The limited participation of physicians, specialists andhospitals in health plans offered through the Patient Protection and Affordable CareAct individual insurance marketplace has undoubtedlybeen a sore spot for the landmark health law.

Consumers and even some providers have complained that the “narrow networks” offeredby PPACA plans make it hard for many consumers,particularly those in rural areas, to find in-network medicalservices.

But whether it’s because insurers don’t want to offer broadnetworks or because doctors aren’t interested in taking PPACAhealth insurance isn’t always clear.

But a new study suggests that, while those with PPACA plansoften have limited choices, thequality of the care they have access to is not bad, on average.

Specifically, a recent analysis by the Robert Wood Johnson Foundation found that ofthe 156 hospitals that landed in U.S. News and World Report’sannual “best hospital” list, more than 95 percent of them took atleast one PPACA plan.

But, and there’s a big but, many of those same hospitals areaccepting fewer PPACA plans than before. And the declines wereparticularly pronounced in metropolitan areas.

“The percent of hospitals in-network with only one marketplaceplan increased from 7 percent in 2015 to 20 percent in 2016,” wroteDr. Katherine Hempstead, the report’s author.“Customers loyal to a particular hospital can in most cases stillfind a marketplace plan that includes it, but choices are narrowedin 2016 relative to 2015; plans with these hospitals may be moreexpensive.”