An influential group of House Republicans has invited a chief architect of the hard-right push for deep Medicaid spending cuts to brief congressional aides Thursday as GOP leaders quietly map out a possible second party-line reconciliation package.
Brian Blase, president of the Paragon Health Institute, will address a staff briefing on health care reform hosted by the Republican Study Committee, according to an invitation obtained by POLITICO.
The RSC, composed of 189 House conservatives, has been a key force pushing for a follow-on to President Donald Trump’s “big, beautiful bill” that was signed into law last month. The group has invited several conservative experts to address staffers in recent weeks though it has yet to endorse any specific health care policies for any forthcoming package.
Those staff-level meetings continue as House GOP leaders try to plot a way forward amid skepticism over whether another sprawling domestic policy bill is even possible given the difficulties Republicans had coming to agreement over the first one.
House leaders discussed the topic with GOP chairs right before the chamber left for August recess, according to two Republicans granted anonymity to discuss the private gathering, tasking them with compiling lists of possible spending cuts and other ideas.
What policies might be addressed in a second package is far from settled, though some House GOP factions are discussing further slashing Medicaid as well as possibly targeting Medicare funding.
Blase was allied with conservative hard-liners earlier this year in pushing for significant cuts to Medicaid in the first GOP package. He was the initial author of a letter arguing for “structural” changes to the program that Rep. Chip Roy (R-Texas) and 19 other hard-right members later sent to their House Republican colleagues.
An RSC spokesperson declined to comment on Thursday’s briefing. But a person granted anonymity to discuss plans in advance said the meeting is set to cover enhanced tax credits for Affordable Care Act health insurance premiums, which are due to expire at the end of the year, as well as rules governing the percentage of Medicaid expenditures covered by the federal government and reimbursed to states.
The briefing will also cover the 340B drug discount program; proposals to even out Medicare payments for outpatient services, known as “site neutral” payments; plans for expanding tax-advantaged Health Savings Accounts for medical expenses; and arrangements that allow employers to reimburse employees for insurance premiums and medical expenses with pre-tax dollars.
Blase, who did not respond to a request for comment, served on the White House National Economic Council during Trump’s first term. He and other conservative health wonks launched Paragon in 2021, and it has rapidly gained influence in GOP policy circles. Former Paragon staffers are now top health aides to Speaker Mike Johnson and President Donald Trump.
Blase will be joined by two other Paragon officials at the RSC briefing: Demetrios Kouzoukas, who is the director of Paragon’s Medicare Reform Initiative, and Gabrielle Minarik, a program manager. Kouzoukas, a former executive in UnitedHealth’s Medicare arm, also served as chief executive of the Medicare program at the Centers for Medicare and Medicaid Services during the first Trump administration.
While Republicans reaped hundreds of billions of dollars of cuts from Medicaid in the One Big Beautiful Bill Act, they stopped short of the more ambitious changes that Blase and conservative lawmakers have advocated. Now, even senior Republicans acknowledge their options for new spending offsets are drastically limited, and both Medicaid and Medicare are likely to emerge as tempting targets as talks proceed. “It’s clear we’re scraping the bottom of the barrel for cuts,” said one Republican with direct knowledge of the early conversations around a second GOP-only package.
But any push to further slash federal health care spending — let alone the politically explosive issue of Medicare changes — is likely to be met by fierce pushback by vulnerable House Republicans as well as some more conservative-leaning members. Some Senate Republicans, meanwhile, are deeply skeptical a second reconciliation package would have enough support to pass — especially absent a major, unifying centerpiece akin to the tax cuts embedded in the first package.
Rep. Mike Flood (R-Neb.), chair of the business-friendly Main Street Caucus, recently warned there would be “severe pushback” to pursuing deeper Medicaid cuts in a second reconciliation bill. Flood said his group of 83 House Republicans supported implementing Medicaid work requirements and SNAP food aid changes in the first bill — savings that have now essentially been exhausted.
Even House GOP leaders are unsure where Republicans will be able to successfully push through another party-line package this fall. A major fight over government funding looms, as well as the expiration of the ACA tax credits — which could lead to drastic hikes in some Americans’ health insurance premiums.
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