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Ryan has proposed that Medicaid be converted into block grants but with the federal government's share of the cost cut by some $800 billion over the next decade. Currently, Medicaid is administered by the states, subject to federal rules concerning eligibility, and the amount paid by the federal government depends on the number of people who qualify. Under Ryan's plan, the federal share would be based on population and inflation and would not increase because of economic downturns, when more people qualify.[citation needed] His plan would also undo a Reagan-era reform by which the federal government prohibited the states from requiring that a patient's spouse, as well as the patient, deplete all of his or her assets before Medicaid would cover long-term care.[4][5][6][135]
An analysis by the CBO showed that the Ryan plan would not balance the budget for at least 28 years, partly because the changes in Medicare would not affect anyone now older than 55.[136] Former U.S. Comptroller General David Walker and Maya MacGuineas, president of the Committee for a Responsible Federal Budget, praised the budget for making tough choices. Walker believes it needs to go even further, tackling Social Security and defense spending.[137] In contrast, David Stockman, Director of the Office of Management and Budget under President Ronald Reagan, has declared that Ryan's budget "is devoid of credible math or hard policy choices" and would "do nothing to reverse the nation's economic decline and arrest its fiscal collapse."[138] Ezra Klein also criticized the budget for making "unrealistic assumptions."[134] The Center on Budget and Policy Priorities was highly critical of Ryan's budget proposal, stating that it would shift income to the wealthy while increasing poverty and inequality.[139]
Parts of the 2012 Ryan budget were criticized by the United States Conference of Catholic Bishops for its proposed cuts to housing and food stamp programs.[140][141] Faculty and administrators of Georgetown University challenged what they called Ryan's "continuing misuse of Catholic teaching" when defending his plan,[142][143] but Ryan rejected their criticism.[144]
Ryan's budget "envisions continued increases in Pentagon spending" and "significant cuts to the much smaller appropriations for the State Department and foreign aid," with diplomacy and development spending being reduced sharply.[145]
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