As healthcare gets more costly, and hospitals close in rural regions, states have moved to allow controversial, anti-competitive mergers of existing healthcare systems. Virginia is one of 18 states that allows such mergers, and a bipartisan effort that sailed through the 2025 session could see those mergers become more frequent. Virginia has a law that allows competing health systems to merge with the approval of the legislature. The only such system created in Virginia is Ballad Health, a network of 20 hospitals in the state's southwestern corner.