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Chan Lai Ly, right, has his mouth examined as part of a regular check-up related to his diabetes, by Honghue Duong, left, a physician's assistant, Friday, March 1, 2013 at International Community Health Services in Seattle. The clinic, which serves patients who speak more than 50 different languages, illustrates a challenge Washington state will face as it launches its new health insurance exchange as part of the federal Affordable Care Act. (AP Photo/Ted S. Warren)