Despite a pandemic that has gutted government budgets across the U.S., the Cook County Board of Commissioners on Tuesday unanimously approved a nearly $7 billion spending plan for 2021 that doesn’t include any new taxes or massive layoffs.

“I’m very grateful to the commissioners,” Democratic County Board President Toni Preckwinkle said in a media briefing after the board meeting. “For the last 10 years we’ve made difficult decisions and structural changes rather than look for one-time fixes. And as a result we’re in pretty impressive shape given the fact that we’re in a pandemic and economic collapse.”

Republican County Commissioner Sean Morrison voted in favor of the budget – his first vote to approve a spending plan since 2015.

But in a statement, he issued a warning:

“The obvious question that lies ahead is: Will we continue to receive federal assistance in the name of COVID, or will we be charged to tackle the revenue deficit on our own … through our own means?”

The new $6.9 billion budget takes effect on Dec. 1. It largely avoids big cuts in services and includes only small fee increases. And like in previous years, the budget continues to focus on making Cook County a more equitable place to live and work by investing in initiatives Preckwinkle says help the most vulnerable residents.

Preckwinkle’s priorities include addressing health care disparities made worse during the pandemic; investing in small businesses; and partnering with regional public transit agencies to make rides cheaper.

She’s taking heat for some of those causes.

For example, Preckwinkle says she plans to increase access to medical care at the county’s vast public health system, which is the go-to provider for low-income and uninsured people in the region. Provident Hospital on the South Side will get a new dialysis center, expanded diagnostic services such as CT scans and a more robust outpatient surgery program.

Preckwinkle also vows to replace Provident, a plan that was put on hold as the health system hired a new CEO.

“Why do we remain committed to these plans?” Preckwinkle wrote in her budget address in October. “Why do we remain committed to our Black and brown communities? Because this is what prioritizing equity looks like.”

More than 80% of Provident’s patients are African American, the most recent state data shows.

But unionized county health system nurses say the plans reduce access for people who need it the most – during a pandemic, and at a time when another hospital, Mercy in Bronzeville, plans to close next year. Mercy is a roughly 10-minute drive north of Provident.

The county is consolidating two South Side clinics into Provident and downgrading the hospital’s emergency department to a stand-by unit. People who don’t need hospital-level emergency care would be sent to walk-in clinics on campus.

In written comments read during the virtual board meeting on Tuesday, one prominent Chicago budget watchdog encouraged commissioners to reconsider plans to build a new Provident. The plea came from Laurence Msall, who runs the nonprofit Civic Federation.

“The Civic Federation has not heard an adequate public case for the need for more hospital beds, and projections for growth in inpatient care seem optimistic,” Msall wrote. “Instead, the county health system should focus on providing outpatient services.”

After the board meeting, Preckwinkle said she’s cautiously optimistic about next year – despite the pandemic’s economic blow.

She acknowledged that the county’s main public hospital, John H. Stroger Jr. on the Near West Side, is filling up with COVID-19 patients.

“We’ve seen … at least a six-fold increase in two and a half weeks in the number of COVID patients in our hospital,” Preckwinkle said. “And when the hospital is required to reserve so many of our beds for COVID patients, we can’t do elective surgeries, which are an important source of revenue.”

Those surgeries are a key money-maker for all hospitals.

“So the combination of the economic challenges that we’ll face and the costs that will be incurred in caring for COVID patients are considerable,” Preckwinkle said.

Public officials and doctors who work at hospitals across Illinois have been sounding the alarm for weeks about potentially running out of beds as the virus surges. In Region 10, which encompasses suburban Cook County, there are just 94 intensive care beds for the sickest patients left – 13% of all ICU beds in the region, according to the Illinois Department of Public Health.

Preckwinkle said she plans to spend Thanksgiving with her daughter, a hospital nurse who works the night shift.

Kristen Schorsch covers public health and Cook County on WBEZ’s government and politics desk. Follow her @kschorsch.