The Republican Party is learning the hard way what happens when control over its message is ceded to unelected ideologues. In key districts across the country, House Republicans are being forced to spend millions defending vulnerable GOP members against a wave of attacks over alleged Medicaid cuts — attacks that are clearly landing. This is putting seats at risk in critical 2026 battlegrounds from California to Maine.
Since President Donald J. Trump took office, Democrats have made Medicaid the centerpiece of their paid media strategy, pumping huge sums into this issue because they know it resonates. The Democrats’ attacks are false, but the mainstream media is nowhere to be found to hand out any Pinocchios. But the danger for Republicans is simple: the attacks are sticking, and they’re not just coming from the left — they’re being enabled by voices within the party itself.
President Donald Trump and Speaker Mike Johnson (R., La.) have explicitly said there will be no cuts to Medicaid for Americans, period. You would think that would be the final word on the issue. And yet, so-called conservative think tanks and self-appointed policy experts in Washington, D.C. — most notably Paragon Health Institute President Brian Blase — continues to push an agenda that undercuts the party’s leadership and gives campaign fodder to the Democrats. Blase recently wrote and organized a letter signed by 20 House Republicans advocating for Medicaid cuts and even told Politico that Republicans should outright disregard Trump’s position on the issue.
The reality is the view that Republicans should gut Medicaid as part of budget reform would be a political disaster at the ballot. According to internal polling conducted by President Trump’s own pollster, the idea of cutting Medicaid is overwhelmingly unpopular, not just among Democrats but among most Trump voters and nearly two-thirds of swing voters. The centerpiece of these alleged cuts, reducing or eliminating the Medicaid provider tax, would disproportionately impact hospitals in the reddest Republican states and rural areas, which is the lifeblood of many of these communities.
Red states like Texas and Florida would be crushed by this nonsense. We know why Democrats and the mainstream media are pushing this false narrative, but why in the world are some Republicans parroting it?
The answer, unfortunately, lies with the fact that outlier GOP voices get disproportionate attention in the mainstream press. Despite President Trump’s clear stance on Medicaid, the mainstream press is not interested in fact checking Democratic attacks and that is why they elevate voices like Blase. Internal GOP divisions, even if far overblown, are a sexy political story.
Republicans are used to taking fire from Democrats. What they didn’t expect is to be sabotaged by their own side. The party has a choice: allow think tank operatives to define the GOP’s health care agenda, or reassert the authority of Trump and Johnson, who were elected because of working-class and rural voters.
If Republicans want to win in 2026, the path is simple. Make it crystal clear that they reject the Medicaid cuts. Reject the fringe policy experiments coming from D.C. think tanks. Embrace the leadership of Trump and Johnson, who understand that safeguarding Medicaid is good policy and smart politics.
GOP operations like the American Action Network (AAN) are already being forced to spend millions now to stop this false attack. If the GOP doesn’t get this right, it risks fighting a two-front war it can’t win: one against Democrats, and one against itself.
Scott Reed is veteran GOP strategist who previously was the chief political strategist for the Chamber of Commerce and ran Bob Dole’s presidential campaign in 1996.