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Millions of Americans may be in for a shock when they file tax returns and learn that they have to pay a fine for failing to enroll in health insurance in 2014 and an even bigger fine for failing to enroll in 2015 before the enrollment period ended on Feb. 15. While there is nothing they can do to avoid the 2014 fine, which must be paid this year, they could avoid the 2015 fine, payable next year, if the Obama administration allowed them more time to enroll. (2/19)

Apparently, there is a movement afoot to get the Barack Obama administration to line up the Affordable Care Act's open-enrollment period with tax season. The reason: Many people are going to find out in March or April that they owe a penalty for not having the minimum essential insurance coverage. ... At first blush, it seems like a no-brainer to just move open enrollment so that people who get hit with the penalty can have an ouchie, then log on to the exchange to sign up. However, it's actually a lot more complicated than that. (Megan McArdle, 2/19)

King v Burwell, the lawsuit before the Supreme Court that conservatives regard as their last big hope to destroy the Affordable Care Act, has been coming apart on the merits for months. Now there's evidence that it was never even properly filed. Pressure is growing on the Supreme Court to drop the case because of doubts that its plaintiffs have any standing to sue: "It would be highly improper (and embarrassing) for the Court to decide the merits of such an important case" when there are such doubts, writes Gerard Magliocca of Indiana University school of law. The fraying of the lawsuit's claims and the doubts about its plaintiffs' standing point to the fundamental problem with King v Burwell: it's an ideological attack on Obamacare, ginned up by the Cato Institute among others, masquerading as a rule-of-law case. (Michael Hiltzik, 2/18)

The Obama years will also be remembered for his signature legislation — the Affordable Care Act. This week, the president said that 11.4 million people had signed up for insurance or renewed coverage under the plan. Needless to say, the program is reducing the number of people who are uninsured but it also appears to be lowering medical costs. Yet the future of the act is unclear. There is a case (King v. Burwell) before the Supreme Court — a laughable case about a language quibble that may be the most significant linguistic imprecision of a generation — that could spell doom for the law by withholding subsidies from millions of low-income Americans to purchase health insurance. (Charles M. Blow, 2/19)

Not that it's going to happen, but we'll say it anyway: Gov. Scott Walker should reverse his decision to say "no" to additional federal money to expand the state's health care programs for the needy. It was a costly, shortsighted decision. For the governor, it was about a conservative standing firm against Obamacare. But for taxpayers, it was about losing the chance to save up to $345 million over the next two years. (2/17)

[T]hanks to Obamacare, which Republican lawmakers have dedicated themselves to repealing, all members of Congress and their staffers have to purchase coverage through an online exchange, just like everyone else who doesn't receive insurance from an employer. Nearly 13,000 members of Congress and staffers are currently enrolled in gold-level Small Business Health Option Program plans on the Washington, D.C., exchange. However, both Republican and Democratic lawmakers have introduced bills challenging the federal subsidies received for their coverage. (David Lazarus, 2/18)

Facing the uncertainties of the complex new world under the Affordable Care Act, Minnesota should be prepared to protect what it's got right when it comes to health care. That's among conclusions we draw from a report ready for release Thursday by the Minnesota Business Partnership, which represents the state's largest employers. (2/18)

In health care there is a similar danger of focusing on improving our “test scores” at the expense of real improvement in patient safety—and in this case, the exams have serious flaws. The federal government uses a composite measure of patient safety to help determine whether hospitals are penalized under two programs. One of those programs, the Hospital-Acquired Conditions Program, in December reduced Medicare reimbursements by 1% for 721 hospitals for their rates of preventable harms, such as serious blood clots, pressure ulcers, and accidental punctures and lacerations. Serves them right, you might think. These hospitals are unnecessarily harming patients. That might be true if the test of their patient safety performance was scientifically sound. (Peter Pronovost, 2/18)

After 40 years of warning Americans to avoid cholesterol-rich foods, the nation’s top nutrition panel is poised to tell the public, in effect, “never mind.” The Dietary Guidelines Advisory Committee, which shapes authoritative federal nutritional recommendations, has concluded that there is insufficient evidence to back up its long-standing 300-milligram-per-day limit on cholesterol intake, The Post reported last week. ... There’s a lesson here for all of us, especially those who urge that this or that public policy be dictated by “the science.” To be sure, that lesson is not that all science is as poor a guide to policy as the cholesterol research that led to such misallocation of scarce resources. ... Still, some science is bound to disappoint, or mislead, at significant social and financial cost, before it gets corrected. Unfortunately, consumers, or voters, including the best-educated ones, are poorly positioned to separate the wheat from the chaff. (Charles Lane, 2/18)

A month ago, I felt that I was in good health, even robust health. At 81, I still swim a mile a day. But my luck has run out — a few weeks ago I learned that I have multiple metastases in the liver. ... It is up to me now to choose how to live out the months that remain to me. I have to live in the richest, deepest, most productive way I can. ... I feel a sudden clear focus and perspective. There is no time for anything inessential. I must focus on myself, my work and my friends. (Oliver Sacks, 2/19)

Some parents of children with attention deficit disorder got a welcome surprise last month. If they went to refill a prescription of Intuniv, a popular ADD treatment, they discovered that its monthly cost had dropped by 80 percent. The reason: The patent on the drug had expired at the end of 2014, and the generic was available. The process of using generic substitutes for expensive prescription drugs can be speeded up even more, saving U.S. consumers billions of dollars a year. This opportunity comes from an unusual source: the negotiations for the Trans-Pacific Partnership treaty. (Caroline Freund, 2/18)

Psychiatric drugs are now being given to infants and toddlers in unprecedented numbers. An analysis of 2013 IMS Data, found that over 274,000 infants (0-1 year olds) and some 370,000 toddlers (1-3 years age) in the U.S. were on antianxiety (e.g. Xanax) and antidepressant (e.g. Prozac) drugs. This report also found over 1,400 infants were on ADHD drugs. ... Most use in such young children is “off-label,” posing safety concerns. For example, a 2013 study of 44,000 children found that antipsychotic drugs tripled the risk for developing diabetes–confirming our warning in 2001. Are psychiatric diagnoses reliable in such young children? Why are tens of thousands of children getting drugs outside guidelines? What is the most humane way to manage behavior changes in children? (Murali Doraiswamy, 2/19)

Fortunately, there's a program that tries to make sure low-income children are able to eat breakfast each day: the decades old School Breakfast Program, which helps provide free or near-free morning meals to poor students. Unfortunately, the program is failing to live up to its potential. The School Breakfast Program still isn't feeding nearly as many poor students as it should be. In fact, the program is falling short by at least ten million students, if not more, according to a new study by the Food Research and Action Center (FRAC). (Ferdman, 2/18)

Information about Theranos, a privately held biotechnology company that has developed novel approaches for laboratory diagnostic testing, has appeared in The Wall Street Journal, Business Insider, San Francisco Business Times, Fortune, Forbes, Medscape, and Silicon Valley Business Journal—but not in the peer-reviewed biomedical literature. ... Moreover, the company has teamed with Walgreens pharmacies in Palo Alto and Arizona to create “Theranos Wellness Centers.” A footnote in the respective Walgreens webpage mentions that the laboratories are Clinical Laboratory Improvement Act–certified. According to the same sources, Theranos has operated in stealth mode for more than a decade, not publishing anything in the literature while preparing to change the entire health system: “One closely guarded secret is… how exactly the technology behind its blood test works.” (Dr. John P. A. Ioannidis, 2/17)