While he's at it, Mr. Ryan would transform Medicaid, the health insurance program for the poor. Currently, the states and federal government share the costs of the program, no matter how many people are eligible for it, at a predetermined ratio. (In Maryland, the costs are split 50-50, but in poorer states, the federal government picks up more of the tab.) Mr. Ryan wants to change it to a block grant program in which the federal government gives the states a set amount and lets them design their own programs. Of course, the amount he envisions providing them is much less than the government does now, which likely means millions of poor Americans -- particularly children -- would suddenly find themselves uninsured. And although it isn't in his most recent proposal, Mr. Ryan has previously pushed for the privatization of Social Security, effectively putting the one guaranteed piece of most Americans' retirement income at the mercy of the stock market.