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........

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