Cook County Health anticipates providing nearly $485 million in free or discounted care in 2027, marking a significant increase from this year and reaching its highest level in over a decade. The expected surge in charity care reflects a growing number of uninsured patients, particularly among low-income populations, reversing some of the coverage gains achieved under the Affordable Care Act.

The increase is largely driven by a sharp rise in uninsured patients, with about 30% of those served by Cook County Health projected to lack insurance next year—more than double the 13% uninsured rate recorded in 2023. This shift is attributed primarily to the loss of Medicaid coverage and the discontinuation of enhanced government subsidies for insurance purchased through health exchanges.

Cook County Health operates two hospitals—John H. Stroger Jr. and Provident—and over a dozen community health centers, primarily serving poor and immigrant communities. Dr. Erik Mikaitis, the system’s CEO, warned that the loss of coverage could have broad repercussions beyond the hospitals, affecting local communities and businesses as individuals postpone care until conditions become critical, resulting in emergency interventions rather than preventive treatment.

The system’s anticipated charity care spike is encompassed within its preliminary $4.7 billion budget for 2027, which is approximately $400 million smaller than this year’s budget. The reduction stems partly from costs being cut in anticipation of lower revenues, including from a shrinking Medicaid health plan, CountyCare. According to Mikaitis, some 50,000 current members may lose Medicaid coverage due to upcoming policy changes.

Starting next year, Illinois is enacting major Medicaid cuts affecting low-income individuals and people with disabilities. These include new work requirements and more frequent eligibility checks. Illinois has around 1.4 million Medicaid recipients, with estimates suggesting over 400,000 could lose coverage—roughly half residing in Cook County.

Despite these challenges, Mikaitis said Cook County Health plans to invest in upgrades such as MRI equipment and does not currently intend to reduce patient services or lay off staff. However, these plans hinge on a potential $40 million contribution from Cook County officials to close a projected funding gap. Without this support, the health system could face around 150 layoffs, along with cuts to medical services, research initiatives, and supportive programs addressing housing and patient needs.

The financial strain on Cook County Health raises questions about broader impacts on the county’s overall budget and government services, including property tax administration, court operations, and jail management. The health system comprises one of the largest components of Cook County’s budget. A spokesperson for Cook County Board President Toni Preckwinkle said discussions are ongoing and that they are aware of the fiscal challenges ahead. The county budget proposal is expected in October, with commissioner approval required before implementation in December.

Mikaitis also highlighted that the pressures facing Cook County Health are being mirrored in other parts of the United States. The termination of enhanced ACA subsidies has contributed to insurance coverage lapses for many, while reductions in other public assistance programs could exacerbate community health issues. At the same time, some safety-net hospitals in the Chicago area have closed recently, and others remain financially vulnerable even before Medicaid cuts take effect. These developments risk increasing patient loads at Cook County Health and could lead to longer wait times and higher costs for insured patients as the financial burdens shift across the healthcare system.