the one that goes to shiftless black folks not hard-working Americans like you and me and Paul Ryan. But look at the actual distribution of Medicaid dollars: This is mostly a program for the elderly and the disabled. It’s the main way we finance long-term care in this country. If you don’t directly benefit from it, you very likely have a parent or grandparent who does and whose financial needs will simply tend to fall on you if the program is cut. Meanwhile, in terms of the "welfare" aspect of Medicaid by far the largest set of poor people it covers are poor children. Is Ryan’s view that these kids should have worked harder to have rich parents?

Let's reiterate a point here—a quarter of Medicaid spending goes for long-term care for the elderly. If Medicaid is not there to pick up those costs, it falls to families. There's already an explicit tax hike for the middle class in Ryan's plan. Taking Medicaid funding from families with disabled children and parents and grandparents in nursing homes compounds that.

Plenty of middle-class families only remain middle class because they're spared crippling medical and long-term care costs. A decade or two of the Ryan plan, and there will be no more middle class in America.