WASHINGTON — Wisconsin Congressman Paul Ryan won almost universal praise from conservative Republicans last year when he laid out his long-term vision for the federal budget in a document he boldly called "The Path to Prosperity."
But in other circles, Ryan, the influential chairman of the House Budget Committee, was viewed as a machete-wielding strongman hacking and slashing federal programs that benefit the poor and the elderly.
Medicare as millions of Americans have come to know it would disappear under Ryan's plan and would be replaced by a system in which the elderly would be given vouchers to buy private insurance. Medicaid, the federal-state health care program for the poor, would be cut and handed over to the states.
Food stamps, Pell grants and other programs that benefit low-income people would be slashed, but the military would be spared billions of proposed cuts. The tax code would be rewritten so rates paid by the wealthy and corporations would be reduced, yet many low-income Americans would see a tax increase.
Ryan's budget blueprint, passed by the Republican-led House last March but currently stalled in the Democratic-controlled Senate, has little, if any, chance of ever becoming law as written.
Still, the 98-page document is drawing close scrutiny once again now that GOP presidential nominee Mitt Romney has picked Ryan to be his vice-presidential running mate.
In Ventura County, the Ryan budget proposal would rip huge holes in the safety net relied on by thousands of residents, say advocates for the poor and elderly
"Essentially, the Ryan plan would hurt not only the lower class, but the middle class," said Gabino Aguirre, a board member of Community Action of Ventura County, which started five decades ago as part of then-President Lyndon B. Johnson's war on poverty.
Ryan's supporters counter that his budget proposal is a rational and responsible prescription for fixing the nation's fiscal problems and is being grossly mischaracterized by his critics on the left.
"Nancy Pelosi has said over and over again that Paul Ryan's plan will leave seniors dying in the streets because Medicare will end as we know it," said Sally Pipes, president and chief executive officer of the Pacific Research Institute, a free market think tank based in San Francisco.
"I think we have to take a broader look at what is the future of Medicare as it is today," Pipes said.
Of all of the budget proposals that Ryan has put forth, his plan to reshape Medicare and turn it into a voucher system has drawn probably the most fire.
Current Medicare recipients or those near retirement would see no change in their benefits under Ryan's plan. But beginning in 2023, when workers under age 55 become eligible for retirement, they would be given a set amount of money to buy health insurance through a private insurer or a government-run program like Medicare. Retirees who chose to remain in the government-run program would have to pay more if that policy costs more than the private plans.
About 4.8 million Californians receive Medicare benefits, the largest number of any state in the nation. The federal government and the states have resisted past efforts to turn the program into a voucher system because of concerns that the money the government would give seniors would not be enough to buy a policy in the private market, said Roberto Juarez, chief executive officer of Clinicas del Camino Real, a group of health clinics that serve farm workers and other low-income people.
"A voucher doesn't guarantee you anything," Juarez said. "It guarantees only that you are going to go and get the lowest (cost) care — and sometimes get the lowest-quality care."
What's more, Juarez said, is that while the money the government would provide would be indexed to inflation, there's no guarantee it would keep pace with fast-rising health care costs.
"The private sector would benefit greatly from (a voucher system)," Juarez said, "but the patient would not."
Pipes and others who back Ryan's plan say the changes he is proposing are necessary to keep Medicare financially sustainable.
The nonpartisan Congressional Budget Office has estimated that by 2022, Medicare spending will exceed $1 trillion — essentially double the program's cost today. Medicare trustees have projected that, on its current course, the program's trust fund for inpatient hospital care would run out of money by 2024.
"If some changes are not made, I don't see how Medicare is going to be able to survive," Pipes said. "And if it doesn't survive, what does that mean for seniors? So I think it's prudent to take a look at some options."
Ryan's proposals for reshaping Medicaid, food stamps and Pell grants also are under fire.
Nearly 112,000 residents in Ventura County receive benefits under Medi-Cal, the state's version of Medicaid. Ryan would hand control of the federal-state program over to the states.
Right now, federal guidelines dictate the basic health care services that must be provided under Medi-Cal. But if Medicaid is put in the states' hands, enrollees could end up with a host of new regulations that vary from state to state, Juarez said.
In addition, he said, many states already are financially squeezed and might be tempted to use the Medicaid money for other programs unless there are requirements that it be used for that purpose, he said.
"It would be devastating to give it to the state and say, 'Just do what you want with it,' " Juarez said.
In July, nearly 66,000 residents in Ventura County were enrolled in CalFresh, the state's food stamp program. The average benefit was $287.48 per household per month. Under Ryan's plan, funding for food stamps would be cut, and the program would be converted into a block grant program tailored for each state's low-income population. To be eligible, recipients would have to work or receive job training.
"There are a lot of people in need in this county," said Jennie Pittman, spokeswoman for the Ventura County Human Services Agency. "These are low-income families who are struggling to make ends meet, so any decrease in their benefit, they certainly would feel."
For many families, food stamps are a matter of survival, Aguirre said. Farm hands and other seasonal workers not only earn low wages, the seasonal nature of their work drives down their annual income even further, he said.
"They count on food stamps to put food on he table," Aguirre said. "Cutting food stamps would be devastating."
Cuts to Pell grants would impact low-income students who depend on the money to get a college education. More than 1,700 students at CSU Channel Islands — roughly 41 percent of the student body — received Pell grants during the 2010-2011 academic year.
For those students, Pell grants "mean the difference between attending the university or not," said Ginger Reyes, the school's interim associate vice president for student affairs in charge of enrollment services.