Trump Taps Merkel and Zinberg + Health Reforms for Congress

On Monday, President Trump took the oath of office to begin his second term as president. I worked for President Trump from 2017 through 2019 at the White House’s National Economic Council, and I am optimistic that he will pursue a health policy agenda consistent with the Paragon mission of empowering patients and reforming government programs. Unfortunately, as we have extensively documented, government health care programs are full of perverse incentives and result in significant wasteful spending that does not contribute positively to Americans’ health.

President Trump has already signed an executive order to withdraw the United States from the World Health Organization and revoked many harmful executive orders issued by President Biden, including one on artificial intelligence. Kev Coleman, Paragon’s health AI expert, supports this action, remarking “President Trump’s recission of the prior administration’s Executive Order on Artificial Intelligence opens the space for many more voices to shape government oversight on AI, ensuring our nation retains its global leadership in the industry while it implements consumer protections necessary to maintain public safety and privacy.”

As President Trump re-enters the White House, so do two of Paragon’s all-star policy experts. I begin the newsletter by highlighting new White House roles for Theo Merkel and Dr. Joel Zinberg. Then, I discuss a new Paragon report authored by Chris Jacobs that lays out a roadmap of quick, but important, health policy wins for a new Congress. Finally, I remember one of Paragon’s public advisors, Paul Mango, who unexpectedly passed away last week.

Trump Taps Merkel and Zinberg as White House Health Policy Advisors

Two Paragon directors were selected by President Trump to be the White House leads on health policy—Theo Merkel is heading to the Domestic Policy Council and Dr. Joel Zinberg is heading to the National Economic Council. Theo and Joel will be responsible for coordinating health policy across the executive branch and will work closely with President Trump’s nominees and senior officials in the Departments of Health and Human Services, Labor, and the Treasury.

Theo and Joel did outstanding work for Paragon and will be highly effective in advancing President Trump’s health policy agenda. We will miss them as colleagues, although we are excited for them in their new positions. American patients and hard-working families that pay taxes to support our federal health programs will benefit from having Theo and Joel in these important roles, and President Trump and other senior government officials will benefit from their counsel.

Constructive Initial Health Policy Actions for Congress

Democrats have occupied the White House for 12 of the past 16 years, and during this period the general policy direction has been to expand federal power and control, with massive new rules and spending programs. The return of President Trump to the White House, along with Republican majorities in Congress, offer opportunities to reduce federal power and control, deregulate markets, and promote limited government principles.

At the dawn of this new governing majority, Chris Jacobs lays out a series of recommendations for the new Congress in an important new Paragon report, Beginning to Stem the Red Ink Tide: Health Care Concepts for a Conservative Congress. Here are his policy suggestions from the executive summary of the paper, which I fully endorse:

The new Congress and administration should begin to roll back the damage caused by misguided and ineffective policies. They can start by declining to renew a costly increase in federal premium subsidies for exchange coverage scheduled to end in 2025. Allowing these increased subsidies to expire would save federal taxpayers billions while preventing a further erosion in employer coverage and sizable amounts of fraud.

Second, policymakers should seek to reverse Biden-era rules that have increased federal spending by hundreds of billions of dollars while adding regulatory burdens. Five rules in particular warrant scrutiny and repeal: (1) a Medicaid eligibility rule published in May 2024, (2) a Medicaid managed care rule also published in May 2024, (3) new staffing requirements for nursing homes published in April 2024, (4) a unilateral—and arguably unlawful—expansion of exchange subsidies for certain dependents finalized in October 2022, and (5) an expansion of exchange subsidies for DACA recipients published in May 2024.

Third, Congress can use the budget reconciliation process to reduce wasteful spending in federal health care programs. Fruitful targets include (1) strengthening citizenship verification procedures for government health programs, (2) removing incentives for states to expand Medicaid to able-bodied adults, (3) preventing attempts by presidential administrations to use taxpayer funds for political purposes by requiring all Medicaid waivers and Medicare demonstration projects to meet strict criteria for budget neutrality, and (4) preventing any new funding schemes that states use to bilk the federal government out of additional Medicaid matching funds—the first step toward a larger reform of these budgetary gimmicks.

Taking these steps would lay down a precedent of regular action by Congress and the executive branch to target ineffective and inefficient spending. Done successfully, it could set the groundwork for more comprehensive measures that could right-size the federal budgetary commitment to health care.

Today’s Paragon Pic (below) demonstrates the growth of government health spending, showing how the share of health care consumption controlled by the government has soared over the past several decades.

Honoring The Extraordinary Paul Mango

Democrats have occupied the White House for 12 of the past 16 years, and during this period the general policy direction has been to expand federal power and control, with massive new rules and spending programs. The return of President Trump to the White House, along with Republican majorities in Congress, offer opportunities to reduce federal power and control, deregulate markets, and promote limited government principles.

In a very sad development, Paul Mango, a proud American who served his country in many different roles and who was a Paragon public advisor, unexpectedly passed away last week. I got to know Paul when I was working in the White House and Paul was hired by HHS Secretary Alex Azar to be his deputy chief of staff. My relationship with Paul continued after our government service as he served as one of my most trusted advisors in building Paragon. Paul is survived by his five daughters and by Dawn Rucker, his wife of more than 42 years. His legacy in public policy was punctuated by his significant leadership and coordination role in Operation Warp Speed, an accomplishment that saved many Americans’ lives as well as those of people around the world, as recounted in his book Warp Speed.

Many of his friends and former colleagues shared heartfelt tributes to Paul on social media, including Secretary Azar who remarked:

I was devastated to learn today of the sudden passing of my dear friend and colleague Paul Mango. Paul was instrumental in the creation and success of Operation Warp Speed, which saved millions of American lives. He was quite simply one of the finest human beings I’ve ever known. He was a servant leader in every respect in the finest tradition of the U.S. Army in which he so proudly served, never seeking personal fame or glory but only caring about the team and the result. We should all aspire to be more like Paul

Another Paragon public advisor, Ge Bai, posted a moving tribute to Paul in Forbes. Rest in Peace Paul Mango.

All the best,

Brian Blase
President
Paragon Health Institute