It means that in order to be certified you have to use providers that in turn are certified or you will have to prove that you have all of your ducks in a row and that goes way beyond certain levels of redundancy, to the point that most companies just give up and use a cloud solution because they have enough headaches just getting their internal processes aligned with various certification requirements.
Medical, banking, insurance to name just a couple are heavily regulated and to suggest that it 'just means certain levels of redundancy' is a very uninformed take.
It is definitely not true that only big companies can do this. It is true that every regulation added adds to the power of big companies, which explains some regulation, but it is definitely possible to do a lot of things yourself and evidence that you've done it.
What's more likely for medical at least is that if you make your own app, that your customers will want to install it into their AWS/Azure instance, and so you have to support them.
