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This past month, President Donald Trump signed what could be one of the most consequential of the many executive orders the White House has put forth during his second term.
The Dec. 11 EO, Ensuring A National Policy Framework For Artificial Intelligence, seeks to supersede what at the moment is an array of different state-led initiatives to regulate – in various areas of focus, and by various means – fast-moving AI technology.
For some time now, in the absence of any meaningful regulatory guardrails from Congress, many U.S. states have been moving on their own to manage the many challenges posed by AI models, in healthcare and beyond.
As Sarah Jaromin, policy specialist at the bipartisan National Conference of State Legislators told us recently, "The states are really involved" in crafting AI-focused legislation focused on an array of challenges and use cases for the technology.
NCSL is tracking more than 1,000 bills related to AI broadly across the states, she said, with more than 200 related specifically to the use of AI in healthcare. Two dozen or so have become law.
But the Trump administration executive order aims for a more unified nationwide approach.
The EO instructs U.S. Attorney General Pam Bondi to create an AI Litigation Task Force, which will challenge state AI laws it thinks are inconsistent with national policy, especially those that "unconstitutionally regulate interstate commerce, are preempted by existing federal regulations" or, in the AG's judgment, "are otherwise unlawful."
The order calls on U.S. Secretary of Commerce Howard Lutnick to do an examination of existing state AI laws over the next 90 days. He is expected to provide Bondi with a list of any that conflict with those policy outlines, or other "onerous and excessive laws emerging from the States that threaten to stymie innovation."
States have had good reason to be taking the lead on AI, especially in areas such as healthcare, where patient safety should be paramount.
For instance, as Republican State Senator Bo Watson of Tennessee explained recently, "States do almost all the licensure for healthcare professionals. If AI is being used in the diagnostic space, who owns that?"
As Watson argues, "State government is the infrastructure of our political system. The federal government is very entertaining. It's a 24-hour show. But state and local governments have a lot of responsibility."
From the Trump administration's point of view, however, American AI developers "must be free to innovate without cumbersome regulation." And, as the White House argues in its EO, "excessive State regulation thwarts this imperative."
"First, state-by-state regulation by definition creates a patchwork of 50 different regulatory regimes that makes compliance more challenging, particularly for start-ups. Second, state laws are increasingly responsible for requiring entities to embed ideological bias within models. .... Third, state laws sometimes impermissibly regulate beyond state borders, impinging on interstate commerce."
In the executive order on AI, Trump says his administration "must act with Congress to ensure that there is a minimally burdensome national standard – not 50 discordant state ones."
How these new policy goals play out in the months ahead remains to be seen. But in the meantime, early reaction from technology developers in the healthcare space appears to echo those concerns – and express cautious optimism that they can be addressed effectively on a nationwide basis.
Meeting the 'expected pace of AI innovation'
"The current patchwork of state-level AI regulations poses real challenges for both health IT developers and the healthcare organizations we serve, particularly those operating in multiple states or treating patients from across state lines," explained Leigh C. Burchell, VP of policy & public affairs at Altera Digital Health, in a statement shared with Healthcare IT News.
"A logical, risk-based federal framework that reflects the nuances of AI use specific to healthcare would provide the clear guardrails needed for consistent, responsible development and adoption across the industry," Burchell added. "By building consensus around how to approach that spectrum of risk, we can maintain high standards for patient safety while ensuring we meet the expected pace of AI innovation."
Aaron Patzer, CEO and cofounder of Vital.io, an AI-enabled patient experience platform, frames the stakes even more starkly.
“In healthcare, regulatory fragmentation is not a nuisance; it is a threat," he said in a statement. "When every state sets its own AI rules, patients face unequal standards of care and critical innovations are stalled at the border. The nation cannot allow life-saving technology to be governed by a patchwork of conflicting policies. A single federal AI framework is imperative to protect patients, accelerate innovation, and keep America ahead.”
Meanwhile, Bill Charnetski, EVP of health system solutions and government affairs at PointClickCare, said he was hopeful that common ground could be found between the Trump administration's policy goals and existing state-level regs.
"While the order creates conflict between states and the federal government over AI regulations, I’m confident all parties can reach consensus that collaboration, open communication and shared data should be standard," he said. "It’s imperative that healthcare adopt policies that allow AI to fulfill its promise while still protecting patient data and preventing misuse.”
And Abhi Gupta, CEO and cofounder of Fold Health, which developed an AI-powered approach to help boost performance across fee-for-service and value-based care, says the EO is "best viewed through a practical healthcare lens: Clearer, more consistent rules can reduce deployment friction and help providers adopt AI responsibly at scale – especially when requirements vary widely across states."
The most helpful framework approach "will be risk-based and operationally usable," said Gupta in a statement shared with Healthcare IT News, with "lighter-touch expectations for low-risk administrative automation and stronger guardrails for higher-impact clinical workflows (validation, auditability, security, and clear human override).
"The goal is predictable standards that accelerate safe adoption – so AI can meaningfully extend the capacity of care teams while preserving trust and reliable, non-misleading outputs."
Mike Miliard is executive editor of Healthcare IT News
Email the writer: mmiliard@himss.org
Healthcare IT News is a HIMSS publication.
