Like the rest of the nation, the metro-east depends mightily on the flow of federal benefit dollars.
Each year, Uncle Sam pumps more than $3.6 billion worth of entitlement checks from a wide range of programs into Madison, St. Clair and Monroe counties.
That sum is nearly 20 times more than the entire budget of St. Clair County for next year.
And it's at least $600 million more than the estimated $3 billion annual economic impact of Scott Air Force Base on the St. Louis region.
In St. Clair County, 20 cents out of every dollar of personal income pours from the federal government, according to a nationwide analysis of federal benefit spending performed by the BND Washington Bureau.
In Madison County, that share is slightly smaller -- 19 cents out of every dollar of personal income, while in Monroe County it's 12 cents out of every dollar, the analysis shows.
The national average is 17.9 cents out of every dollar.
With President Barack Obama and U.S. House Speaker John Boehner at an impasse over how to avoid the so-called "fiscal cliff," much of the attention has shifted to ways of cutting the growth of entitlement programs such as Social Security and Medicare as a strategy for trimming the nation's $16 trillion public debt.
The expansion in recent decades of these entitlement programs, coupled with their immense popularity, explains why the question of which ones to cut or restructure has become so difficult to answer, according to Alan Dunstan, the Madison County Board chairman.
"Everyone wants to see cuts until you cut their services," Dunstan said. "Everyone I talk to knows there has to be cuts at the state and federal level. Something has to be done."
A key part of the problem with cutting entitlements stems from the number of American households that receive some sort of federal support, said U.S. Rep. John Shimkus, R-Collinsville.
The report shows nearly 150 million Americans -- 49 percent -- receive some government benefit.
To cut the growth of entitlement programs, several steps can be taken, such as raising the age of qualifying for Medicare or setting an income limit for qualifying for Social Security, Shimkus said.
It might make sense to exclude extremely wealthy recipients, he said.
"Should Mitt Romney get Social Security?" Shimkus asked. "Should Mitt Romney get Medicare? If we drop him out of the system, you save money by doing that."
Obama, like other Democratic leaders, is seeking $1.4 trillion in new revenue by raising taxes on households earning more than $250,000 per year and individuals earning $200,000, while overhauling the tax code.
Boehner, the Republican House speaker, opposes any tax increases. Instead, he's pushing for $800 billion in new revenue by reforming the tax code, principally by closing loopholes and capping deductions.
Shimkus said it makes no sense to seek higher tax rates without addressing entitlement spending.
"Until we really address that spending problem, why do you expand that revenue when you don't have the reforms needed to fix that problem?" he said.
Of Illinois' 102 counties, Alexander County has the highest ratio of federal entitlement dollars to total personal income: 40 cents of every dollar of personal income arrives via the federal government.
Alexander County, whose seat is Cairo in the state's southern tip, also is burdened with the state's highest unemployment and poverty rates -- 11.5 percent and 26 percent, respectively.
For Harold McNelly, the county commissioner, the high rate of dependence on government assistance comes as no surprise.
Finding a job is difficult in his county because of the high cost of workers' compensation insurance. As a result, employers set up shop in the neighboring states of Missouri and Kentucky, where business costs are much lower, McNelly said.
"It's eating our lunch and we can't get any relief from it," McNelly said. "There just isn't any businesses down here."
McNelly, 74, acknowledged that bold steps need to be taken to reform the federal entitlement programs that sent the nation's debts soaring.
"If we don't do something, the whole country's going to collapse," he said.
As for which programs to cut, McNelly declined to offer an opinion.
McNelly, retired after serving as supervisor of his county's public aid programs.
In that capacity, he learned a lesson that Obama and federal lawmakers are now confronting:
"When they bring these programs into effect, people get adjusted to them," he said. "It's hard to get unadjusted to them."
Contact reporter Mike Fitzgerald at firstname.lastname@example.org or 618-239-2533.