Paul Ryan’s Republican budget plan would privatize Medicare and dramatically slash Medicaid over time. The result: senior citizens, poor children and the disabled paying dramatically more for care, getting worse health insurance coverage and/or losing coverage altogether, according to a report by the CBO.

Under the proposal, most elderly people would pay more for their health care than they would pay under the current Medicare system. For a typical 65-year-old with average health spending enrolled in a plan with benefits similar to those currently provided by Medicare, CBO estimated the beneficiary’s spending on premiums and out-of-pocket expenditures as a share of a benchmark: what total health care spending would be if a private insurer covered the beneficiary. By 2030, the beneficiary’s spending would be 68 percent of that benchmark under the proposal, 25 percent under the extended-baseline scenario, and 30 percent under the alternative fiscal scenario.

Federal payments for Medicaid under the proposal would be substantially smaller than currently projected amounts. States would have additional flexibility to design and manage their Medicaid programs, and they might achieve greater efficiencies in the delivery of care than under current law. Even with additional flexibility, however, the large projected reduction in payments would probably require states to decrease payments to Medicaid providers, reduce eligibility for Medicaid, provide less extensive coverage to beneficiaries, or pay more themselves than would be the case under current law.

Cutting Medicaid enrollment means making life worse for the absolute weakest in our society. Most people covered by Medicaid are children and most of Medicaid’s spending is on care for the elderly and this disabled. Although, I guess Ryan probably thinks his plan is the motivation these lazy toddlers and 90-year-olds with dementia need to go get a job.

Paul Ryan’s future America is a truly dark place, where we as a country decide it is simply not worth it to help the most vulnerable in our society.