Now you listen. I don’t give a d*** which way you go, just don’t follow me. You got that? This is not what President Trump said to Department of Homeland Security Secretary Kristi Noem when he fired her. This is what one character in The Fugitive says to another as they plan their getaway from the federal and local authorities. It is who has authority over AI regulation that is the focus of today’s One Thoughtful Paragraph.
Other news from people in a position of authority:
- CMS requested stakeholder feedback on its Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative to better identify healthcare fraud. Key questions include requirements about program integrity, identity proofing and ownership, and oversight of genetic tests and molecular diagnostic tests and AI in MA coding practices. See HHS’ press release here.
- The FDA issued 30 warning letters to telehealth companies for false or misleading claims about compounded GLP-1 products, including implying equivalence with FDA-approved drugs. The letters are the second batch since the agency launched increased oversight of direct-to-consumer platforms in September 2025.
- HHS shared its annual report analyzing the impact of the No Surprises Act, showing that the law reduced out-of-network billing for patients. Notably, in disputes with health plans over out-of-network billing, providers won 80% of the time through the No Surprises Act’s Independent Dispute Resolution (IDR) system. Also notably, 60 employer groups, insurers, patient advocacy, and labor groups accused four specific provider groups of abusing the IDR system and urging regulators to reform it.
“What I want from each and every one of you is a hard-target search of every gas station, residence, warehouse, farmhouse, henhouse, outhouse and doghouse in that area.” This is what the great Tommy Lee Jones tells the local police team in his role as U.S. Marshal Sam Gerard in The Fugitive. In that scene, U.S. Marshal Gerard dismisses the local sheriff who is not doing a good job tracking down prisoners who got away after a train-bus collision. In real life, there is similar tension between local and federal authorities on a more complicated issue: AI. More than 50 Republican state and local lawmakers are urging the feds (in fact, it is a letter to President Trump) to stop trying to block state AI laws. They are saying that “efforts to freeze state policymaking [about AI] … risk[s] infringing on states’ rights” to make their own laws. But typically, whenever there is something that doesn’t recognize state borders, like interstate commerce or transportation across state lines, the states respect the unifying authority of the feds. With AI, it is even more complicated — technology does not know or care where it is being deployed. So, it only makes sense that developers of AI should have to follow the same law regardless of whether it is being used in Montana or Maryland. It is important to have a national regulatory scheme if AI is going to be able to scale safely – but in the absence of a federal framework, states are legislating on the issue in an uncoordinated and sometimes conflicting ways. Looking at the growing patchwork of state AI laws, this quote from U.S. Marshal Sam Gerard captures the right sentiment: “My, my, my. What a mess.”
