Cuts in Health
Care May Undermine Role in Labor Market
Published: August 17, 2011 - New York Times
Even during months of stubborn unemployment, the health care industry has
provided a solid underpinning, reliably adding jobs in an otherwise dismal
environment.
For example, hospitals, nursing
homes and the like added about 430,000 jobs during the recession,
as the country shed 7.5 million jobs. With the latest government
reports showing a meager overall gain of 117,000 jobs in July, health care
remained a significant contributor with an additional 31,000 jobs for the month,
a tad higher than an average monthly addition of 25,000 health jobs in the last
year. Hospitals, which had a slight decline in June, added 14,000 jobs in July.
While few experts can predict how the stock marketfs gyrations and government
cutbacks this month will affect the health industry, several health industry
analysts warn that the sector is showing signs of economic sluggishness that has
long kept other business sectors beleaguered.
The situation has led many in the health industry to caution that it cannot
be relied upon to keep hiring workers. gItfs not realistic to believe that wefre
going to continue to generate job growth when youfre speaking about Medicare
and Medicaid
reductions in the hundreds of billions of dollars over the next few years,h said
Daniel Sisto, president of the Healthcare Association of New York, which
represents the statefs hospitals and health systems.
Companies that rely on government spending have been bracing for deeper
reductions, and President Obama recently alluded to another round of
belt-tightening from one of the industryfs bedrock payers — Medicare.
Signs of a gloomier outlook have been surfacing in various spots, from a
slowing in new construction plans to falling share prices of nursing home
companies to announced layoffs among hospital support staff.gNobody is sure what
will happen,h said Alan M. Garber, a physician and health policy expert at
Stanford. The cuts in government programs like Medicare and Medicaid, and
pressure to reduce costs, are thwarting health care employers in trying to meet
the rising demand for their services.
gThe health care industry is facing greater uncertainty than in any time in
memory,h Dr. Garber said.
Yet even though economists and other experts still predict increasing demand
for health care as the population ages, with an accompanying demand for job
growth, health care officials and executives cite a daunting cascade of recent
events as reasons to reassess any expansions.
They point to Congressf intent to reduce spending, economically depressed
states struggling to deal with a rash of cuts in Medicaid programs and the
continued uncertainty of financial costs that will be imposed by the federal
health care law, including contradictory lower court decisions about the
constitutionality of various provisions.
A
survey by the Conference Board, a business research group, found that
help-wanted ads for health care providers and technicians fell by 61,200
listings in July.
In Florida, for example, health care led the state in job gains during the
recession — it was the only industry that did not lose jobs during that time.
But since September of last year, the leisure and hospitality industry has been
adding more jobs, according to a state economist.
The Palo Alto Medical Foundation, a large physician group in Northern
California that employs 5,500 people, including 1,000 doctors, says it has no
plans to add many more people in the near future. gReally our focus these days
is to do more with the assets we have,h said Cecilia Montalvo, the vice
president for strategic development for the medical group.
Hospitals also appear to be slowing the pace of building, as projects begun
before the recession started are now being completed. The volume of tax-exempt
debt for hospitals in the first half of the year has fallen by nearly half from
a year ago, said David Johnson, a managing director at BMO Capital Markets.
gWefre overinvested in hospitals and hospital beds,h he said.
The University of Michigan Health System, for example, is adding some 560
jobs as a result of new childrenfs and womenfs hospitals it plans to open soon
and an expansion of its emergency department. But Doug Strong, who heads the
systemfs hospitals, said his overall goal is to shrink his work force in future
years as he tries to make the system more efficient.
While he expects the demand for health care services to rise, he believes he
needs to deliver that care with fewer people at less cost. gI think that is what
the nation is asking of all of us,h he said.
The impact of state cuts in Medicaid are already being felt in doctorfs
offices, hospitals, nursing homes and home health agencies around the country.
Hospitals experienced reductions in Medicaid reimbursement in 37 states for next
yearfs budgets, according to Lisa Goldstein, an analyst at Moodyfs, who predicts
further cuts.
At the Elliot Health System in Manchester, N.H., the seemingly abrupt
decision by state lawmakers to sharply reduce hospital reimbursements led the
hospital to recently lay off 182 people.
gFor the last 10 years, wefve been pretty stable and wefve been able to
grow,h said Elliotfs chief executive, Doug Dean. But faced with the loss of
millions of dollars in Medicaid revenue that would wreak havoc on the coming
hospital budget, Mr. Dean said he had no choice but to cut jobs. gIt was simply
because of the economics of Medicaid,h he said. Elliot is among a group of
hospitals filing a lawsuit to stop the cuts.
Health care employers are also confronting cuts to the federal Medicare
program. In July, nursing home operators learned their reimbursements would be
cut
by 11 percent in October, and hospitals expect further reductions in what
they are paid under the new health care law as well as in future efforts to
reduce the federal deficit.
Still, these continue to be boom times in many corners of the industry.
Partners in Care, a New York nonprofit provider of home health care services, is
hiring so many home health aides that it recently opened a second training
center to handle the flood of new employees.
Its staff of aides has grown from close to 5,800 in 2006 to about 9,200
today. In June, the group, which is part of the Visiting Nurse Service of New
York, hired 374 new people, the second-biggest month in its history.
Jay Conolly, vice president of human resources at Partners in Care, said his
group is benefiting, not just from the growing elderly population, but also from
the consolidation of nursing homes and hospitals in the New York area and a
heightened interest in low-cost alternatives to inpatient care. The Bureau of
Labor Statistics has predicted that jobs will grow
faster in the home health care area than in any other section of the health care
industry.
gTherefs never been enough home health aides, and there never will be,h Mr.
Conolly said.
And many expect that when the economy finally does rebound, hiring will,
again, take off, especially when more people are expected to be insured under
the federal health care law. Geraldine Bednash, chief executive of the American
Association of Colleges of Nursing, expects there is pent-up demand for their
services, especially for nurse
practitioners and nurse midwives,
who would work in primary care. gWe are going to see this huge onslaught of need
for nurses,h she said. gSo wefre in a blip, thatfs all.h
There are some who wonder whether the country should continue to rely on
health care as a stalwart supplier of new jobs. If spending on health care
continues at its current pace, it will choke out other vital sectors and end up
hurting the rest of the economy, said Joshua Shapiro, chief United States
economist at MFR Inc. gI think the path that wefre on now is clearly
unsustainable,h he said.
Tom Torok contributed reporting.