Texas's proposed Responsible AI Governance Act represents the next wave of comprehensive state AI legislation following Colorado and Utah's pioneering laws, with healthcare-specific provisions requiring transparency and risk management. The analysis reveals a regulatory landscape in flux as Trump's administration reverses Biden's AI oversight policies, leaving states to fill federal gaps with varying approaches from California's strict safety measures to Texas's innovation-friendly frameworks. Healthcare AI companies must develop agile compliance systems as the regulatory patchwork intensifies, particularly given potential federal preemption challenges that could reshape the entire state-level AI governance landscape.