Preckwinkle Faces 2026 Election With $138 Million Revenue Loss Looming

Cook County Board President Toni Preckwinkle is set to face a final election challenge from Libertarian Michael Murphy on November 3, 2026. The 79-year-old incumbent defeated Alderman Brendan Reilly in the March Democratic primary with a 69 percent to 31 percent margin. If she wins this election and serves a full four-year term, Preckwinkle will lead the county for two decades, a tenure that places her second only to George Dunne, who held the office from 1969 to 1990.

The upcoming term presents immediate financial challenges for the county. Cook County Health, which accounts for approximately half of the county's $10 billion budget, projects a loss of $138 million in patient revenue next year. The health system also expects to assume more than $100 million in new charity care costs. These figures result from federal Medicaid work requirements and eligibility checks signed into law by President Donald Trump. An estimated 400,000 patients across Illinois are expected to lose coverage unless these provisions are reversed or delayed.

Preckwinkle's 2027 budget proposal, introduced in October, closed a roughly $550 million shortfall using reserve dollars and spending cuts. The pressure on the budget stems not only from Medicaid changes but also from a legal loss involving transportation funds. A county circuit court judge ruled earlier this year that approximately $250 million in annual spending on public safety offices was an ineligible cost under the county's "lockbox" rules. Budget officials are withholding those funds pending an appeal.

Preckwinkle has historically resisted raising taxes, noting that the county's base property tax levy has remained unchanged since the 1990s and the sales tax rate has been flat since 2016. However, she has indicated that taxpayers may face higher costs in the future. "We cannot pretend this year's approach will be enough forever," Preckwinkle said when presenting her budget. She stated that the county will need to consider additional revenue to maintain essential services and the healthcare safety net.

During the primary campaign, Preckwinkle raised funds from across the state's Democratic establishment to counter Reilly's advertising spend. Governor JB Pritzker contributed $250,000 through his trust in early 2026. Illinois Senate President Don Harmon provided just over $103,000. The Service Employees International Union Illinois State Council PAC contributed $272,800 between the summer of 2025 and the primary, while other unions added nearly $300,000.

Reilly, who lost the primary, criticized Preckwinkle's handling of crime, her relationships with Mayor Brandon Johnson and State's Attorney Kim Foxx, and the county's property tax system upgrade. Preckwinkle responded by citing her record of stabilizing county finances and improving retirement funding following the 2016 sales tax hike. She also pointed to the county's ability to gather community feedback on its $1 billion share of federal pandemic relief money without resorting to emergency spending.

Preckwinkle has stated that a priority for her next term is identifying a successor who shares her values regarding healthcare and criminal justice reform. She expressed a desire to avoid a chaotic transition, saying she does not want to be in the position of former President Barack Obama, who was succeeded by Donald Trump. Sources close to Preckwinkle have suggested that members of her political network, including State Senator Robert Peters and Commissioner Bill Lowry, are on her potential short list.

Murphy, a 33-year-old IT professional from the Austin neighborhood, has campaigned on reducing property taxes and managing the county's population trends. He has less than $500 on hand for the general election. In the 2024 and 2022 cycles, he received 6.4 percent and 2.3 percent of the vote, respectively, for county clerk and treasurer positions. He argues that voters are experiencing fatigue with officials serving multiple terms.

Preckwinkle has continued to lead the Cook County Democratic Party while preparing for the general election. She took several weeks off after the primary, citing exhaustion from the campaign. She has maintained that stability in county government distinguishes Cook County from other jurisdictions where political drama has been more frequent.

The board also faces a contest in the 17th district, where Democratic Lyons Township Clerk Elyse Hoffenberg is challenging Republican Elizabeth Doody Gorman. This race will determine the replacement for Sean Morrison, the board's only Republican commissioner, who is not seeking reelection. Preckwinkle hopes to flip this seat to restore a full Democratic majority on the 17-member board.