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  * Hospitals across the nation are being swept up in thebiggest wave of mergers since the 1990s, a development that iscreating giant hospital systems that could one day dominateAmerican health care and drive up costs. Hospital executives saythey have little choice but to combine. Many hospitals arestruggling with lower payments from the federal government anddeclining patient admissions. They are also being confrontedwith changes in how they are paid under President Obama'ssignature Affordable Care Act and by private insurers. ()