The Movement: The think tank at the center of the MAGA Medicaid firestorm

The Hill

12-05-2025

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.