Cook County Board President Toni Preckwinkle unveiled a $9.1 billion budget for 2024 on Thursday, a proposal she says closes a $161 million gap by, in part, eliminating hundreds of vacancies at the county’s flagship health system.
Preckwinkle said her plan calls for no new taxes, fines or fees, nor does it rely on layoffs.
“Our investments in health care, public safety, small businesses, housing and infrastructure are paying off. But, as we all know, progress is not achieved overnight, and there’s still work to be done,” Preckwinkle said during a brief budget address Thursday morning. “And through a pandemic, inflation, economic uncertainty and numerous other regional and global challenges, I can confidently say today that the financial condition of Cook County is strong.”
During the budget address, Preckwinkle highlighted county efforts over the last decade to reduce outstanding debt, upgrades by bond rating agencies and pension reform efforts that she said puts the county on the path to having a fully funded pension system in the next 35 years.
The budget next year will be nearly 4% higher, or about $342 million more, than the 2023 budget. A large portion will be spent on fixed charges such as increased wages for current county employees and paying down pension costs that serve retired county employees.
Among the challenges facing the county is the crisis around asylum-seekers. The county has been picking up the cost to provide health care and transportation — between $1.8 million and $2.2 million monthly — since February. But Preckwinkle told the Chicago Tribune Editorial Board she expects that number to grow.
“If we’re going to get seven or eight buses a day, there’ll be a significant increase in that number as well,” she said.
The county is budgeting $10 million for health care and transportation costs for some of the asylum-seekers who have arrived in Chicago and the suburbs in the past year. Since 2022, the county’s health system has cared for 13,200 new arrivals and provided more than 60,500 visits, officials say.
Though the county is not picking up housing costs, Preckwinkle said she had on behalf of Mayor Brandon Johnson asked suburban municipalities to help share the burden, but they declined unless they get additional money to pay for it.
“The city is one municipality out of 134 in Cook County, and each of those cities, towns and villages has control over their own operations. It’s not like we can just impose upon them the burden of being responsible for new arrivals,” Preckwinkle said. “That’s not the way it works.”
Preckwinkle also repeated the need for more federal and state money to respond to the crisis. Migrant patient volumes have increased 30% to 40% in recent weeks, Cook County Health CEO Israel Rocha said.
While Preckwinkle said she would continue to advocate for a federal solution, “the state needs to step up as well, because $42.5 million barely covers the city’s costs for a month,” she said, describing the sum that the state recently announced in awards to local governments as a “drop in the bucket.”
While the $161 million budget gap was among the smallest since Preckwinkle took office in late 2010, the projected shortfall for the end of this fiscal year has nearly doubled since June. Her initial forecast pegged the deficit at just $86 million.
But the budget gap grew, officials said, in part because short-term labor agreements reached with most of the county’s unions — including retroactive raises dating back to December 2021 — drove up 2023 costs beyond budgeted totals. In all, retroactive raises paid to all county employees cost $101.6 million.
Another 5% pay hike for county employees included in the one-year extensions will land in June 2025.
Extending existing contracts for a year — rather than inking new ones — provided “labor peace, certainty for budgeting purposes, and close(d) the wage gap created by record high inflation by relieving the economic burden to our employees,” spokesman Nick Mathiowdis said in an email last month.
While empty positions can be a budget boon because planned spending on salaries never come to pass, hiring and retention have been an ongoing issue at the county.
Chief Financial Officer Tanya Anthony said 4,650 countywide positions — almost 20% of the county’s entire budgeted workforce — remain unfilled. Some unionized health care employees have complained about an overreliance on contract workers at the county’s network of hospitals and clinics.
A nationwide health care labor crunch has led to hospitals across the country not being able to hire as many people as they need and instead relying on contract workers for short stints at sometimes higher hourly pay than full-time workers earn. To address the problem, county health officials said they have held hiring fairs, established an externship program, offered tuition reimbursement for nursing-related programs and piloted a recruitment and retention bonus program.
Compared with 2023, the county is budgeting for 414 fewer full-time equivalent employees, a 1.7% decrease from the 23,760 positions budgeted last year.
The majority of vacancy eliminations are planned for Cook County Health. A total of 308 vacant full-time equivalent positions are slated to be cut there, most of which are roles that have gone unfilled for a year. The “preponderance” of those eliminated roles were nonclinical, and no nursing positions were cut, officials said.
Aside from “defunding long term vacancies,” the county’s gap was closed thanks to higher revenues than officials anticipated this summer and other expenditure cuts across departments.
The year 2024 will mark the county’s biggest spending surge in federal pandemic relief funds. Preckwinkle on Thursday morning opened her budget speech sharing an anecdote about a new mother, Bella Magaña, who was one of the 3,250 participants — out of more than 230,000 people — taking part in the county’s two-year guaranteed income program.
“This program doesn’t make life perfect. But now, life is just a little bit better, a little bit easier, for Bella and her family,” Preckwinkle said. “That’s what we do here at Cook County. That’s why we’re here. We seek to make life a little better for all of Cook County — and that’s whether you’re a lifelong resident or newly arrived. Our commitment. Our promise to you — is action. It never wavers.”
Through the end of August, the county had spent less than a third of its $1 billion in American Rescue Plan Act funds. In 2024, it plans to spend close to $240 million, including $40 million on a relaunch of a small business grant program, $20 million to spend on local infrastructure projects, and $118 million on expanded services — and a new Behavioral Health Authority — at Cook County Health.
The latter program is “a critical, transformative endeavor that is long overdue in the region,” Preckwinkle said in her speech. “A recent report shows that African Americans are the only racial or ethnic group in Cook County whose suicide rates are now higher than they were at the height of the COVID-19 pandemic. More alarmingly, even before the pandemic, 69% of Black adults with mental illness received no treatment.”
Under federal rules, ARPA money must be spent by the end of 2026. But Preckwinkle intends to begin setting aside $158 million in unspent 2023 county dollars now to “carve a staircase into our fiscal cliff” after 2026, Deputy Chief Financial Officer Dean Constantinou said Wednesday in a briefing with reporters before the budget was formally unveiled. In all, the county plans to set aside $167 million “to preserve vital programs in a financially responsible manner,” Preckwinkle said.
The county plans to continue to work to find additional dedicated funding to sustain ARPA programs. Among Preckwinkle’s previously stated priorities is continuing the guaranteed income program, which cost $42 million.
Other offices receiving a slight boost: 16 more employees are budgeted at the county assessor’s office and the Board of Review to “alleviate a backlog of property tax assessments and review of appeals.” Issues between the offices have contributed to delays in mailing out fall property tax bills. The county also plans to spend $9 million to equip sheriff’s officers with body-worn cameras.
The county’s departments will kick off their presentation to commissioners starting Oct. 24 and the final budget vote will take place in November.
