Missouri continues to be plagued by job layoffs in the health care sector.  Though it is admittedly hard to track these job layoffs specifically without exact details (reports I have on these are based on press reports which are notoriously lacking in detail, for good reasons) -- and it could be that some of the job layoffs have not been reported at all publicly, this post will be based on what I have been able to find in the news over the period April 2013 to June 2014.

Over that period as this table shows about 919 jobs have been affected in Missouri (including layoffs, jobs eliminated that are vacant but will not be refilled, and jobs where hours will be reduced).  This number is indeed an estimate, especially since the latest large job reduction of 200-300 jobs to Mercy Health System over four states did not include an estimate of how many of those jobs would be cut in Missouri.  

However, as noted in the table, a recent independent survey by the Missouri Hospital Association also found a similar estimate of 1,000 job losses and a hiring freeze on 2,000 positions.

What is causing these job layoffs in Missouri?  It is perhaps tempting to blame these job layoffs on the lack of a Medicaid expansion in Missouri.  The story is complicated though.  Hospitals and health systems face many challenges.  Essentially it is a perfect storm: they face reductions in payment from Medicare and Medicaid due to payment changes by federal and state governments in a series of legislative changes; they face lingering effects of a slow recovery especially here in Missouri which faces slower economic growth than other neighboring states; they face effects of policies such as the "readmission" policy Medicare recently put in effect; they face private sector changes from remarkable delivery system changes.  All this means a squeeze on the health care system.  All this would be mitigated by a huge increase in revenues that would come from new enrollment from the Affordable Care Act (ACA), however in Missouri our state chose not expand Medicaid and fiercely resisted implementing the Marketplaces, so we have a very slow growth in the number of insured persons.  This means hospitals and health systems face very dark clouds, especially when they see cutbacks in "disproportionate share" (DSH) payments coming soon. What would be their response?  A logical response would be to make layoffs, I would expect, or that is my supposition.

To be fair and balanced, it must be said that job losses in the health care sector -- as presented here -- are just one side of the story, and there can be, and certainly is hiring going on as well.  In fact, for many months and years the health care sector has been the primary engine of job growth in the economy, as the data has shown.  For example, the excellent statistics compiled by Altarum has show that since the start of the recession the health sector has added 1.6 million jobs, and in the last 12 months added 218,000 jobs.  But this brief does show the rate of growth has slowed recently, which does show some concordance with this report.  Furthermore, a recent story by David Nicklaus, based on Bureau of Labor Statistics data, showed that in the last year health care employment fell by a remarkable 2,700 jobs in the St. Louis area, even while employment in the health care sector did not fall in the rest of the state nor in other metro areas in the state, nor in Illinois.  This also seems to comport with what is shown here, and is particularly troubling.

This trend is worrisome, to say the least, and is worth watching.  Especially if the state continues to resist expanding Medicaid and fights implementation of the ACA.