Compared to a decade ago — when employers readily paid for costly preventive, care-focused insurance plans to keep employees on-board and happy — oh, how the health care spectrum has changed. Today, federal legislation mandating that individuals purchase insurance or pay a fine has pricked the hackles of Washington and 25 other states, which have challenged its constitutionality with the U.S. Supreme Court. And recent three-visit emergency room limits for Medicaid and Medicare recipients have panicked low-income households across the country. On top of this, doctors are refining patient lists and practices are closing or merging. In the South Sound, the melding of Swedish and Providence hospitals, and mass layoffs at other major medical bases, have put health care workers on edge.