Two major health care hospitals in Missouri have announced manpower reductions and other cuts in this field may be coming. University of Missouri Health Care in Columbia and BJC in St. Louis have announced staff reductions.

Generally speaking, the job losses are due to cuts in federal health care payments from Medicare and the failure of Missouri lawmakers to expand Medicaid eligibility.

The 2010 Affordable Care Act (Obamacare) is a factor. It includes cuts to Medicare and reductions to the program that provides support to hospitals that care for poorer populations.

For hospitals, the full impact of Obamacare provisions are not known, but the act is going to be a challenge for all hospitals, and some may not be able to continue operations, according to reports.

There is some hope that Missouri legislators will tackle Medicaid reforms in the 2014 session. Legislation pushed by Gov. Jay Nixon, a Democrat, was rejected by the Republican-controlled House and Senate in the 2013 session. Legislative leaders have established a special panel to study Medicaid reform and draft legislation for the 2014 session. The rejected Medicaid legislation this year would have expanded eligibility requirements to include more people and would have meant millions of dollars to the state from the federal government.

For hospitals, and all health care providers, this is an era of uncertainty.