Updating a story from earlier this morning, the Saint Louis-based Catholic-sponsored health care system, SSM Health Care, is cutting 586 jobs in four states, including 206 in the Saint Louis region.  They announced the cuts yesterday.  A spokesman says nearly half of the eliminated positions are through attrition, and most are administrative.  SSM employs more than 30,000 workers in Missouri, Illinois, Oklahoma and Wisconsin.  More than 12,000 of those jobs are in the Saint Louis area.  A statement from SSM says health care organizations are facing “unprecedented changes and challenges,” including a shift to more outpatient settings, reduced reimbursement from federal payers, increased bad debt and charity care and the financial impacts from sequestration.  The SSM system includes 18 hospitals, two nursing homes, more than 150 outpatient sites and other units.