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The change affects 28 states that rely on the federal health insurance exchange and 11 states that operate exchanges in some sort of partnership with the federal government. (Photo: Shutterstock)

Under the Affordable Care Act, the federal government was the backstop for making sure that health plans sold in every state had enough in-network hospitals and physicians, including specialists, in their service area so that those buying their coverage could receive in-network care and not have to pay for more expensive out-of-network treatments.

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