In the high-stakes political battles determining the future of American healthcare, a surprisingly small player is driving policy decisions for the Republican Party—creating significant friction on Capitol Hill and within the White House, reports Politico.
The Paragon Health Institute (PHI), established in 2021 with only 11 full-time staffers, is credited with formulating proposals that have already resulted in sweeping changes affecting millions of Americans.
At the center of this influence is founder Brian Blase, who previously served as a top economic official in the first Trump White House. Blase is described as “exceptionally smart, principled, and motivated by good intentions,” driven by the belief that government itself is the cause of many health policy problems.
Paragon’s success stems from its aggressive advocacy and a vast alumni network spread across the highest levels of government, including the Speaker’s office and the Trump administration. Alumni like Theo Merkel, a senior domestic policy adviser at the White House, and Marty Makary, the head of the Food and Drug Administration, ensure the think tank’s views flow directly into policymaking.
Paragon has already left an indelible mark. Blase is credited with formulating proposals that led to nearly $1 trillion in Medicaid cuts enacted as part of the recent GOP megabill.
The group played a leading role in securing changes to state Medicaid payments, including limiting provider taxes—which Paragon described as a form of “money laundering”—and capping state-directed payments to increase transparency. While Congress did not adopt all of Paragon’s deepest cut proposals, the final provisions were heralded as “historic achievements” by conservative health policy wonks, even as they cause “political headaches for Republicans in swing districts”.
Now, PHI is mounting a fierce crusade against the Affordable Care Act (ACA), pressuring Republicans to let enhanced ACA tax credits expire at the end of the year. The group complains about the estimated cost—$350 billion if permanently extended through 2035—and argues the subsidies are a huge windfall for the insurance industry.
Paragon also asserts its research shows the enhanced subsidies have led to the improper enrollment of more than 6 million people.
This aggressive stance has unnerved moderate House Republicans, many of whom privately express concern that Paragon is focused solely on conservative wins, “irrespective of the damage” to the GOP’s fragile midterm majority.
Pollsters and vulnerable incumbents warn that letting the subsidies expire will cause out-of-pocket insurance premiums to skyrocket and kick millions off their coverage.
Despite the internal Republican division—and an ideological split inside the White House where Paragon alumni clash with political advisors over the wisdom of extending the credits—Paragon is forging ahead. With its talking points flowing directly to conservatives, this small institute continues to exert outsized pressure on issues that directly impact the health coverage and finances of millions of Americans.