By Darius Tahir, Lauren Sausser, KFF Health News

It’s the rare policy question that unites Republican Gov. Ron DeSantis of Florida and the Democratic-led Maryland government against President Donald Trump and Gov. Gavin Newsom of California: How should health insurers use AI?

Regulating artificial intelligence, especially its use by health insurers, is becoming a politically divisive topic, and it’s scrambling traditional partisan lines.

Boosters, led by Trump, are not only pushing its integration into government, as in Medicare’s experiment using AI in prior authorization, but also trying to stop others from building curbs and guardrails. A December executive order seeks to preempt most state efforts to govern AI, describing “a race with adversaries for supremacy” in a new “technological revolution.”

“To win, United States AI companies must be free to innovate without cumbersome regulation,” Trump’s order said. “But excessive State regulation thwarts this imperative.”

Across the nation, states are in revolt. At least four — Arizona, Maryland, Nebraska, and Texas — enacted legislation last year reining in the use of AI in health insurance. Two others, Illinois and California, enacted bills the year before.

Legislators in Rhode Island plan to try again this year after a bill requiring regulators to collect data on technology use failed to clear both chambers last year. A bill in North Carolina requiring insurers not to use AI as the sole basis of a coverage decision attracted significant interest from Republican legislators last year.

DeSantis, a former GOP presidential candidate, has rolled out an “AI Bill of Rights,” whose provisions include restrictions on its use in processing insurance claims and a requirement allowing a state regulatory body to inspect algorithms.

“We have a responsibility to ensure that new technologies develop in ways that are moral and ethical, in ways that reinforce our American values, not in ways that erode them,” DeSantis said during his State of the State address in January.

Ripe for Regulation

Polling shows Americans are skeptical of AI. A December poll from Fox News found 63% of voters describe themselves as “very” or “extremely” concerned about artificial intelligence, including majorities across the political spectrum. Nearly two-thirds of Democrats and just over 3 in 5 Republicans said they had qualms about AI.

Health insurers’ tactics to hold down costs also trouble the public; a January poll from KFF found widespread discontent over issues like prior authorization. (KFF is a health information nonprofit that includes KFF Health News.) Reporting from ProPublica and other news outlets in recent years has highlighted the use of algorithms to rapidly deny insurance claims or prior authorization requests, apparently with little review by a doctor.

Last month, the House Ways and Means Committee hauled in executives from Cigna, UnitedHealth Group, and other major health insurers to address concerns about affordability. When pressed, the executives either denied or avoided talking about using the most advanced technology to reject authorization requests or toss out claims.

AI is “never used for a denial,” Cigna CEO David Cordani told lawmakers. Like others in the health insurance industry, the company is being sued for its methods of denying claims, as spotlighted by ProPublica. Cigna spokesperson Justine Sessions said the company’s claims-denial process “is not powered by AI.”

Indeed, companies are at pains to frame AI as a loyal servant. Optum, part of health giant UnitedHealth Group, announced Feb. 4 that it was rolling out tech-powered prior authorization, with plenty of mentions of speedier approvals.

“We’re transforming the prior authorization process to address the friction it causes,” John Kontor, a senior vice president at Optum, said in a press release.

Still, Alex Bores, a computer scientist and New York Assembly member prominent in the state’s legislative debate over AI, which culminated in a comprehensive bill governing the technology, said AI is a natural field to regulate.

“So many people already find the answers that they’re getting from their insurance companies to be inscrutable,” said Bores, a Democrat who is running for Congress. “Adding in a layer that cannot by its nature explain itself doesn’t seem like it’ll be helpful there.”

At least some people in medicine — doctors, for example — are cheering legislators and regulators on. The American Medical Association “supports state regulations seeking greater accountability and transparency from commercial health insurers that use AI and machine learning tools to review prior authorization requests,” said John Whyte, the organization’s CEO.

Whyte said insurers already use AI and “doctors still face delayed patient care, opaque insurer decisions, inconsistent authorization rules, and crushing administrative work.”

Insurers Push Back

With legislation approved or pending in at least nine states, it’s unclear how much of an effect the state laws will have, said University of Minnesota law professor Daniel Schwarcz. States can’t regulate “self-insured” plans, which are used by many employers; only the federal government has that power.

But there are deeper issues, Schwarcz said: Most of the state legislation he’s seen would require a human to sign off on any decision proposed by AI but doesn’t specify what that means.

The laws don’t offer a clear framework for understanding how much review is enough, and over time humans tend to become a little lazy and simply sign off on any suggestions by a computer, he said.

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Still, insurers view the spate of bills as a problem. “Broadly speaking, regulatory burden is real,” said Dan Jones, senior vice president for federal affairs at the Alliance of Community Health Plans, a trade group for some nonprofit health insurers. If insurers spend more time working through a patchwork of state and federal laws, he continued, that means “less time that can be spent and invested into what we’re intended to be doing, which is focusing on making sure that patients are getting the right access to care.”

Linda Ujifusa, a Democratic state senator in Rhode Island, said insurers came out last year against the bill she sponsored to restrict AI use in coverage denials. It passed in one chamber, though not the other.

“There’s tremendous opposition” to anything that regulates tactics such as prior authorization, she said, and “tremendous opposition” to identifying intermediaries such as private insurers or pharmacy benefit managers “as a problem.”

In a letter criticizing the bill, AHIP, an insurer trade group, advocated for “balanced policies that promote innovation while protecting patients.”

“Health plans recognize that AI has the potential to drive better health care outcomes — enhancing patient experience, closing gaps in care, accelerating innovation, and reducing administrative burden and costs to improve the focus on patient care,” Chris Bond, an AHIP spokesperson, told KFF Health News. And, he continued, they need a “consistent, national approach anchored in a comprehensive federal AI policy framework.”

Seeking Balance

In California, Newsom has signed some laws regulating AI, including one requiring health insurers to ensure their algorithms are fairly and equitably applied. But the Democratic governor has vetoed others with a broader approach, such as a bill including more mandates about how the technology must work and requirements to disclose its use to regulators, clinicians, and patients upon request.

Chris Micheli, a Sacramento-based lobbyist, said the governor likely wants to ensure the state budget — consistently powered by outsize stock market gains, especially from tech companies — stays flush. That necessitates balance.

Newsom is trying to “ensure that financial spigot continues, and at the same time ensure that there are some protections for California consumers,” he said. He added insurers believe they’re subject to a welter of regulations already.

The Trump administration seems persuaded. The president’s recent executive order proposed to sue and restrict certain federal funding for any state that enacts what it characterized as “excessive” state regulation — with some exceptions, including for policies that protect children.

That order is possibly unconstitutional, said Carmel Shachar, a health policy scholar at Harvard Law School. The source of preemption authority is generally Congress, she said, and federal lawmakers twice took up, but ultimately declined to pass, a provision barring states from regulating AI.

“Based on our previous understanding of federalism and the balance of powers between Congress and the executive, a challenge here would be very likely to succeed,” Shachar said.

Some lawmakers view Trump’s order skeptically at best, noting the administration has been removing guardrails, and preventing others from erecting them, to an extreme degree.

“There isn’t really a question of, should it be federal or should it be state right now?” Bores said. “The question is, should it be state or not at all?”

©2026 KFF Health News. Distributed by Tribune Content Agency, LLC.

DICAMILLO/LANGEMO: Award-winning Minnesota writer Kate DiCamillo and musician Jimmi Langemo team up for stories, music, inspiration and connection to benefit Joyce Uptown Foodshelf. Tickets required. For information, visit redballoonbookshop.com. 1 p.m. March 1, Judson Memorial Baptist Church, 4101 Harriet Ave., Mpls.

NINA McCONIGLEY: Colorado-based writer introduces her debut novel “How to Commit a Postcolonial Murder,” in conversation with Minnesotan V.V. Ganeshananthan. Free. 2 p.m. Saturday, Plymouth library, 15700 36th Ave. N., Plymouth, in partnership with Valley Bookseller of Stillwater.

SCOTT MESLOW: Presents “A Place Both Wonderful and Strange: The Extraordinary Untold History of Twin Peaks.” 7 p.m. Wednesday, Magers & Quinn, 3038 Hennepin Ave. S., Mpls.

IMANI PERRY: National Book Award winner of “South to America,” which argues you must understand the South to understand America, and “Black in Blues: How a Color Tells the Story of My People” discusses her writing in Friends of Hennepin County Library’s Pen Pals series. 7:30 p.m. Thursday, 11 a.m. Friday. Hopkins Center for the Arts, 1111 Mainstreet, Hopkins. $59-$49 in-person, $35 virtual. Call: 612-542-8112.

What else is going on

(Courtesy of Routledge)

Christopher Danielson, St. Paul author and educator, won the national Simons Laufer Mathematical Sciences Institute Mathical Book Prize for his picture book “How Did You Count?” for grades K-2. Images were taken by Minneapolis photographer and educator Asha Belk.

In the announcement the Mathical committee writes: “Young readers … are invited to share their thought process — and sometimes whimsical ways — for tallying things up — as they explore colorful photos featuring mathematical groups of everyday objects.”

Danielson, a former teacher at Normandale Community College and in St. Paul public schools, is director of strategic projects at CPM Educational Program. He’s the founder of Math On-a-Stick, an outdoor family math play event that takes place during the Minnesota State Fair. The Mathical prize is awarded in partnership with the National Council of Teachers of English, and the National Council of Teachers of Mathematics in coordination with Children’s Book Council. The winning book also has a companion teachers’ guide.

Attention all Barbara Kingsolver fans (and who isn’t?) Her new novel, “Partita,” releases in October. It’s the story of a gifted woman pianist who finds solace in music after her brother’s death. When she meets a mysterious man her life takes a turn to self-discovery and love.

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Today’s offerings: a new mystery set in the years of the Raj in India, an imagination-stretching dry-erase book for the little ones and a congratulation.

(Courtesy of the author)

“The Star from Calcutta” by Sujata Massey (Soho Crime, $29.95)

Perveen Mistry steps into the world of Indian filmmaking in the fifth in this series featuring the only woman solicitor in Bombay in 1922.

Perveen, a partner with her father in their law firm, is excited about taking on as clients director Subhas Ghoshal and his beautiful wife, Rochana, a popular movie star who recently left a rival studio. It seems a simple contract dispute at first, until things turn deadly.

A man who is a member of the powerful censorship board, seen at a party with Rochana, is found dead by Perveen in a puddle caused by the monsoon. Then, Rochana disappears just before the first showing of her latest film. There are plenty of suspects and Perveen walks a fine line between doing her duty to her clients and investigating the man’s death with the risk of implicating them.

Behind the glitz of an Indian film community striving to overtake British and American companies, she finds bribery, deceit and marital affairs.

Sujata Massey, who grew up in St. Paul, introduces the fifth book in her Perveen Mistry series, “The Star from Calcutta,” March 3, 2026, at Once Upon a Crime bookstore in Minneapolis. (Courtesy of the author)

Perveen’s first case was “Widows of Malabar Hill” (2018), where readers learned of the tightrope Perveen has to walk as a female lawyer who uses her position to ask hard questions but must also back off so her conduct is never perceived as unseemly.

Her family belongs to the tight-knit Parsi community of the Zoroastrian faith who migrated from what was then Persia, and their young women must follow strict rules. For instance, when Perveen and her best friend, Alice, must spend the night at the studio both families are upset because women, even those in their 20s with careers, are expected to be home at night. Perveen, who left an abusive marriage, must hide her attraction to a handsome former civil service officer because she is technically still married and will be for the rest of her life.

Alice, who is gay, plays a crucial part in “The Star from Calcutta,” hiding a stunning secret from Perveen. Alice’s father is a British government official high in the ranks of Bombay society so her friendship with film star Rochana is frowned on by her strict mother.

As the story unfolds we also learn of relations between Indians and the colonial British and the awkward position of Anglo-Americans, as well as India’s diversity in languages and religious faiths.

This is the most complicated mystery in this series and a cast of characters would have been helpful for readers.

Massey was born in England and grew up in St. Paul’s University Grove neighborhood, attending the old Alexander Ramsey high school. She lives in Maryland with her husband Tony.

Before she started the Perveen series she wrote 11 award-winning mysteries featuring a Japanese-American antiques dealer based on her time living in Japan. Her Perveen books have also won awards. The new one is described by Kirkus Reviews as a “lush, leisurely, and well-researched 1920s historical mystery.”

Massey will introduce her book at a free reading at 6:30 p.m. Tuesday at Once Upon a Crime, 604 W. 26th St., Mpls.

TEASER QUOTE:

“She was standing in a film frame and felt transported. She was Rochana: the runaway almost-bride, and a fleeing film studio wife. But was she escaping one kind of danger only to find a new, unknown one?”

(Courtesy of Candlewick Press)

“This Superhero Needs Your Help!” by David LaRochelle and YOU” (Candlewick Press, $10.99)

Fans of Minnesotan David LaRochelle’s children’s books will be happy to see “This Superhero Needs Your Help!”, third in his interactive Draw & Erase Adventure series that offer youngsters 4 to 8 the chance to stretch their imaginations (after “This Sheep Needs Your Help!” and “This Pirate Needs Your Help!”)

Using the wipe-clean marker that comes with the board book, youngsters are invited to draw themselves as superheroes on dry-erase pages and help catch Dr. Dreadful who is creating chaos. The young superhero is asked to draw museum masterpieces in empty frames, draw happy faces on daycare babies, catch Dr. Dreadful as he escapes in his Robo-mobile by turning a trash heap into a playground, and finally catching the scoundrel.

The great thing about these books is they aren’t classwork, although teaching art is a wonderful thing that’s being taken away in many schools. It’s just the child and the book with no pressure to follow any drawing guidelines. The young superhero can erase and change the story at any point.

More good news: For the coming holidays LaRochelle will offer “These Elves Need Your Help!”

LaRochelle is the author of the Theodor Seuss Geisel award-winning “See the Cat” and its sequels as well as many other books for young readers.

And a shout-out

“February 22nd was a great day for America,” proclaims poet/author/baker Danny Klecko. He’s referring to the U.S. men’s hockey team’s winning gold and — equally important, he says — his poem “At Jimmy’s Corner” was his 10th published in the New York Times Metropolitan Diary feature, one of the oldest in that newspaper. In the poem Klecko weaves together boxer Frazier’s left hook, butterflies and gods. He believes he is one of the most-published poets in the Diary series. “I’m Danny Klecko, the hardest-working poet,” he says, “right up there with the hockey winners.”

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The big show astronomically in March is another total lunar eclipse, more popularly known as a blood moon, the last one we’ll have for a while. It’ll happen this coming Tuesday during a full moon, very early in the morning in the predawn hours. The moon will be fairly low in the western skies, on its way to setting.

About 3:50 a.m., you’ll start to see the moon’s upper left limb begin to darken as it heads into the Earth’s umbra shadow. By 5:11 a.m., the moon will be completely eclipsed, and that’s when it’ll take on a blood-red hue. At 6:02 a.m., the moon will start to come out of the Earth’s shadow, ending totality. Shortly after, morning twilight kicks in, and by 6:50 a.m., the show is over as the moon sets below the western horizon.

Lunar eclipses occur when the moon, orbiting the Earth, passes through the Earth’s shadow opposite the sun, known as the umbra. An eclipse can only occur during a full moon, when our planet lies between the sun and the moon and casts a shadow on the moon. An eclipse doesn’t occur every full moon because the moon’s orbit is tilted five degrees to the Earth’s orbit around the sun. Most of the time, the full moon misses the Earth’s shadow. It passes either above or below the umbra. But this Tuesday the moon will charge right through the umbra, and we’re in for a bloody treat. No one can predict for sure just how bloody it’ll be, but that’s part of the fun of a total lunar eclipse. The color depends on local atmospheric conditions. The ruddy appearance of Earth’s umbra is due to the strained sunlight that passes through Earth’s atmosphere and reaches the moon.

Total lunar eclipses are entirely safe to view, even with telescopes. Let’s hope for clear skies on the night of March 2-3, because this will be the last total lunar eclipse we’ll see around here until 2029.

March has a nice advantage for stargazers because overall it’s not as cold, and we can still enjoy the bright winter constellations, although this is the last month that they’re in their prime. The disadvantage for March stargazing fans is that our night hours continue to shrink as we head toward spring. To add to the fire, daylight saving time begins in many parts of the world on March 8, pushing back sunset times even more, so get out there and make the most of your time under the stars!

The two brightest planets available this month are Jupiter and Venus, although Venus only makes a brief appearance, especially in early March. As the month begins, look for Venus in the western sky a little after sunset during twilight. You can’t miss it, but don’t wait too long to look for it because it sets below the horizon toward the end of twilight.

Jupiter will also put on a really nice show, shining high and bright in the southern sky as evening begins in early March. It’ll be among the bright winter stars and constellations, but it’ll outshine them all. As March continues, Jupiter will move farther and farther to the southwest each evening.

The largest planet in our solar system is a terrific telescope target. You’ll easily see up to four of Jupiter’s largest moons with even a small telescope. They resemble tiny stars on either side of the giant planet. As they orbit the giant planet, on some nights you can’t see all four because one or more may be behind Jupiter or camouflaged in front of it. With a telescope, you should also see at least some of Jupiter’s darkest cloud bands.

The great winter constellations that Jupiter is part of this year totally dominate the south-southwest heavens in the early evenings. Just to the lower right of Jupiter, majestic Orion is the ringmaster of the winter heavens, surrounded by his posse of bright constellations. They include Taurus the Bull, Auriga the Charioteer, Orion’s hunting dogs Canis Major and Minor, and Gemini the Twins, where Jupiter resides this month. The three bright stars in a row that form Orion’s belt jump out at you. Below his belt are three fainter stars in a row that outline the hunter’s sword. The middle star is the famous Orion Nebula. It appears as a “fuzzy star” to the naked eye and is a superb telescope target, even if you have a small scope. You’re witnessing a giant cloud of excited hydrogen gas with stars forming gravitationally within it

(Mike Lynch)

Meanwhile in the early evening eastern sky, the first of the major spring constellations, Leo the Lion, is on the rise. Look for a distinct backward question mark of stars that outline the chest and head of the mighty beast. At the bottom of the question mark is Regulus, a moderately bright star that marks the heart of Leo. As March continues, Leo will be higher and higher in the sky at the start of the evening as the stars of Orion and his gang start lower and lower in the west. It appears as if the mighty lion is chasing Orion and his gang out of the night sky. This is due to the Earth’s orbit around the sun. The nighttime side of the Earth is gradually turning away from the direction of space where Orion and company are located and more toward the not-so-vibrant spring constellations. Enjoy the winter constellations while they are still visible.

Stay tuned because in early April, a comet may put on a good show. It’s formally known as C/2026 A1 (MAPS), or just Comet MAPS. This dirty cosmic snowball is on its way from the outer reaches of the solar system. In early April, shortly after it swings around the sun without disintegrating, it could briefly produce an impressive tail in the early morning sky. Fingers crossed!

Mike Lynch is an amateur astronomer and retired broadcast meteorologist for WCCO Radio in Minneapolis/St. Paul. He is the author of “Stars: a Month by Month Tour of the Constellations,” published by Adventure Publications and available at bookstores and adventurepublications.net. Mike is available for private star parties. You can contact him at mikewlynch@comcast.net.