WASHINGTON -- Congressman Paul Ryan's plan for Medicare gets all the attention, but the GOP vice presidential candidate has proposed even bigger changes to medical care for the poor and disabled.

The Wisconsin congressman is calling for states to take over the Medicaid program.

At the same time, Ryan's budget would reduce projected federal spending on Medicaid by about $800 billion over 10 years, shrinking the program as a share of the overall national economy.

Ryan is in sync with his new boss, Republican presidential candidate Mitt Romney.

Advocates for the poor and nonpartisan analysts say cuts would result in millions of vulnerable people losing health insurance. Republicans say that won't happen if states can make the program more efficient.

Medicaid serves nearly 60 million people.