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LTCI Watch: Money talks

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Personally, I find that the appendix showing detailed 2015 budget estimates for the U.S. Department of Health and Human Services (HHS) is hard to read.

Some of the entries — for various types of “obligations by program activity” — seem to represent expenses, but other “obligations” look revenue.

Example: The “marketplace user fees” entry for the new Patient Protection and Affordable Care Act (PPACA) public exchanges would go up to $1.1 billion in 2015, from $200 million this year, and that looks as if it must be revenue, not an expense, but it’s in the obligations section.

It’s all a mystery, but maybe not all that important of a mystery, because Republicans and Democrats will probably go into an electronic cigarette vapor filled room somewhere, push the country to the brink of nuclear war, then, just when the bombers are about to reach the point of no return, approve a tweaked version of the 2014 budget.

But I think one message is that the Obama administration is not optimistic about the idea that the country will spend much more on Administration for Community Living programs for the elderly.

The budget includes $380 million for a senior employment program, but the allocations for many other nice little programs for the elderly, such as a long-term care ombudsman program ($16 million) or an Alzheimer’s disease initiative ($11 million) are flat.

Some, including an item for an Aging and Disability Resources Center ($6 million this year) seem to go to zero in 2015.

Maybe, in some cases, the administration has simply shifted funding for programs from one part of the budget to another.

In some cases, maybe the programs really aren’t all that necessary. If, for example, the government is spending just $6 million on an Aging and Disability Resources Center: On the one hand, the center sounds really nice. On the other hand, couldn’t there be some way to get a private organization to write a check and create a bigger, better version of the same center?

But, whether you love government spending on information resource centers or think the government would be better off blowing off the idea entirely, or just paying eHealth a little cash for aging resources custom content campaign: The Democratic “big spenders” are not being particularly ambitious about aging resources programs.

If this is what big spending looks like in fiscal year 2015 — when the baby boomers are obviously getting creaky, but we actually haven’t had to spend much money on their care yet, and are still able to keep up the illusion that we’re solvent — then government big spending on aging resources in 2035 may not be pretty.

All sorts of factors could go surprisingly well and ease our problems.

But, if current trends continue, there simply is no practical alternative to private long-term care (LTC) planning. The federal government is not going to come to the rescue. 

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