There’s a lot of talk about the Paul Ryan budget and its intended destruction of Medicare — but even more disturbing are the enormous cuts Ryan proposes to make to Medicaid, the system that helps millions of low-income Americans when they need it most: Paul Ryan’s Biggest Budget Cuts Are to Medicaid, Not Medicare.

Paul Ryan’s Medicare overhaul may be the most controversial part of his budget. But the proposed cuts to the program are not the biggest cuts in the plan.

As Ezra notes, Ryan’s cuts to Medicare “are only 60 percent as large as the cuts to Medicaid and other health-care programs.” What’s more, his biggest change to Medicare wouldn’t kick in until 2023—the start date for his voucher-based premium support program. By comparison, Ryan’s cuts to Medicaid are more drastic, and they start sooner: Between 2013 and 2022, it would make nearly $1.4 trillion in cuts to Medicaid that “would almost inevitably result in dramatic reductions in coverage” as well as enrollment, according to the non-partisan Kaiser Family Foundation.

Over the next 10 years, the Ryan plan would cut Medicaid by $642 billion by repealing the Affordable Care Act and by $750 billion through new caps on federal spending—a 34 percent cut to Medicaid spending over the next decade, according to Edwin Park of the Center and Budget and Policy Priorities.