U.S. President Donald Trump sits the Oval Office to sign an executive order on AI and pediatric cancer research, at the White House, Washington, D.C., U.S., September 30, 2025. REUTERS/Nathan Howard
During Donald Trump's first presidency, he aggressively pushed for the Affordable Care Act of 2010, a.k.a. Obamacare, to be repealed and replaced. But after a replacement bill passed in the U.S. House of Representatives in late 2017, it failed in the U.S. Senate when three Republicans — Sen. Lisa Murkowski (R-Alaska), Sen. Susan Collins (R-Maine), and the late Sen. John McCain (R-Arizona) — joined Democrats in voting "no." And the health care issue, according to polls, proved to be a major liability for Republicans when Democrats retook the House in the 2018 midterms and enjoyed a net gain of 40 seats.
But so far during Trump's second presidency, Republicans have avoided trying to get Obamacare flat-out repealed. A measure to repeal Obamacare wasn't part of Trump's One Big, Beautiful Bill Act of 2025, although the megabill does include deep Medicaid cuts. And this time, many Republicans are pushing to defund the ACA rather than overturn it.
Those Republicans include Paragon Health Institute, a small right-wing think tank founded by GOP activist Brian Blase in 2021.
According to Politico reporters Benjamin Guggenheim, Robert King and Meredith Lee Hill, Paragon has "created friction on Capitol Hill and in the White House as Republicans clash over the future of Obamacare."
"Now, Blase is looking to exert his clout again, mounting a fierce campaign to convince lawmakers to let enhanced Affordable Care Act tax credits expire at the end of the year," the Politico journalists explain in an article published on October 1. "Democrats have made an extension of the boosted Obamacare subsidies, first approved by Congress in 2021, as their centerpiece demand in the current government funding fight. Republicans need to figure out if they're willing to deal — and Paragon doesn't want them to bend at all…. But Paragon is making a key segment of congressional Republicans uncomfortable, according to interviews with a dozen House GOP lawmakers, senior aides, White House officials and people close to the (Trump) Administration, many of whom were granted anonymity to provide their candid views or describe private conversations."
Guggenheim, King and Lee note that some of the more moderate Republican lawmakers fear that Paragon's efforts could hurt their party.
"Mindful of the possible political blowback from inaction, at least a dozen moderate House Republicans support a one-year extension of the subsidies," the Politico reporters observe. "Some GOP senators are working on their own proposal. Yet Paragon is forging ahead with its crusade to kill the credits outright. It complains about the cost — an estimated $350 billion through 2035 if extended permanently — and argues the subsidies have proven to be a huge windfall for the health insurance industry. The group also contends Obamacare itself is rife with fraud and 'phantom enrollment' — scenarios where people are on health plans but don’t file any medical claims."
A moderate House Republican, interviewed on condition of anonymity, told Politico, "We had to hold these people off once before; we will do it again."
Read the full Politico article at this link.