Dr. Jay Shannon performed a balancing act during his more than five years at the helm of the Cook County Health and Hospitals system, whose nearly 6,600 full-time employees run the county’s two public hospitals and manage its growing Medicaid managed care program.

The CEO was forced to make several rounds of deep budget cuts while keeping the system’s services competitive enough to attract insured patients. Shannon was tasked with scoping out new revenues while relying on a shrinking pool of taxpayer dollars. And he oversaw a more than three-fold expansion of the county’s Medicaid services amid federal efforts to roll back the Affordable Care Act.

But by Friday, when the health system’s independent board voted unanimously not to renew Shannon’s contract, the $2.8 billion health system also faced mounting financial and political pressures. Skyrocketing costs from unpaid debt and the county’s provision of care to uninsured patients, plus a contentious report on the health system’s fiscal stewardship, meant county officials peppered Shannon with tough questions this year.

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