Cook County’s budget gap is projected to rise to $550 million heading into next year — the highest figure since Board President Toni Preckwinkle took office in 2011. The shortfall, driven by a lost lawsuit over transportation tax spending, rising payroll costs, and expected federal healthcare cuts, presents the most significant fiscal challenge of Preckwinkle’s tenure even as the county maintains a $1.4 billion reserve fund.
Lawsuit Loss Accounts for Nearly Half
More than half of the deficit — $258 million — stems from a Cook County Circuit Court ruling that the county’s use of transportation tax money violated the state’s Safe Roads Amendment. The county had spent the funds on public safety agencies including the sheriff, state’s attorney, and public defender. The Illinois Road and Transportation Builders Association sued in 2018, and the January ruling requires the money to be spent only on transportation projects going forward. The county plans to appeal, the Tribune reported.
Federal Cuts Loom Over Healthcare
Long-anticipated federal cuts to healthcare are expected to hit in 2027, including the impact of the One Big Beautiful Bill’s Medicaid eligibility reductions. Cook County Health projects uncompensated care costs will rise by $100 million to approximately $470 million, as fewer patients carry Medicaid coverage and more uninsured patients arrive at county facilities. The county health fund gap alone is projected at $214 million.
Bright Spots and Budget Math
Despite the deficit, Cook County is expected to end this year with a surplus of roughly $240 million — driven by a $115 million tobacco tax settlement from Sam’s Club and $122.7 million in higher-than-expected sales tax receipts partly attributed to tariffs driving up goods prices. County policy directs one-time surpluses to reserves rather than ongoing spending.
The $550 million deficit represents roughly 7% of the county’s total budget — a much smaller share than the 21% gap Preckwinkle inherited in 2011. Budget director Kanako Ishida Musselwhite noted that the county’s improved reserves, strengthened bond ratings, and progress on pension funding provide a cushion that did not exist 15 years ago. Still, the structural pressures are real: payroll costs from retroactive raises agreed during the pandemic, growing pension contributions, and the health system’s rising uncompensated care burden all point to persistent gaps unless revenue grows commensurately. Preckwinkle will formally announce her budget proposal in the fall, and the county board will have until year-end to reach a balanced budget.
Preckwinkle, who is running for a fifth term in November, said new taxes or fees would be “a last resort.” Budget officials said payroll costs across the county’s two major funds are projected to climb by $176 million, driven by 5% raises awarded in 2025 and retroactive increases dating back to 2021.
