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The AWS cloud controller will automatically set up an ALB for you if you configure a LoadBalancer service in Kubernetes. I've also done custom setups with AWS NLBs.
> Does IPv6 address any of these issues?
It could address some issues- you could conceivably create a CNI plugin which allocates an externally addressable IP to your Pods. Although you would probably still want a load balancer for custom routing rules and the improved reliability over DNS round robin.