CHICAGO (AP) Gov. Pat Quinn previewed some tough budget choices Tuesday, saying he wants to cut $2 billion from the state’s Medicaid budget to help solve the state’s fiscal woes.

That amounts to about 14 percent of total spending on a health care program that covers 2.7 million poor and disabled Illinoisans. Quinn didn’t offer any details on how he could achieve that.

“We want to have better health care and wellness for those who are Medicaid recipients,” the Chicago Democrat said. “That may mean we step on some of the toes of some of those providers in the system. Some of those sacred cows may have to be challenged.”

Some options for restructuring the system are shrinking payments to hospital and doctors, reducing how many people are eligible and cutting benefits the state isn’t legally required to offer.

Rep. Greg Harris, D-Chicago, said even ending optional benefits would mean tremendous pain for some people.

“If you look at the services the federal government says are ‘optional,’ they are prescription drugs, they are long term care nursing homes, they are hospice care. So this is going to be horrible decision making,” said Harris, chairman of the House Human Services Committee.

Reforming Medicaid won’t be easy, particularly in an election year. Last year, Quinn proposed cutting payment rates for providing care under the Medicaid program, which would have meant a reduction in what state government owes. But state legislators did not approve it.

The state’s Medicaid budget is about $14 billion, which includes federal money. The state contribution is around $8.6 billion. A Quinn aide said the governor envisions cutting $2 billion from the larger figure that includes both state and federal spending.

The state has paid some current Medicaid costs out of future budgets, and there has been buildup of late payments. The backlog of unpaid Medicaid bills is expected to reach $1.8 billion by the end of the fiscal year.

Quinn said he also wants to reform public pensions system this year; the state’s five state-employee pension systems are underfunded by about $83 billion.

He said he will look at employer and employee contributions, cost of living adjustments and the retirement age. Previously, he has suggested making local school districts pick up the employers’ portion of teacher retirement benefits.

“If we want to have adequate resources for education and public safety and all the other important things in life, we’re going to have to deal with this very difficult issue,” he said Tuesday as he addressed the City Club of Chicago.

Quinn also said he wants to reform the state’s tax system, which he says has “too many loopholes.” He offered no details.

Quinn will unveil his state budget on Feb. 22 at a time when Illinois’s backlog of unpaid bills is at $9.2 billion and expected to continue growing.

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