Cook County Board President Toni Preckwinkle is pitching an optimistic $9.14 billion budget for next year: no new taxes, fees or hikes of any kind, and no layoffs of government employees.

Among her priorities, Preckwinkle is bracing to pay more to help provide medical care for thousands of asylum-seekers arriving in Chicago. And she plans to use about $166 million in reserves to continue some programs the county created with federal pandemic relief dollars after that lifeline runs out in a few years. 

“We’re in a very good place financially, and programmatically we’re addressing some of the historic challenges the county has faced, and some of the newer ones,” Preckwinkle said during a briefing with reporters Wednesday, where she unveiled her proposed budget for next year.

Preckwinkle is set to officially pitch her 2024 budget to the Cook County Board of Commissioners on Thursday. That kicks off a series of public hearings and negotiations with elected and appointed county leaders who run the government’s public jail, courts and vast hospital and clinic system called Cook County Health. Commissioners typically vote on the proposed budget in November, and it takes effect Dec. 1.

Health care and public safety typically make up the bulk of the county budget. 

Preckwinkle’s proposed financial roadmap is about 4% more than this year’s budget, and it’s her second since migrants and asylum-seekers started getting routinely sent here from border states just over a year ago. More than 17,000 people have arrived, according to a city spokesperson. 

Cook County Health, which is one of the biggest public health systems in the nation and has a legacy of treating patients whether they can pay or not, is the main health care provider for asylum-seekers. County leaders say the tab to treat them has been increasing to about $2.2 million a month. Patient visits have increased about 45% in the last three months alone, Cook County Health CEO Israel Rocha Jr. said.

Preckwinkle and her executive team want to set aside an additional $10 million in next year’s budget in case the cost to provide medical care for asylum-seekers grows.

“While we are in a good place now, that won’t last,” said chief of staff Lanetta Haynes Turner. “Cook County Health and the rest of our team are really projecting out what it looks like to get that increased volume of 20 to 25 buses for however long. So we’re certainly going to need more resources. And we are standing with the city of Chicago to advocate for more state and federal resources to mitigate some of the impacts of providing health care, and all of the follow-up care that many of the new arrivals have.”

Preckwinkle has other ambitious plans for next year. They include pouring another $70 million into the county’s Equity Fund, bringing investments in the fund to nearly $130 million, and earmarking revenue from the Illinois Gaming Casino Tax to permanently flow to the Equity Fund. The fund aims to make the region a more equitable place. Recommendations for how to use the money include creating more affordable housing, investing in behavioral health and making public transit more affordable. 

“All of these inequities certainly have persisted for a very long time, and it will take more than just the county to eliminate them,” Haynes Turner said. 

Other priorities include expanding the use of body cameras for law enforcement officers and absorbing an immigration unit that’s now funded by grant dollars. 

Of the $1 billion in federal pandemic relief funds the county has received, the government has so far spent $291 million, and plans to spend another $265 million next year. The clock is ticking. All of the money must be spent by 2026, which has led to contentious discussion among commissioners. They know they won’t be able to keep all of the dozens of programs they have started, such as guaranteed income and violence prevention programs. 

That’s also why county leaders say they want to use reserve funds  — to buy time to retain some of the programs while they search for other ways to pay for them, such as grants.

“In this way, we hope to carve a staircase into our fiscal cliff,” said Dean Constantinou, the county’s deputy chief financial officer. 

Preckwinkle declined to say which programs she would prioritize keeping. 

The backdrop to all of this is having enough workers to accomplish the county’s goals. The government has roughly 19,000 employees, and about 4,650 vacancies. Around half of the unfilled positions are at Cook County Health, a spokeswoman said. The county plans to eliminate just over 400 vacancies, but hire for the rest. That includes adding staffers to help alleviate the backlog of property tax assessments and appeals.

This summer, county leaders estimated they would head into next year with a roughly $170 million gap due to pay hikes for employees. But they say that gap has been eliminated by scrubbing jobs that have sat empty for at least two years, and giving departments a ceiling of how many new jobs to request, said county chief financial officer Tanya Anthony. 

Preckwinkle also credited Rocha for budgeting conservatively as he planned ahead for the health system.

Other factors that are projected to help boost the county coffers include consumers spending more money, fueling a small increase in the sales, amusement and hotel tax. The county also expects to generate more revenue from investments due to rising interest rates. 

But over the next five years, the county expects to be battling deficits as several key sources of revenue decline. That includes cigarette and gas tax dollars that can’t keep pace with how much money the county expects to spend.

Kristen Schorsch covers public health and Cook County for WBEZ. Follow her @kschorsch.