Under the Affordable Care Act, the federal government was thebackstop for making sure that health plans sold in every state hadenough in-network hospitals and physicians, includingspecialists, in their service area so that those buying theircoverage could receive in-network care and not have to pay for moreexpensive out-of-network treatments.

But the Trump administration has changed all that.

A report from the Pew Trusts says that, as of last month, it’snow up to the states to make sure that insurers have “networkprovider adequacy”—enough doctors and facilities to treat thepatients who sign up for their care.

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