Hospitals tend to be among the largest employers in their communities -- which means that any individual decision to lay off staff can have an outsized local impact. And taken together, a dozen recent announcements seem to paint an especially dire picture for hospitals (and their communities) around the nation. For example, NorthShore in Illinois says it will lay off 1% of its workforce. The staffing cuts "ensure NorthShore remains well positioned to deal with the unprecedented changes brought on by the Affordable Care Act," according to a memo from the health system's chief human resources executive. And California's John Muir Health is offering staff voluntary buyouts ahead of ACA implementation.