Even with the implementation of the Affordable Care Act (ACA), states are still dealing with legislative barriers that limit healthcare access and patient choice. One such barrier to affordable healthcare is the existence of Certificate of Need (CON) laws. CON laws require any person or corporation that wishes to open a new healthcare facility or expand an existing facility to prove to an independent regulator that the community they wish to serve has a legitimate need for the expansion. These laws were originally intended to restrain healthcare spending, keep patient cost down, and coordinate expansion of new services and facility construction. However, a study performed by researchers at George Mason University concluded that CON laws have stifled patient choice, increased costs for patients, and detracted from the overall quality of healthcare. CON laws require hospitals to prove a legitimate need in the community in order to expand. Part of this process allows rival hospitals to testify against their competitor’s need to expand. This process allows hospitals to challenge the right to practice of any competitor that exists in the immediate area, effectively granting monopolistic powers to existing facilities. Larger facilities also typically have the funds to appeal challenges from existing hospitals; something that small, low-cost, or new facilities typically lack. While some states legislatures have taken action to repeal their CON laws, most recently South Carolina, such laws remain in place in 35 states and the District of Columbia. As states work to repeal these laws, healthcare farcicalities will be able to grow and expand to fit their needs without legislation limiting their size.