Editorial: Impact of COVID-19 emphasizes role of ACA in Cook County budgeting

Even a shallow dive into the proposed $6.9 billion Cook County budget for 2021 will leave some memorable impressions, but one in particular looms ominously as the election spotlight turns on the Affordable Care Act. Whatever the act's flaws or merits broadly, it has been very good for Cook County, and its demise, the numbers show, would have a substantial impact on the county and county taxpayers.

County Board President Toni Preckwinkle uses the word "calamity," and she might not be far off. At the very least, the loss of ACA funding for tens of thousands of Cook County residents who get insurance through the program that they could not get before 2010 would force a monumental restructuring of spending priorities.

When Preckwinkle took office, just as the act became law, the county faced a chronic fund deficit of nearly a half-billion dollars. A disciplined program of significant job cuts - totaling a 9 percent reduction since 2011 - and sometimes controversial spending controls in every county agency helped whittle into that deficit, but the most substantial impact came in the area of health care. With the advent of the ACA, hundreds of thousands of uninsured county residents whom the county previously had to provide care for became eligible for and acquired insurance that reimbursed the costs of their health services.

The effect on the county's Health Fund was almost immediately noticeable, and naturally it had a concurrent impact on the overall county budget. By 2019, the county's one-time $489 million structural deficit had been trimmed down to just $18.6 million, even as funding was applied elsewhere to help small businesses, support housing initiatives, improve job training and, significantly, revitalize the outlook for the county's pension fund.

If not for the devastating impact of COVID-19, that deficit would have been eliminated this year. As it is, the influx of health care revenues enabled the county to build a modest emergency fund that provided $76.8 million this year to help close a $222 million gap caused by unexpected crippling impact of COVID-19.

Without those revenues, the county foresees a steady decline in its fund balance by as much $328 million in five years, all but eroding the advances made since 2010. And that's assuming the coronavirus epidemic is brought under control.

There is plenty of room to argue whether the ACA is the best approach to health care for all Americans, but it's clear that the health of Cook County government operations follows in a direct line from the health care resources available to its most vulnerable residents.