Cook County expects to head into next year with a nearly $86 million budget gap and is still struggling to fill around 4,000 vacant jobs.
Still, Cook County Board President Toni Preckwinkle touted some good news in a briefing: no new taxes, fees or hikes of any kind next year to help close the projected gap. Instead, the county plans to rely on belt-tightening across agencies and departments.
While the estimated budget hole is larger than the $18.2 million gap projected this time last year, it is one of the county’s smallest deficits in the last decade.
Nearly 20,000 people work for the county. Government leaders on Wednesday revealed that hiring hasn’t budged much in the past year.
“We do need to staff up,” Preckwinkle said during a briefing with reporters. “We’re trying to fill these vacancies so we can take the sort of extra burden off the folks we’ve already got to work who are doing yeoman’s service. I wouldn’t say that our operations are affected.”
The latest glimpse into Cook County’s finances comes as more than 10,000 migrants and asylum-seekers have arrived in Chicago since last summer, testing the limits of what the government can or will provide. The county is the main health care provider for the migrants.
The persistent workforce shortage came up as Preckwinkle and her finance team unveiled what next year’s budget could look like, and offered a glimpse into how Cook County might end the current fiscal year on Nov. 30.
The annual budgeting process involves Preckwinkle negotiating with elected and appointed county leaders who run the government’s public jail, courts and large hospital and clinic system called Cook County Health. Currently, the county has a nearly $9 billion budget.
While Cook County government isn’t unique in having a workforce shortage on the heels of the COVID-19 pandemic, having enough employees to help the county carry out its priorities with $1 billion in pandemic relief dollars is key. Preckwinkle’s initiatives have included launching a guaranteed income program and erasing up to $1 billion in medical debt. Preckwinkle said staffing up is among her biggest challenges.
Where Cook County finances stand
The workforce shortage ironically means that in some cases, the county is saving money by having fewer people on the payroll. That’s contributed to an estimated nearly $617 million budget surplus for the current fiscal year — money that could be tucked away or funneled elsewhere instead of going toward filling next year’s projected gap, county leaders said.
Tanya Anthony, chief financial officer for the county, said belt-tightening comes first.
“What we don’t want to do is start to support our ongoing expenses with a one-time revenue source,” Anthony said.
Also fueling that projected surplus are inflation and economic growth, meaning goods and services are more expensive, which in turn generates more sales tax revenue for the county.
But some financial lifeboats that helped to float the county’s economy during the pandemic are running aground.
For example, for three years during the health crisis, the state kept its public Medicaid health insurance rolls at a sort of status quo, and did not drop people who may have no longer qualified. That enabled the county to be paid for care it provided to the most in need. The county also during that time saw enrollment swell in its own big Medicaid health insurance plan called CountyCare, which receives a fixed rate per enrollee.
Those pandemic-related efforts are largely coming to an end. The state is once again requiring people prove they are eligible for Medicaid. The county expects CountyCare enrollment to drop. But, it does expect to get paid more per member, which they say may help balance out potential financial losses.
County leaders largely pin the expected budget hole next year on a big drop in revenue from a business income tax. They say that’s due to changes in how the state doles out this money.
The county received $184 million from this pot in 2022— more than three times the amount received in 2020 when COVID-19 hit. But the county expects to receive around $75 million next year.
Then there are other broader economic factors that impact the county, where sales tax is the biggest money-maker. County officials expressed concern about a slowing of the national economy, which would impact the region.
“If inflation continues to remain persistently high and job growth remains strong, the Fed may go a bit too far in its hikes, forcing the economy into a recession,” said Dean Constantinou, county deputy chief financial officer.
Then he ticked off other concerns. More regional bank failures could spook markets and consumers, leading to a recession. If the Ukraine war persists, gas prices could rise.
The county is banking on just a modest increase in sales tax revenue next year, is putting $22 million more into its pension fund, and expects to pay its unionized workforce more.
Cook County Health is projecting just a $3 million shortfall next year., despite being the main medical provider for migrants and anticipating a $40 million drop in revenue due to patients losing their Medicaid coverage.
So far, the county has spent at least $20 million on its clinic dedicated for migrants.That includes staffing, screenings and treatment on-site, as well as for patients who need more specialized care at the health system’s flagship John H. Stroger Jr. Hospital.
Migrant health care likely to require more nurses
Health system CEO Israel Rocha Jr. said details would come later about how Cook County Health would achieve that small $3 million gap but said the mission hasn’t changed. Cook County Health is the biggest provider in the region for people who are low income or uninsured.
“We are going to be there to provide care for individuals who need it,” Rocha said. “We hope — and I say I’m an optimist — that in partnership with the state and other partners we can make sure that we’re able to continue doing that.”
The health system also expects an increase in contracted labor next year as leaders try to hire more nurses in particular. That’s largely driven by expectations that the county will provide a substantial amount of care to migrants next year, a health system spokeswoman said.
Cook County Health spent an estimated $170 million on temporary nurses last year, and about $32 million in the first quarter of the current fiscal year, according to the health system. Temporary nurses are typically more expensive than those who are on staff.
Preckwinkle added that the county is reevaluating needs at Provident Hospital, which the county previously planned to replace. Provident is not only near UChicago Medicine, a prominent research-focused hospital on the South Side, but Northwestern Medicine is building a large outpatient facility within blocks of Provident.
Rocha said the county is investing in Provident by expanding and restoring services, such as having ambulances return to the emergency department.
The county plans to have a virtual public hearing about its finances on July 11. Commissioners typically vote on Preckwinkle’s proposed budget for the following year in November.
Kristen Schorsch covers public health and Cook County for WBEZ.
