Republicans may cling to this belief that they still want to muck around with Medicare, but it’s not going to happen. For one, their partners in an entire house of Congress don’t want to touch the thing. I suppose they can give means testing a shot, but privatization isn’t happening.

So for any big changes in the safety net, there’s Medicaid, as I said yesterday. The proposed cuts to Medicaid in the House Republican budget, which combined with nullifying the Medicaid expansion in the health care law equals around $1.3 trillion over 10 years, would kick 31-44 million off the insurance rolls, more than the total gains from the Affordable Care Act. And I said yesterday that Medicaid doesn’t have an organized constituency on its behalf. But it doesn’t have to be that way. The same people who routinely defend Medicare, seniors advocates, could and should fight for Medicaid. Because the same individuals are threatened by cuts to Medicaid.

While the largest number of Medicaid recipients are low-income children and adults, who tend to be far less politically potent voices in battles over entitlement programs than older voters, the changes to Medicaid proposed by Representative Paul D. Ryan of Wisconsin, the House budget chairman, could actually have a more direct impact on older Americans than the Medicare part of his plan.

The House plan would turn Medicaid, which provides health coverage for the poor through a combination of federal and state money, into a block grant program for states. The federal government would give lump sums to states, which in turn would be given more flexibility and independence over use of the money, though the plan does not spell out what the federal requirements would be.

Beginning in 2013, these grants would increase annually at the rate of inflation, with adjustments for population growth, a rate far below that of inflation for health care costs. As a result, states, which have said that they cannot afford to keep up with the program’s costs, are likely to scale back coverage. Such a reduction, critics fear, could have a disproportionate effect on Medicaid spending for nursing home care for the elderly or disabled [...]

“This is a huge deal for the nation’s seniors, and it’s been largely unrecognized,” said Jocelyn Guyer, the co-executive director of the Center for Children and Families at the Georgetown University Health Policy Institute. “Obviously Medicaid is a program designed for low- and modest-income people. But when it comes to nursing homes, a lot of seniors start off middle class and pay for their care with private funds but end up using the Medicaid program.”

70% of all nursing home residents are on Medicaid. The majority of Medicaid spending, around 65%, goes to the elderly. If you called this provision in the House budget the “Force People to Live with Their Mother-in-Law Act,” I’m pretty sure it wouldn’t get out of the gate. But that’s the practical effect. If you effectively eliminate nursing home care through Medicaid by allowing states to reduce their coverage, what you’ll see is children having to take in their parents. They’ll also have their own children at home, in all likelihood, as 85% of all college grads these days are moving back in with their parents. There’s a seriously negative economic impact to all of this, but it also hurts the quality of life of both children and parents.

This seems ripe for AARP to handle. The Medicaid cuts are more dangerous because Americans have less of a conception of Medicaid as a crucial element in the social safety net. Some education would be paramount.