This past week two major health systems in Missouri announced job cutbacks: the BJC health system in St. Louis (announcing 160 layoffs for the first time in their history), and the University of Missouri Health Care system (announcing reduced hours for 35 employees, and that they will not fill 90 positions).  

If I have kept track correctly this is the fourth time in the last two months cutbacks, affecting jobs.  The PDF document posted above lists each job loss, with references.

Although it is always difficult to pinpoint exactly why health systems precisely make these personnel changes, the reasons they have cited for these changes is consistent, and the timing of all of these changes follows closely the end of the Missouri Legislative session.  Thus, it seems quite likely that these changes are at least partly if not greatly attributable to these health systems needing to adjust to cuts in funding that are anticipated (or that have already occurred) because of Medicaid and Medicare funding cuts at the federal and state levels, some of these due to legislative changes from the Affordable Care Act (ACA).  Of course, some of this is due to the fact that the state of Missouri chose not to expand Medicaid coverage, which would have increased funding to the health care sector (by about $2 billion per year eventually) to offset cuts in federal and state reimbursement; but without the Medicaid expansion the hospitals and other providers will just see the payment cuts.  Other cuts come in the form of payment cuts to Medicare, and from the "fiscal cliff" or sequester legislation.  Finally, some of changes may be resulting from delivery system changes that are occurring because of profound changes that are happening in the health care sector due to shifts to make the sector more efficient, quality driven, and effective.  

Whatever is the cause, and many analysts believe that in the short run at least most of these employment effects are most likely driven by government payment cuts (not offset in Missouri by the Medicaid expansion), the employment effects seen in this chart may be the beginning of a trend.  So I will try to keep track of this as we see reports of this in the press, as it is important to monitor this on a real-basis.  If anyone sees any errors in this reporting, or hears reports of employment changes I have not found, please feel free to send me a message.