A young, well-connected think tank is at the center of Republicans’ efforts to reform Medicaid as part of President Trump’s “one big beautiful bill” — and the divide in the party about how far to go with cuts.
Here’s one sign of the impact of Paragon Health Institute, founded in 2021 and led by former first Trump administration economic adviser Brian Blase: Metadata for a letter Rep. Chip Roy (R-Texas) put out this month advocating for controversial Medicaid reforms listed Blase as the author.
Another, perhaps bigger, sign: Attacks from others on the right. MAGA crusader Laura Loomer personally attacked Blase and Paragon as “RINO Saboteurs,” accusing them of working against Trump’s promise to not cut Medicaid and digging up a 2016 tweet from Blase critiquing Trump and pointing to Paragon’s funding connection to the Koch network.
“They’re trying to undermine me with that accusation — and I don’t think it’s worked,” Blase told me of the attacks from Loomer and others. “We’re a threat to the healthcare industrial complex, and they’re very powerful, and they’re very well-funded, and I think they’ll continue to attack Paragon and me over the next few months.”
Blase, for his part, told me he had “no recollection” of making his tweet expressing disappointment for Trump not wanting to reform entitlement programs. And not only is Blase on good terms with the White House, a host of Paragon alums now have positions of influence there and elsewhere: Its former directors Theo Markel and Joel M. Zinberg have White House policy positions, and, and Drew Keys is policy adviser for Speaker Mike Johnson (R-La.).
One of those Paragon-pushed, supposedly “RINO” policies lawmakers were considering was adjusting the federal matching percentage for the Obamacare expansion population. Another was ending the “provider tax” mechanism that states use to boost their federal Medicaid matching funds, which Paragon calls “Medicaid money laundering.” Loomer named the provider tax specifically.
While fiscal hawks and free marketers have lauded Paragon’s ideas, they’ve faced resistance from those who worry that the increased burden on states could lead to them cutting benefits. It’s not only Democrats and moderate Republicans who voice that concern, but MAGA populists like Steve Bannon who warn that cuts could backfire politically since there are “a lot of MAGAs on Medicaid.”
That MAGA-based argument is being pushed by those in the hospital and healthcare industry with a financial state in the policy outcomes. Ryan Cross, vice president of government relations for Franciscan Missionaries of Our Lady Health System in Louisiana (ahem, Speaker Johnson and Majority Leader Steve Scalise), commissioned a poll from Trump pollster McLaughlin & Associates finding support for Medicaid in competitive congressional districts – including from 9 in 10 Republicans. And he’s also taking swipes at Paragon.
“Washington think tanks like Paragon are out-of-touch with the life-saving healthcare being delivered in communities across America,” Cross told me in a statement. “Their ideas for reform are simply trojan horses designed to cut the Medicaid program for people who need it the most. American voters are clear on this issue: don’t cut Medicaid.”
Blase dismissed the poll, saying it is “worthless” because of the way it asked questions. Paragon has released its own polling that “really suggests strongly that when people learn about the issues and Republican voters learn about the issues like they come to the same policy conclusion,” he added. Blase also went on Bannon’s War Room last week to push back on Loomer’s attacks.
Ultimately, the most controversial policy proposals pushed by Paragon-aligned conservatives did not make it into the bill, which has some fiscal hawks like Roy fuming. But it did include a moratorium on new provider taxes, in a win for Paragon — along with new work requirements for “able bodied” beneficiaries.
And through it all, the think tank has been instrumental in crafting and distilling the conservative messaging behind Medicaid reform.
“If states spend $1 on the able-bodied expansion enrollees, they get $9 in federal funding. If they spend the dollar on traditional enrollees, kids, people with disabilities, pregnant women, on average, they get $1.33,” Blase said. “I think that’s a moral outrage.”
Part of the reason Paragon gained prominence, though, is because of a lack of think tank firepower on the right in the health care reform space that is practical for lawmakers. Blase’s assessment is that the Heritage Foundation is no longer doing that kind of free market health policy work; the Cato Institute will outline a free market “north star” on the policy, but “that is often not very helpful to members of Congress and staff”; the American Enterprise Institute is “too academic.” And he said he also placed a priority on staffing it with people who have experience in government and know how it works.
As for the Roy letter with metadata that showed ties to Blase, which Politico first reported, Blase told me that he did not write the letter. Roy’s staff took a template of Paragon-provided list of Medicaid reform ideas to write the letter.
Roy told my colleague Mychael Schell that the people at Paragon are “just really good on healthcare, and they understand it, and have borne a lot of great ideas, and they’ve been extremely helpful.”
“I couldn’t have imagined when we launched Paragon three and a half years ago, the success and impact that we would have,” Blase said.
Further reading: My colleagues Nate Weixel and Joseph Choi detail the newly revealed Medicaid portion of the bill.
Welcome to The Movement, a new weekly newsletter looking at the influences and debates on the right in Washington. I’m Emily Brooks, House leadership reporter at The Hill. Tell me what’s on your radar: ebrooks@thehill.com or @emilybrooksnews on X.
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Paradigm shift on taxing the rich
The last-minute pitch from the White House to add a new tax hike on those pulling millionaire incomes did not make it into the tax portion of President Trump’s “big beautiful bill.” The House Ways and Means Committee released the tax portion of its sweeping tax bill on Monday and did not include that provision.
After talking with Americans for Tax Reform’s Grover Norquist on Friday, that’s the result I was expecting. The tax-cut advocate said he had been told that the White House has told GOP leadership they were taking the proposal off the table, and he said that he was “not losing any sleep” over the idea.
But as I wrote over the weekend, the entire debate is rewriting the conventional Republican political wisdom on the issue.
The president has sent mixed messages publicly about where he stands on the policy, and whether he thinks it’s good politics — both recognizing the political perils of reneging on a promise to keep tax rates lower, while seeing the upside in neutralizing Democratic arguments and finding more revenue.
Trump referenced the infamous quote from former President George H.W. Bush — “Read my lips, no new taxes” — in a Truth Social post on Friday when he said Republicans should “probably not” raise taxes on those pulling multimillion-dollar incomes, musing that Democrats could use it against Republicans.
But Trump also said it was not that broken promise that lost Bush the election in 1992: “NO, Ross Perot cost him the Election!” Trump said, referencing the independent presidential candidate who pulled nearly 19 percent of the popular vote.
Trump later in the day pointed to those political optics as an argument in favor of the tax hike. Republicans are wary of the talking point from Democrats that Republicans are cutting entitlements for the poor to pay for tax cuts for the rich.
“I actually think it’s good politics to do it, where richer people give up — and it’s a very small, it’s like a point — but they give it up to benefit people that are lower income,” Trump said, according to a pool report.
Related: House panel releases sweeping GOP tax bill, from my colleagues Mychael Schnell and Tobias Burns.
Qatari jet alarm
President Trump’s move toward accepting a luxury Boeing jet from Qatar to replace Air Force One, and then keep it in his eventual presidential library, is getting some pushback from the right.
Laura Loomer — man, she sure is at the center of a lot of MAGA divides these days — was among those on the right who piped up to criticize the move.
“I love President Trump. I would take a bullet for him,” Loomer wrote in a post on the social platform X. “But, I have to call a spade a spade. We cannot accept a $400 million ‘gift’ from jihadists in suits.”
And Sen. Rand Paul (R-Ky.) told HuffPost’s Igor Bobic that he doesn’t “think it looks good or smells good.”
“It just doesn’t seem right to have a jet. Plus, we make decisions on troops there. I mean, there’s just a lot of foreign policy decisions. And I think people will think that it could possibly sway your decisionmaking process,” Paul said.
Sen. Shelley Moore Capito (R-W.Va.) brought up the possibility of “bugs” on the plane.
“I think they should run the legal challenges to see [if it’s OK]. I’d be checking for bugs, is what I’d be checking for,” Capito said. ”We need to look at the constitutionality of it, sure.”
But don’t count on a wave of public GOP criticism. Senate Majority Leader John Thune (R-S.D.) told The Hill: “I understand his frustration. They’re way behind schedule on delivering the next Air Force One.” As for “whether or not this is the right solution … I don’t know.”
Trump, for his part, is defending his decision, as my colleagues Alex Gangitano and Al Weaver report.
“I could be a stupid person and say, ‘Oh no, we don’t want a free plane.’ We give free things out, we’ll take one too. And, it helps us out because … we have 40-year-old aircraft,” Trump said of the current plane on Monday. “So, I think it’s a great gesture from Qatar, I appreciate it very much. I would never be one to turn down that kind of an offer. I could be a stupid person and say, ‘No we don’t want a free, very expensive airplane,’ but I thought it was a great gesture.”
On my calendar
Tuesday, May 13: Trio of major markups in the House on the “big beautiful bill”: Ways and Means at 2:30 p.m.; Energy and Commerce at 2 p.m.; Agriculture Committee at 7:30 p.m.
Wednesday, May 14, 5:30 p.m.: Education Secretary Linda McMahon fireside chat at the Cato Institute on ending the Department of Education as it turns 45. Details here.
Tuesday, May 20, 11:00 a.m.: Breitbart News Washington bureau chief Matt Boyle hosts a policy event with Agriculture Secretary Brooke Rollins. Breitbart is partnering with CGCN and the ALFA Institute for the event. Details here.
Three more things
Mark Sen. Josh Hawley (R-Mo.) down on the populist side of the Medicaid debate. Hawley’s Monday op-ed in The New York Times is headlined “Don’t Cut Medicaid.” He writes: “We Republicans are having an identity crisis of our own, and you can see it in the tug of war over President Trump’s ‘one big, beautiful bill.’ The nub of the conflict: Will Republicans be a majority party of working people, or a permanent minority speaking only for the C suite?”
Shock poll: Sen. John Cornyn (R-Texas) is down 16 points against Texas Attorney General Ken Paxton in a Senate Leadership Fund-commissioned poll, Punchbowl News reported Monday. Cornyn senior adviser Matt Mackowiak said: “In 10 months when Texas GOP primary voters completely understand the record of both candidates, we are confident we will win.”
Checking in on MAHA-MAGA alliance: President Trump’s second choice for U.S. surgeon general has set off a wave of infighting within the “Make America Healthy Again” (MAHA) movement, as my colleagues Joseph Choi, Alejandra O’Connell-Domenech and Nate Weixel reported. Meanwhile… Health and Human Services Secretary Robert F. Kennedy Jr. went swimming in Rock Creek despite warnings against high bacteria levels.
What I’m reading
The Free Press’s Joe Nocera: The Intellectual Godfathers of Protectionism
The Telegraph’s Rob Crilly: Don’t forget it’s America first, Marjorie Taylor Greene warns Trump
The Dispatch’s Nick Catoggio: Rubio or Vance? Trump World’s 2028 Succession Struggle
The National Pulse: DDT Network Emerges as Hub for Never Trump Operatives
NOTUS’s Liz Skalka: The Activist Who Persuaded Republicans To Target Trans Rights
