Among lower-paid workers, union members are less likely than nonunion members to be enrolled in lower-end insurance plans imposing stricter limits on medical services and requiring doctors to see more patients, and spend less time with each.
imposing stricter limits on medical services and requiring doctors to see more patients, and spend
imposing stricter limits on medical services, requiring doctors to see more patients, and spending
that impose stricter limits on medical services, require doctors to see more patients, and spend
that impose stricter limits on medical services and require doctors to see more patients, spending
that impose stricter limits on medical services, requiring doctors to see more patients and spending
in choice d, you could legitimately make a case that 'spending' could modify the entire huge clause about what insurance plans do, and is therefore ambiguous. however, that's the OA, so you've learned that this problem is ok in the eyes of the gmat people. if there's a rule that can be articulated here, it's probably something along the lines of 'participial modifier applies to nearest action'.
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