St. John's Hospital in Springfield has announced it will lay off 43 managers over the next few months.
President and Chief Executive Charles Lucore says cutting management costs will help preserve the quality of patient care.
The (Springfield) State Journal-Register quotes him as saying the decision was driven by financial pressures from the Affordable Care Act as well as the lower reimbursements.
The 43 positions represent about 1 percent of the hospital's workforce.
St. John's says non-management positions are not affected and the hospital continues to recruit nurses and clinicians.
Those who were laid off will receive severance packages.