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Inside the 2020 county budget Preckwinkle unveils today
In her proposed spending plan, Cook County Board President Toni Preckwinkle lives up to her promise to not hike taxes, but health officials say they might have to rethink operations amid rising uncompensated care costs.

Thursday, October 10, 2019
Crain's Chicago Business
by A.D.Quig

Cook County Board President Toni Preckwinkle stayed true to her word from this summer — that the county’s 2020 budget would feature no additional tax asks. But county hospital officials say planned cuts to vacant positions amid rising uncompensated care costs might force them to "limit charity care based on available resources."

Preckwinkle's proposed budget anticipates cutting more than 600 vacant positions at the county’s health system, bringing the headcount to the lowest number in her tenure. It also adds dozens of positions to help clear marijuana convictions from criminal records and manage rising numbers of property tax appeals.

The $6.18 billion budget is being formally introduced Thursday morning and reflects “hard choices and difficult decisions” made over the nine years since Preckwinkle took office. The county’s budgeted headcount has gone down by close to 3,600 employees — a 14% decline — since 2010.

Preckwinkle proposes adding 206 public safety employees, 36 in property and taxation, and 23 in finance and administration.


Cook County Health, which operates Stroger and Provident Hospitals, its own Medicaid managed care program and clinics across the county, will see 638 vacant positions cut from its budget, which will save $53.2 million. The majority, about 400, will come from ambulatory services, according to health system budget briefing documents. More than 90 positions will be cut from the managed care program, CountyCare, and the system’s integrated care.

Administration officials said the cuts would not impact service. Health department officials somewhat contradicted that.

“The elimination of vacancies will impact our operations but we intend to take a thoughtful approach and believe we can manage for FY20 while we develop strategies to address the need for additional resources. We may be at a point where we need to limit charity care based on available resources,” CCH spokeswoman Caryn Stancik said in an email.

The system’s mission is to accept all patients, regardless of their ability to pay, but it is facing rising uncompensated care costs from charity care and bad debt. Hospital officials estimate the total number will be roughly $590 million in 2020. After a dramatic drop in uninsured patients since the start of the Affordable Care Act, the number of uninsured patients visiting county facilities has been on the rise since 2016. CCH estimates that though it only operates two hospitals, it absorbs more than half of all the charity care provided in Cook County.

“We can no longer absorb increases in charity care, negotiated salary increases and general health care inflation while improving our facilities so we can compete for insured patients,” Stancik said.

CCH has seen its tax allocation from the county decrease by roughly $150 million since 2013.

Uncompensated care “is the main issue the health system faces,” Chief Financial Officer Ammar Rizki said at a briefing with reporters Tuesday. “This is becoming a challenge for the health system, we’re going to continue to work with them and address these things in a structural manner.”

Preckwinkle did not say how the county could offset uncompensated care costs or offer ideas for reforms. That solution is “to be determined,” after discussions with CCHHS’ independent board. She has previously called on other providers to pick up more of those patients.

The system is building a new nine-story inpatient/outpatient facility to replace Provident Hospital on the city’s South Side, and will demolish the Sengstacke Clinic to make way for it. It is also adding health centers at North Riverside and Blue Island.


Cook County State’s Attorney Kim Foxx will receive nine additional assistant state’s attorneys — some will help the office wipe criminal records related to marijuana convictions, others will be added to the office’s gun crimes strategy unit. The Clerk of the Circuit Court will also see extra staff to help with expungements. In August, Foxx announced she’s pairing with a California civic group to automatically reverse “tens of thousands” of past convictions of illegal possession of less than 30 grams of marijuana.

“Black and brown communities have been devastated by the war on drugs and disproportionately impacted by the criminal justice system generally,” Preckwinkle said. Adding these positions to help with expungement rights some of the wrongs perpetrated by government in the past, she said.

The county’s assumptions around the revenues it will bring in from recreational marijuana have shifted since this summer. While it initially anticipated receiving $3.3 million from receipts, it now says it won’t count on any cannabis revenues. It is still expecting to receive $3.2 million from the expansion of gaming positions in the county, and $1.75 million from sports wagering.

Chief Judge Timothy Evans will also see close to 90 more budgeted positions.

16 new positions will be added to the county’s Board of Review, and 17 will be added to the Assessor’s office to help offset the volume of property tax appeals. County officials say those have risen 15% year over year. Those will likely rise as property owners adjust to new standards under Assessor Fritz Kaegi.

The president said commissioners had a “positive” reception to the proposal. After her budget address Thursday, hearings will be held between Oct. 28 and Nov. 4, with an anticipated final vote by commissioners on Nov. 21. The fiscal year begins on Dec. 1. The county has launched an interactive budget portal here.

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