Certificate Of Need statutes, are designed to hold down health costs by limiting unnecessary duplication, improve quality by regionalizing procedures like surgeries in which volume affects quality, and improve access to care by preventing competitors from “cream-skimming” paying patients, leaving some providers with disproportionately high uncompensated care loads. The dark money group, Americans For Prosperity headed by billionaire Charles Koch, is spending large sums of money on the Kentucky legislature in an attempt to repeal the state’s Certificate Of Need healthcare law.