With members expressing concern about the accuracy of financial projections and the lack of a long-term plan, Jackson Health System's governing board voted Monday, 11-1, to approve a proposed 2011 budget that almost breaks even. "We're going to have to make tougher decisions," said veteran board member Ernesto de la Fé, who voted against the budget that predicts a loss of about $11 million on $1.9 billion in revenue. "This is a budget just to create a budget." The budget now goes to the Miami-Dade County Commission, which will consider Jackson's proposal in workshop meetings before finalizing it late next month. The budget approved by the Public Health Trust comes close to breaking even by proposing more than $220 million in initiatives that would either cut costs or increase revenues. Even board members who voted for the budget expressed concerns. Some, like Angel Medina, the Trust's co-chair and a former bank president, worried that if any of the new initiatives failed, the numbers would not work: "This is certainly a high-risk budget."