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.

But the Trump administration has changed all that.

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

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