State Law and Private Enforcement: The 2027 Compliance Calendar for Health and Life Sciences Boards

In November 2024, I expected federal oversight to recede and state and private enforcement to rise. It did, and the result is that state legislatures, state attorneys general, courts, and private plaintiffs now write much of the law that health and life sciences boards must follow in 2027.

In Brief

The Problem. States enacted 109 artificial intelligence (AI) laws in the first half of 2026 alone, several aimed at health insurers and clinical care, while private plaintiffs and state attorneys general test AI practices in court. States also diverge sharply on reproductive and gender-affirming care, controlled substances, health equity, and health data privacy.

Why It Persists. A federal effort to preempt state AI laws invites boards to wait. An executive order cannot overturn state law, and the litigation that might do so is uncertain and outside the organization's control.

What Boards Should Do. Ask management for one document: a calendar of every state obligation that applies to the organization's AI uses and sensitive services, with a named owner for each, and review it until the dates have passed or a court or Congress has changed the law.

Fewer Federal Rules Did Not Mean Fewer Rules

In November 2024, I drafted an assessment for boards and chief executives of 14 areas where I expected federal health policy to shift. One of them was a decrease in federal oversight with state and private enforcement on the rise. I wrote that it would create a fragmented environment, with differing state laws, more litigation, and higher compliance cost. That forecast was right in direction. What I missed was the federal response: a direct challenge to state AI laws, which is now the central open question in AI policy.

My argument in this briefing is that, for 2027, the binding constraints on a health or life sciences organization are the state compliance calendar and private litigation, not the federal rulebook. The board's task is not to predict which state laws survive preemption. It is to make sure the organization complies with the laws in force, knows the dates, and can change course quickly if a court or Congress acts. This article covers the areas of my 2024 assessment where states, courts, and private plaintiffs now set the rules: state and private enforcement, state health data privacy, reproductive and gender-affirming care, controlled substances, and health equity and access. Our companion briefing, Federal AI and Health Policy: What Boards Should Know in October 2026, covers the federal instruments.

State Law Is the Law in Force

As of July 1, 2026, states had enacted 109 AI laws that year, across 29 states (Brennen, 2026). At least six of those laws restrict how health insurers use AI, and both Republican-led and Democratic-led states passed them (Brennen, 2026). The risks I listed in 2024 have arrived as described: inconsistent standards across states, higher compliance cost, and more exposure to state and private legal action. So has the opportunity I listed. An organization with a strong compliance program stands out when its peers are uncertain, and engagement with state regulators can shape how rules are written.

For a board, the question is practical. Which state laws reach our AI uses, from what date, and who in management owns compliance with each? The sections that follow set out the laws most relevant to health and life sciences organizations.

Colorado: S.B. 26-189 Replaces the 2024 AI Act

Governor Jared Polis signed S.B. 26-189 on May 14, 2026. It replaces the 2024 Colorado AI Act, which will not take effect, and the new law takes effect on January 1, 2027 (Ropes and Gray, 2026). The replacement drops the earlier duties to run risk management programs and annual impact assessments. In their place, deployers must give consumers clear notice before covered technology materially influences a consequential decision. After an adverse outcome, they must explain the decision and the technology's role within 30 days. Developers and deployers must keep compliance records for at least three years (Ropes and Gray, 2026).

Entities covered by the Health Insurance Portability and Accountability Act (HIPAA) are largely exempt, with three limits. The exemption does not cover employment decisions. Covered entities must give patients a general notice of how they use advanced technologies. Providers must operate from a Colorado location to qualify (Ropes and Gray, 2026). Where covered technology determines eligibility for financial assistance, the organization must disclose the technology's role and offer correction and human review. The Attorney General has exclusive enforcement authority, with a 60-day cure period for curable violations. The law creates no private right of action, and it excludes medical devices and certain research regulated by the Food and Drug Administration (FDA) (Ropes and Gray, 2026).

Colorado also shows how quickly the ground can move. Before the replacement, on April 27, 2026, a federal magistrate judge entered an order, requested by both parties, delaying enforcement of the 2024 Act in a lawsuit brought by xAI, which the federal government had joined the week before (Goodland, 2026). The state then replaced the law itself. A board that had waited for the court would have been planning for a statute that no longer exists.

California: Clinical AI Rules From January 1, 2027

Governor Gavin Newsom signed three health care AI bills and vetoed two (Montano and Tran, 2026). AB 1979 takes effect on January 1, 2027. Health facilities, clinics, and physician offices must take reasonable steps to ensure that a licensed provider exercises independent judgment when AI informs care, and AI may not perform functions reserved for licensed professionals (Montano and Tran, 2026).

SB 503 also takes effect on January 1, 2027, and addresses bias in clinical decision support systems. Developers must reduce the risk of biased results and give deployers documentation on training data, testing, intended use, risks, and monitoring. Deploying facilities must monitor the tools and act on problems (Montano and Tran, 2026). SB 947 takes effect on July 1, 2027, and bars employers from disciplining or dismissing a worker on the output of an automated decision system alone. The Governor vetoed AB 2575, on clinicians who override AI, and SB 903, on AI in psychotherapy (Montano and Tran, 2026). An earlier law, AB 489, has applied since October 1, 2025, and bars AI systems from implying that a licensed professional is providing care (Fenwick, 2025).

Texas: Disclosure, Practitioner Review, and Data Location

Texas has two laws in force. SB 1188, effective September 1, 2025, lets practitioners use AI for diagnosis if they review all AI-generated records and disclose the use to the patient. It also requires electronic health records to be stored in the United States, including records held by cloud providers (Akin Gump, 2025). HB 149, the Texas Responsible Artificial Intelligence Governance Act, took effect on January 1, 2026, and requires providers to disclose AI used in patient care (Akin Gump, 2025). The data location requirement is easy to miss. An AI vendor that processes records offshore can put a Texas provider out of compliance without any change in clinical practice.

Illinois and Washington: Limits on Specific Uses

Illinois HB 1806 took effect on August 4, 2025. It bars AI from making independent therapeutic decisions or communicating therapeutically with clients, and it bars AI-generated treatment plans without review by a licensed professional. Penalties reach USD 10,000 per violation (Fenwick, 2025).

Washington SB 5395 was signed on March 23, 2026, and most of it took effect in June 2026. AI may approve a prior authorization request but may not deny one without review by a health professional (Casolo, 2026). Determinations may not rely primarily on group datasets, and the insurance commissioner may audit these practices (Casolo, 2026). Payer boards in other states should expect similar rules.

Private Enforcement: Plaintiffs and Attorneys General

In 2024, I warned that private actions would add financial penalties and reputational harm. The AI coverage cases show what that looks like. In Estate of Lokken v. UnitedHealth Group, a class action filed in November 2023 on behalf of Medicare Advantage enrollees, plaintiffs allege that the insurer used a predictive tool, nH Predict, in place of clinical judgment to deny post-acute care; the company disputes the claims and describes the tool as a care-support tool (Greenberg et al., 2026). On March 9, 2026, a magistrate judge ordered discovery that includes the insurer's internal AI review board, its members' identities, and compensation data for medical directors, with some categories reaching back to January 2017 (Greenberg et al., 2026). In Barrows v. Humana, a similar case in the Western District of Kentucky, a motion for class certification is due on November 5, 2026 (Georgetown University Health Care Litigation Tracker, n.d.).

State attorneys general use consumer protection law as well as AI statutes. On September 18, 2024, the Texas Attorney General announced a settlement with Pieces Technologies, whose generative AI product, used by at least four major Texas hospitals, summarized patients' conditions and treatment for hospital staff. The company had advertised a "severe hallucination rate" of "<1 per 100,000," metrics the investigation found were likely inaccurate; it agreed to disclose its products' accuracy and to make sure hospital staff understand how far to rely on them (Office of the Attorney General of Texas, 2024). The case shows that a vendor's marketing claims can become the deploying organization's problem.

The lesson for directors is not that these allegations are proven; they are contested. It is that governance records, including the minutes and materials of AI committees, are discoverable. The 2024 mitigation steps still apply, with the board's role made explicit: oversee a compliance program that spans federal, state, and local requirements; ask legal counsel for a standing assessment of conflicts between state and federal law; support engagement with state regulators and comment on proposed rules; and confirm that employees are trained on state-specific requirements.

State Health Data Privacy Beyond HIPAA

I expected a patchwork of state privacy laws, and it has grown. Washington's My Health My Data Act, in effect since March 2024, regulates consumer health data collected outside HIPAA, requires consent before collecting or sharing it, and allows individuals to sue under the state consumer protection statute (Nahra et al., 2025). The first lawsuit under the Act, filed on February 10, 2025, alleges that an advertising software kit embedded in third-party apps collected location data that could reveal health information without notice or consent (Nahra et al., 2025).

At the federal level, one HIPAA protection fell. On June 18, 2025, a federal court in Texas vacated the 2024 HIPAA Privacy Rule to Support Reproductive Health Care Privacy nationwide (Hartsfield and Bourque, 2025). For reproductive health information, state law now does more of the work. Add the Texas data location rule and the Colorado patient notice, and a multistate organization faces privacy duties that differ by state for the same data.

AI raises the stakes, because AI tools often collect, combine, and move exactly this kind of data. The board should ask management for a map of where sensitive health data flows through AI tools and vendors, which state laws govern each flow, and whether vendor contracts carry the protection clauses that the strictest applicable law requires. Clear communication with patients about data practices remains, as I wrote in 2024, the foundation of their trust.

Reproductive Health and Gender-Affirming Care: A State-by-State Map

I expected restrictions on access to reproductive health services and gender-affirming care, with organizations facing differing legal regimes, public scrutiny, and ethical questions. That forecast proved right, and the decisive instruments came from courts, Congress, and federal rulemaking that leaves room for state choice. On June 18, 2025, the Supreme Court upheld Tennessee's prohibition on certain gender-affirming treatments for minors in United States v. Skrmetti, applying rational basis review (American Bar Association, 2025). The Centers for Medicare and Medicaid Services (CMS) published a final rule on August 13, 2026, effective October 13, 2026, that ends federal Medicaid funding for these procedures for people under 18 and federal Children's Health Insurance Program funding for people under 19, with a transition of up to six months for minors already receiving hormone therapy and with states free to fund care separately (Crowell and Moring, 2026). A companion proposal that would bar hospitals participating in Medicare and Medicaid from performing these procedures on minors remains in proposed form (Crowell and Moring, 2026).

For reproductive health, the One Big Beautiful Bill Act barred federal Medicaid payments to certain prohibited entities, including Planned Parenthood, for one year (Association of State and Territorial Health Officials [ASTHO], 2025), and the vacatur of the reproductive health privacy rule, described above, returns much of the protection of those records to state law.

These are contested public questions, and boards hold a range of views on them. The governance question does not depend on those views. An organization that provides or supplies these services operates under rules that now differ by state and by payer, and that may change again. The 2024 mitigation steps remain sound and belong at board level: a review of which products and services are exposed, how significant they are financially, and their regulatory status; a compliance strategy for differing state laws and possible federal action; a check that policies align with legal obligations and the organization's ethical commitments; a plan for transparent communication; and a crisis management plan. Where AI tools handle scheduling, triage, or records for these services, the board should ask how the data is protected under each state's law.

Controlled Substances: Federal Rescheduling Moves Toward the States

I expected a possible reversal of the effort to move marijuana out of Schedule I. That forecast was wrong. Executive Order 14370 of December 2025 directed the Attorney General to complete the Schedule III rulemaking as quickly as federal law permits (Berman et al., 2026). A Drug Enforcement Administration (DEA) final rule issued on April 22, 2026, moved to Schedule III marijuana that is either in an FDA-approved drug product or subject to a state license for medical manufacturing, distribution, or dispensing, and created an expedited federal registration pathway for state-licensed entities (Berman et al., 2026). Products outside those medical categories remain in Schedule I. A hearing on broader rescheduling ran from June 29 to July 15, 2026, and a recommended decision is pending (Berman et al., 2026).

The federal rule now relies on state licensing, which brings the federal and state systems closer for medical products without making them the same. Even if broader rescheduling is finalized, marijuana will remain a federally controlled substance (Berman et al., 2026). The opportunities I listed in 2024, new markets and more research into therapeutic uses, are more open than they were. The risks I listed, legal ambiguity and divergence between state and federal law, are narrower but remain.

A board weighing this field should ask management whether the compliance framework covers federal registration and recordkeeping duties, state licensing, and international rules; how the strategy fits the organization's risk tolerance; whether the organization is engaged in the pending rulemaking; and whether research programs are designed for the schedule that will apply when they reach the market.

Health Equity and Access: Where Federal and State Duties Meet

I expected policy changes that would reduce coverage and weaken protections for vulnerable populations, with higher uncompensated care for providers and reputational risk for organizations seen as neglecting equity. Several of those changes are now law. The One Big Beautiful Bill Act ends Medicaid eligibility for refugees, asylees, and humanitarian parolees from October 1, 2026, and requires states to implement Medicaid work requirements by December 31, 2026 (ASTHO, 2025). The Congressional Budget Office estimated that the law will increase the number of uninsured people by 10 million in 2034 (Center for Children and Families, 2025). In July 2026, the Department of Homeland Security finalized a rule that rescinds the 2022 public charge regulations, including their list of exemptions, and cites Medicaid and the Children's Health Insurance Program as examples of means-tested benefits (American Hospital Association, 2026).

Anti-discrimination rules intersect directly with AI. The 2024 rule under Section 1557 of the Affordable Care Act required covered entities to review patient care decision support tools for potential bias by May 1, 2025; as of April 2025, commentators noted that the extent of federal enforcement of the rule was unclear (Pressly and Leeds, 2025). California's SB 503, described above, now requires bias mitigation and monitoring for clinical decision support from January 1, 2027, and the Joint Commission's voluntary AI certification includes risk and bias reduction among its five areas (Guerra, 2026). Where federal enforcement is uncertain, state law and accreditation standards set the expectation.

The 2024 mitigation steps hold, framed for the board: embed equity in mission and strategy; require data on patient demographics, outcomes, and disparities, including the performance of AI tools across populations; ask management how it engages with communities and develops programs that address barriers to care; and oversee workforce and training commitments. When management deploys AI to manage eligibility, outreach, or utilization in this environment, the board should ask who checks the results for disparate effect and how often.

The Federal Preemption Challenge

Executive Order 14365, signed on December 11, 2025, directs a federal challenge to state AI laws the administration considers burdensome (BakerHostetler, 2026). It directed the Attorney General to create a Department of Justice (DOJ) AI Litigation Task Force "whose sole responsibility shall be to challenge State AI laws" inconsistent with the order's policy, and it makes states with AI laws the administration identifies as onerous ineligible, to the extent federal law allows, for non-deployment funds under the federal broadband program (Exec. Order No. 14365, 2025). The order also calls for a federal legislative framework, and specifies that the proposal should not preempt otherwise lawful state laws on child safety, AI compute and data center infrastructure, or state government procurement and use of AI (Exec. Order No. 14365, 2025). The Attorney General established the task force by memorandum on January 9, 2026 (BakerHostetler, 2026).

Colorado is the first test. xAI sued the state over its 2024 Act on April 9, 2026, and DOJ moved to intervene on April 24, 2026, on equal protection grounds (Jenner and Block, 2026). Separately, the Federal Trade Commission (FTC) proposed a policy statement in 2026 asserting that conflicting state AI laws are impliedly preempted. It cited Colorado, and comments closed on July 31, 2026 (Ballard Spahr, 2026). An executive order does not itself overturn state law; only Congress or the courts can do that (Paul Hastings, 2025).

The Strongest Objection: Wait for Preemption

A director could argue that compliance work on state AI laws is premature. The federal government is litigating against them, the FTC has asserted preemption, and Colorado has already rewritten its law once. Building notices, explanations, and records for laws that may not survive looks like waste, and a board has a duty to use resources well.

I disagree, for three reasons. First, no court and no act of Congress has displaced the health care AI laws described here, and state laws remain enforceable until one does (Paul Hastings, 2025). Second, the federal challenge has a defined scope: even the order's proposed federal framework would leave several categories of state law in place (Exec. Order No. 14365, 2025), and much of what the states require, such as practitioner review, patient disclosure, and records, is good practice that a board would want regardless. Third, Delaware courts treat oversight of mission-critical regulatory compliance as a core board duty (Marchand v. Barnhill, 2019), and in September 2025 the Court of Chancery allowed such a claim to proceed against directors of a drug maker whose board "had no committee charged with overseeing" FDA compliance (Giuliano v. Grenfell-Gardner, 2025). For a health system or payer, clinical and coverage AI now falls under specific state statutes. A decision to wait for litigation the organization does not control is a decision the board would have to defend.

The prudent course is to comply with state law as written, track the litigation, and keep a plan that updates if the law changes. Courts may narrow some state laws, and Congress may legislate. The organization should be able to adjust within weeks, not start from nothing.

What the Board Should Do

I suggest boards ask management for one document: a calendar of every state AI obligation that applies to the organization, with the owner of each, and a companion list of the state rules that govern the organization's sensitive services and health data. The key AI dates are these:

• In force since 2025: Illinois HB 1806 (August 4, 2025), Texas SB 1188 (September 1, 2025), and California AB 489 (October 1, 2025).
• In force since 2026: Texas HB 149 (January 1, 2026) and Washington SB 5395 (June 2026).
• January 1, 2027: Colorado S.B. 26-189, California AB 1979, and California SB 503.
• July 1, 2027: California SB 947.

My 2024 draft closed with a call for continuous learning, a focus on stakeholders, and ethical leadership. Those still apply, in specific form. Directors need regular briefings on state law as it changes. The board should hear how AI decisions affect patients, members, and employees in each state. And the organization should hold its standards on privacy, bias, and human review even where a state does not yet require them, because the next state, court, or plaintiff may.

For the Board

• In which states do our AI tools affect patients, members, or employees, and which state AI laws apply to each tool?
• Who is the named executive accountable for each obligation on the state AI compliance calendar?
• Are our patient notices and adverse-decision explanations ready for the January 1, 2027 effective dates?
• Do our vendor contracts require the documentation that California SB 503 and Colorado S.B. 26-189 expect developers to provide, and do they keep records where Texas requires?
• Would our AI committee's minutes and materials show reasonable oversight if a plaintiff obtained them in discovery?
• If a court or Congress preempts a state law, how quickly would management change our approach, and who would tell the board?

Follow these state developments each month in Oversight Rounds, from Avancer.

References

Akin Gump. (2025, June 27). Texas enacts a pair of AI governance laws, HB 149 and SB 1188. https://www.akingump.com/en/insights/ai-law-and-regulation-tracker/texas-enacts-a-pair-of-ai-governance-laws-hb-149-and-sb-1188

American Bar Association. (2025, June 18). Supreme Court upholds Tennessee ban on gender affirming care for minors. https://www.americanbar.org/groups/health_law/news/2025/6/supreme-court-upholds-tennessee-ban-gender-affirming-care-minors/

American Hospital Association. (2026, July 16). DHS finalizes changes to public charge rule. AHA News. https://www.aha.org/news/headline/2026-07-16-dhs-finalizes-changes-public-charge-rule

Association of State and Territorial Health Officials. (2025, July 9). One Big Beautiful Bill law summary. https://astho.org/advocacy/federal-government-affairs/leg-alerts/2025/one-big-beautiful-bill-law-summary

BakerHostetler. (2026, January 20). Navigating the emerging federal-state AI showdown: DOJ establishes AI Litigation Task Force. https://www.bakerlaw.com/insights/navigating-the-emerging-federal-state-ai-showdown-doj-establishes-ai-litigation-task-force/

Ballard Spahr. (2026, July 14). FTC takes aim at AI accuracy. Consumer Finance Monitor. https://www.consumerfinancemonitor.com/2026/07/14/ftc-takes-aim-at-ai-accuracy/

Berman, J. R., Buenafe, M. L., and Chesnick, K. (2026, September 24). High time for a change? Post-DEA hearing, broader marijuana rescheduling questions remain. Morgan Lewis. https://www.morganlewis.com/pubs/2026/09/high-time-for-a-change-post-dea-hearing-broader-marijuana-rescheduling-questions-remain

Brennen, S. B. (2026, July 6). Where state AI legislation stands half way into 2026. Tech Policy Press. https://techpolicy.press/where-state-ai-legislation-stands-half-way-into-2026

Casolo, E. (2026, April 10). 5 states reforming prior authorization in 2026. Becker's Payer Issues. https://www.beckerspayer.com/policy-updates/5-states-reforming-prior-authorization-in-2026/

Center for Children and Families. (2025, August 14). New CBO health coverage estimates of budget reconciliation law. Georgetown University McCourt School of Public Policy. https://ccf.georgetown.edu/2025/08/14/new-cbo-health-coverage-estimates-of-budget-reconciliation-law/

Crowell and Moring. (2026, August 19). CMS's final rule bans federal Medicaid funding for youth gender-affirming care. https://www.crowell.com/en/insights/client-alerts/cmss-final-rule-bans-federal-medicaid-funding-for-youth-gender-affirming-care

Exec. Order No. 14365. (2025, December 11). Ensuring a national policy framework for artificial intelligence. Daily Compilation of Presidential Documents, DCPD-202501186. https://www.govinfo.gov/content/pkg/DCPD-202501186/html/DCPD-202501186.htm

Fenwick. (2025, September 29). The new regulatory reality for AI in healthcare: How certain states are reshaping compliance. https://www.fenwick.com/insights/publications/the-new-regulatory-reality-for-ai-in-healthcare-how-certain-states-are-reshaping-compliance

Georgetown University Health Care Litigation Tracker. (n.d.). Artificial intelligence in Medicare Advantage. Retrieved October 21, 2026, from https://litigationtracker.law.georgetown.edu/issues/artificial-intelligence-medicare-advantage

Giuliano v. Grenfell-Gardner, C.A. No. 2021-0452-KSJM (Del. Ch. Sept. 2, 2025) (mem. op.). https://courts.delaware.gov/Opinions/Download.aspx?id=384430

Goodland, M. (2026, April 28). Colorado's unprecedented AI law can't be enforced yet, judge rules. Denver Gazette. https://www.denvergazette.com/2026/04/28/colorados-unprecedented-ai-law-cant-be-enforced-yet-judge-rules/

Greenberg, D. S., Heilman, K., and Shlaferman, H. Z. (2026, April 23). Federal court orders broad discovery against UHC in AI coverage denial lawsuit. ArentFox Schiff. https://www.afslaw.com/perspectives/alerts/federal-court-orders-broad-discovery-against-uhc-ai-coverage-denial-lawsuit

Guerra, A. (2026, June 1). Joint Commission launches AI certification as adoption outpaces oversight. healthsystemCIO. https://healthsystemcio.com/2026/06/01/joint-commission-ai-certification/

Hartsfield, S. B., and Bourque, D. (2025, June 20). HIPAA's reproductive health rule is vacated nationally. Holland and Knight. https://www.hklaw.com/en/insights/publications/2025/06/hipaas-reproductive-health-rule-is-vacated-nationally

Jenner and Block. (2026, April 29). DOJ joins xAI in lawsuit challenging Colorado AI Act. https://www.jenner.com/en/news-insights/client-alerts/doj-joins-xai-in-lawsuit-challenging-colorado-ai-act

Marchand v. Barnhill, 212 A.3d 805 (Del. 2019). https://www.leagle.com/decision/indeco20190619048

Montano, M., and Tran, S. (2026, October 8). Newsom approves 3 health care AI bills, vetoes 2. California Health Care Foundation. https://chcf.org/blog/2026/10/08/newsom-approves-3-health-care-ai-bills-vetoes-2

Nahra, K. J., Jessani, A. A., and Olivero, A. (2025, February 20). First lawsuit filed under Washington's My Health My Data Act. WilmerHale. https://www.wilmerhale.com/en/insights/blogs/wilmerhale-privacy-and-cybersecurity-law/20250220-first-lawsuit-filed-under-washingtons-my-health-my-data-act

Office of the Attorney General of Texas. (2024, September 18). Attorney General Ken Paxton reaches settlement in first-of-its-kind healthcare generative AI investigation [Press release]. https://texasattorneygeneral.gov/news/releases/attorney-general-ken-paxton-reaches-settlement-first-its-kind-healthcare-generative-ai-investigation

Paul Hastings. (2025, December 16). President Trump signs executive order challenging state AI laws. https://www.paulhastings.com/insights/client-alerts/president-trump-signs-executive-order-challenging-state-ai-laws

Pressly, D. F., and Leeds, E. I. (2025, April 17). Section 1557: Deadlines approach, but long-term prognosis unclear under executive orders. Ballard Spahr. https://www.ballardspahr.com/insights/alerts-and-articles/2025/04/section-1557-deadlines-approach-but-long-term-prognosis-unclear-under-executive-orders

Ropes and Gray. (2026, May 19). Colorado scales back AI law, with targeted implications for health care. https://www.ropesgray.com/en/insights/alerts/2026/05/colorado-scales-back-ai-law-with-targeted-implications-for-health-care