Cook County government is staring down a nearly $270 million projected budget deficit next year, and that gap could grow depending on how the U.S. Supreme Court rules on President Barack Obama’s health-care law.

The bulk of the projected deficit, $152 million, comes from the Cook County Health and Hospital System, which has been overburdened during the economic downturn by patients who do not have insurance. County budget officials are bracing for another $87.8 million in lost revenue as the county rolls back the last of its penny-on-the-dollar sales tax starting January 1, 2013.

“This is going to be difficult,” Preckwinkle told reporters Wednesday. “But this is the economic reality that we face.”

The wild card is the Supreme Court’s decision on the president’s health care law, which is expected to come down Thursday. If justices uphold the law, Cook County could be in for “tens of millions of dollars” in federal Medicaid money, provided the state obtains a federal waiver, Preckwinkle said.

“If the Supreme Court decides that they will not sustain the Affordable Care Act … as it pertains to Medicaid expansion, that’s more problematic for us,” she said.

When asked how she plans to close next year’s projected budget gap, Preckwinkle said repeatedly “everything is on the table.”