Under the U.S. House GOP death-budget plan authored by Reps. Paul Ryan, R-Wisc., and Hal Rogers, R-Pork, Kentucky’s Medicaid system will shed almost 50 percent of its projected enrollment by 2021, and reduce federal funding by nearly 32 percent, leaving scores of impoverished Kentuckians without insurance and placing a greater burden on the state to make up the shortfall. (And we all know how well that goes in Frankfort)

According to a report released yesterday by the Kaiser Family Foundation:

Projected federal spending on Medicaid for the 10-year period 2012 to 2021 would fall by $1.4 trillion, a 34 percent decline. By 2021, states would receive $243 billion less annually in federal Medicaid money than they would under current law, a 44 percent reduction.

The effect on enrollment in state Medicaid programs could vary widely. By 2021, between 31 million and 44 million fewer people nationally would have Medicaid coverage under the House Budget Plan relative to expected enrollment under current law, the analysis finds, examining three possible scenarios using different assumptions about how states might respond to lower federal funding. Most of those people, given their low incomes and few options for other coverage, would end up uninsured.

The House Budget Plan also could affect health centers, hospitals and safety-net facilities that serve low-income and uninsured people and rely heavily on Medicaid revenues. By 2021, hospitals could see reductions in Medicaid funding of between 31 percent and 38 percent annually, or as much as $84.3 billion, under the plan compared with projected funding under current law. The reductions would come at a time when millions more people would lack coverage, increasing the potential demand for uncompensated hospital care.

Its effect in Kentucky would have a devastating impact, as well.

Under the Ryan-Rogers plan, federal Medicaid spending in the Bluegrass State will be cut by 31.7 percent, meaning that the state will have to pick up the multi-billion dollar slack. Given the commonwealth’s hideously regressive tax system, it’s pretty clear who that burden will fall on:

Ah, Objectivism at its finest: Because the wealthiest are allowed to abscond with trillions of dollars in tax breaks, working-class Kentuckians and their children will suffer a $21.8 billion cut in federal Medicaid spending over the next decade, all in the name of “fiscal austerity.”

Further, Medicaid payments to state hospitals will be slashed by 39 percent, and current state Medicaid expenditures (about $3.4 billion) must increase by a staggering 65 percent just to prevent the projected 50 percent drop in enrollment the budget plan will likely create.

But if you’re too wealthy to need government-subsidized health care, and you won’t be paying for the fallout anyway, there’s another way of looking at this tragic scenario: