CHICAGO — Cook County, Ill. Board President Toni Preckwinkle Thursday unveiled a nearly $4 billion2015 budget for the nation's second-largest county, home of Chicago, that relies heavily on the new federal health care law to close a projected $169 million budget gap.
For the second year in a row, Preckwinkle eliminated the county's chronic deficit without any new taxes, fees or layoffs.
"It's because of all of our efforts, not just now but over the last four years, that we can provide a balanced budget," she told commissioners during a budget presentation.
The board is expected to vote on the spending plan in November after a series of public hearings. The county's fiscal year begins Dec. 1.
Proposed 2015 revenues include $220 million of debt proceeds.
The county's all-funds budget totals $3.99 billion, up from $3.56 billion in fiscal 2014. The general fund totals $1.43 billion, a nearly 4% increase from 2014 expenditures.
The budget for the Cook County Health and Hospital System, the county's massive health system that accounts for a third of its expenditures, totals $1.536 billion, up from $1.125 billion, according to budget documents. The $409 million increase is due to increasing costs associated with an increased Medicaid population that is part of the new CountyCare program under the Affordable Care Act.
However, "after subtracting the associated third-party provider costs, the revenue from the federal reimbursement for CountyCare members is projected to have a net positive impact of $348 million to offset system expenditures in fiscal 2015," according to budget documents.
"The most important investment we make is in the Cook County Health and Hospital System," Preckwinkle said during her budget talk.
The county itself expects to contribute roughly $200 million to the health system, less than half of what it was four years ago, she said.
"The reason is pretty simple," she said. "The Affordable Care Act."
The county started relying on the new federal health care law to bring in new revenue into the long-struggling system in 2012, when it applied for and won a waiver that allowed it to expand its Medicaid program ahead of the 2014 implementation of the new law.
Now, the president said, "The county has one of the largest and most successfully Medicaid expansion programs in the country."
The $169 million general fund deficit was driven in part by increased wages, including police and fire overtime, health benefit cost increases combined with revenues growing more slowly than expected.
Preckwinkle wants to eliminate the deficit with $49 million of cuts, including eliminating vacant positions and debt-service savings. Revenue projections have also been revised upward by $23.4 million compared to the most preliminary budget, released in June, according to budget documents.
Another $61.1 million of the deficit was eliminated with health department initiatives, including $56.3 million from CountyCare. An increase in the size of federal reimbursements for patients is also expected to bring in a "substantial revenue increase," according to budget documents.
Cook has faced a series of downgrades from ratings firms due to its two underfunded pension plans.
Preckwinkle said she hopes to get reform legislation passed in a special General Assembly session set for January. The county has a reform plan that passed the Senate last year but failed to garner enough votes to pass in the House. The bill would increase the county's contribution by $147 million a year starting in 2016 and raised employee contribution by 2 percentage points starting next year. Supporters said the reform would bring the funds to full solvency after 30 years.
The county's pension funds are 58% funded. That's better than Chicago and Illinois, but still dismal, Preckwinkle told local reporters. She likened it to having "the best house in a bad neighborhood."
In July, Fitch Ratings dropped the county's general obligation rating to A-plus. Moody's Investors Service rates Cook County A1 and Standard & Poor's rates it AA. Moody's also maintains a negative outlook on the county, chiefly due to underfunded pension obligations.
The county's long-term projections estimate a deficit of $179 million in fiscal 2016 that grows to $558 million by fiscal 2019, budget documents show.