A heroic nurse stepped in to save an elderly patient from a Doctor that was about to cut into the patients vein with a scalpel in order to take a blood sample. Doctor Vincent Osunkwo received the job of senior house officer at Midland Regional Hospital in Portlaoise after he was the only one to apply for the position Continue Reading

It’s been more than 15 years since the Institute of Medicine released its seminal 1997 report detailing the suffering many Americans experience at the end of life and offering sweeping recommendations on how to improve care.

So has dying in America gotten any less painful since then?

Despite efforts to build hospice and palliative care programs across the country, the answer seems to be a resounding no. The number of Americans experiencing pain in the last year of life actually increased by nearly 12 percent between 1998 and 2010, according to a study released Monday in the Annals of Internal Medicine. In addition, depression in the last year of life increased by more than 26 percent.

All that, as guidelines and quality measures for end-of-life care were developed, the number of palliative care programs rose and hospice use doubled between 2000 and 2009.

“We’ve put a lot of work into this and it’s not yielding what we thought it should be yielding. So what do we do now?” asked study author Dr. Joanne Lynn, who directs the Center for Elder Care and Advanced Illness at the Altarum Institute.

The study looked at 7,204 patients who died while enrolled in the national Health and Retirement study, a survey of Americans over age 50.  After each participant’s death, a family member was asked questions about the person’s end-of-life experience, including whether the person suffered pain, depression or periodic confusion. Those three symptoms were all found to have become more prevalent over the ten-year analysis.

One reason, Lynn said, is that doctors are using a greater range of high-tech treatments, which can lengthen the process of dying without curing the patient. “We throw more medical treatment at patients who are on their way to dying, which keeps them in a difficult situation for much, much longer,” she said. “We’ve increased the number of people put on ventilators and kept in hospitals, and we simply have more treatments that are possible to offer.”

The majority of our research, she added, focuses on wiping out diseases, rather than long-term supports or symptom management for people with chronic conditions or disabilities associated with aging: “Think about how much we invest in curing Alzheimer’s disease, and how little we put into making the course of Alzheimer’s better.”

Most physicians tend to under-treat pain and other symptoms at the end of life because they don’t recognize them or are hesitant to candidly talk about the process of dying and the pain associated with it, said Dr. Tim Ihrig, a palliative care physician at UnityPoint Health in Fort Dodge, Iowa.

“A lot of practitioners aren’t honest. We fail to empower patients with the truth,” said Ihrig. “In that setting, it’s easier to continue to do procedures and diagnostics rather than having that conversation which is very honest and very difficult.”

Take a cancer patient who has stopped eating and is writhing in pain, he said. An oncologist might recognize the person is going to die, but rather than telling the patient, he or she begins another round of treatment that causes more pain and suffering.

“We don’t have the vernacular in our society to have the conversation about the end of life. People say, ‘I don’t want to take away someone’s hope.’ But in a metastatic pancreatic cancer, for example, we have to redefine what we mean by hope,” he said, citing one of the most deadly cancers.

Often, those conversations aren’t happening until last days or hours of life, according to Ihrig.

Jonathan Keyserling, a senior vice president with the National Hospice and Palliative Care Organization, points out that half of all hospice patients receive hospice care for less than 30 days.

“If these patients had been under the care of a hospice or palliative care program [earlier], their pain and symptoms could have been brought under control for a much longer and sustained period of time,” Keyserling said via email.

It’s possible, however, that caregivers interviewed in the study simply reported more suffering, reflecting Americans’ changing awareness of pain and depression over the past decade.

“We’ve raised the expectation of better pain management over the years, which may make [the caregivers interviewed] more likely to report it,” says Rosemary Gibson, author of The Treatment Trap and senior advisor at The Hastings Center, a bioethics think tank based in New York. There are many more Americans diagnosed with depression today than in 1998, she added, “so it’s not surprising that people would report it more.”

Nonetheless, said Gibson, the country has a long way to go in improving care at the end of life.  The increase in palliative care and hospice use over the last decade was just ”an oasis in the desert. We did nothing to stop the tsunami of overuse [of aggressive treatments] and doing things to people at the end of life that have no benefit.”

It’s time to pick up the speed of change, said study author Joann Lynn.

“We are all going to pass through this part of our lives, and we have a strong interest in its not being awful. So let’s buckle down and get it right.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Carl Krawitt has watched his son, Rhett, now 6, fight leukemia for the past 4 and a half years. For more than three of those years, Rhett has undergone round after round of chemotherapy. Last year he finished chemotherapy, and doctors say he is in remission.

Now, there’s a new threat: measles.

Rhett cannot be vaccinated, because his immune system is still rebuilding. It may be months more before his body is healthy enough to get all his immunizations. Until then, he depends on everyone around him for protection — what’s known as herd immunity.

But Rhett lives in Marin County, Calif., a county with the dubious honor of having the highest rate of “personal belief exemptions” in the Bay Area and among the highest in the state. This school year, 6.45 percent of children in Marin have a personal belief exemption, which allows parents to lawfully send their children to school unvaccinated against communicable diseases like measles, polio, whooping cough and more.

“It’s very emotional for me,” Carl Krawitt said. “If you choose not to immunize your own child and your own child dies because they get measles, OK, that’s your responsibility, that’s your choice. But if your child gets sick and gets my child sick and my child dies, then your action has harmed my child.”

Krawitt is taking action of his own. His son attends Reed Elementary in Tiburon, a school with a 7 percent personal belief exemption rate. (The statewide average in California is 2.5 percent). Krawitt had previously worked with the school nurse to make sure that all the children in his son’s class were fully vaccinated. He said the school was very helpful and accommodating.

Now Krawitt and his wife, Jodi, have emailed the district’s superintendent, requesting that the district “require immunization as a condition of attendance, with the only exception being those who cannot medically be vaccinated.”

Carl Krawitt provided me with Superintendent Steven Herzog’s response. Herzog didn’t directly address their query, instead saying: “We are monitoring the situation closely and will take whatever actions necessary to ensure the safety of our students.”

Typically, a response to health emergencies rests with county health officers. During the current measles outbreak, unvaccinated students at Huntington Beach High School in Orange County were ordered to stay out of school for three weeks after a student there contracted measles. It’s one way to contain an outbreak.

But those steps were taken in the face of a confirmed case at the school.

Marin County health officer Matt Willis said he was going to check with the state to see what precedent there was to keep unvaccinated kids out of school even if there were no confirmed cases. “This is partly a legal question,” he said.

Right now, there are no cases of measles anywhere in Marin and no suspected cases either. Still, “if the outbreak progresses and we start seeing more and more cases,” Willis said, “then this is a step we might want to consider” — requiring unvaccinated children to stay home, even without confirmed cases at a specific school.

Rhett has been treated at the University of California, San Francisco, and his oncologist there, Dr. Robert Goldsby, said that he is likely at higher risk of complications if he were to get measles.

“When your immune system isn’t working as well, it allows many different infections to be worse,” Goldsby said. “It’s not just Rhett. There are hundreds of other kids in the Bay Area that are going through cancer therapy, and it’s not fair to them. They can’t get immunized; they have to rely on their friends and colleagues and community to help protect them.”

Goldsby pointed to the number of people who, when facing a friend or family member who receives a challenging diagnosis, will immediately ask how they can help. “Many families will say, ‘What can I do to help? What can I do to help?’ ” he said, repeating it for emphasis. “One of the main things they can do is make sure their [own] kids are vaccinated to protect others.”

Krawitt has been speaking up about vaccination for a long time now. He told me about going to a parent meeting at his daughter’s school just before the start of the school year, where a staff member reminded parents not to send peanut products to school, since a child or children had an allergy. “It’s really important your kids don’t bring peanuts, because kids can die,” Krawitt recalls the group being told.

The irony was not lost on him. He told me he immediately responded, “In the interest of the health and safety of our children, can we have the assurance that all the kids at our school are immunized?”

He found out later from a friend that other parents who were present were “mad that you asked the question, because they don’t immunize their kids.”

This story is part of reporting partnership that includes KQED, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

More than 400,000 Medicare beneficiaries who may have been confused or misinformed about the pharmacy details of their 2015 Aetna prescription drug plans have until the end of this month to find participating pharmacies or switch plans, according to the Centers for Medicare & Medicaid Services.

The kerfuffle highlights the growing complexity of many Medicare prescription drug plans, policy experts say. Today, in the majority of plans, beneficiaries who want to keep their out-of-pocket costs as low as possible have to contend not only with whether a pharmacy is in a plan’s network. But they also generally have to make sure that their pharmacy is part of the “preferred” network set up by the insurer to get the lowest cost-sharing.

“When you look at the top 10 standalone drug plans by enrollment, the vast majority use preferred pharmacy networks,” says Christine Harhaj, a senior manager in the health reform practice at Avalere Health. “It’s a way to offer plans with a really low premium.”

Plans with preferred pharmacy networks typically offer Medicare beneficiaries the lowest copayments or coinsurance at select pharmacies or pharmacy chains. Members can also use other pharmacies that are in their plan’s network, but their out-of-pocket costs will generally be higher, though not as high as if they went to a pharmacy that was outside their plan’s pharmacy network.

Figuring out those details isn’t always straightforward, even for those who use the CMS’ online Medicare Plan Finder, where beneficiaries can enter their drug and pharmacy specifics and compare drug plans. Choosing a plan is complicated, and a preferred pharmacy may not always offer the best price for every drug someone takes. In addition, other factors such as star ratings may influence a beneficiaries’ choice of plan.

Beneficiary problems with Aetna plans were twofold. The insurer inaccurately identified roughly 5,000 pharmacies as available in-network for retail customers on both the Medicare Plan Finder and the insurer’s own website, as well as through its customer service representatives, according to CMS.

In addition, the insurer made significant changes to its pharmacy networks this year. In 2015, pharmacies that were in network for approximately 220,000 members last year no longer fall into that category, CMS says. Similarly, the in-network pharmacies that provided preferred cost-sharing to 240,000 members last year no longer do so in 2015.

According to an email from a CMS spokesperson, “Because of the number of pharmacy disruptions, inaccurate information provided to beneficiaries, and confusion experienced at the beginning of 2015 by both beneficiaries and pharmacies,” Aetna, at CMS’ urging, gave all its Part D plan members in-network access to its broadest pharmacy network until at least the end of February. During that time, members who want to remain in the plan but have discovered that their pharmacy of choice is out of network can identify a pharmacy that’s in their plan’s network; others can request a Special Enrollment Period to pick a new plan.

“Many members saw changes to their networks and plans for 2015,” Cynthia Michener, a spokesperson for Aetna, said in an email. “Throughout last year, we reached out to members in several ways to ensure these changes were well communicated. But we’re finding members may need more time to understand their benefits.”

Although preferred pharmacy networks may make comparing drug plans more complicated, they’re generally less expensive, research has found.

According to an analysis of 2014 drug plan premiums by Avalere Health, average monthly premiums were $29.83 for basic plans with preferred networks, 17 percent less than the average cost of plans without. Likewise, the average premium for enhanced drug plans–which generally have lower cost sharing but higher premiums than basic plans, and may cover more drugs–was $49.15 with a preferred network, 57 percent less than for a plan without.

Preferred networks are “another way for plans to manage costs within their existing pharmacy network,” says Juliette Cubanski, associate director of the Program on Medicare Policy at the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.)

Drug plans with preferred cost sharing are somewhat less accessible in urban areas, according to a CMS analysis. On average, 79 percent of beneficiaries who live in urban areas have convenient access to pharmacies with preferred pricing, compared to 94 percent of beneficiaries in the suburbs and 88 percent of beneficiaries in rural areas.

Independent pharmacies say they’re too often excluded from bidding to be included in insurers’ preferred pharmacy networks, to the detriment of patients.

“We do think that patients are being steered to pharmacies and not being allowed to go to the pharmacy of their choice,” says Douglas Hoey, CEO of the National Community Pharmacists Association.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

California spends less per person than any state on diabetes prevention programs, even as one in 12 California adults is estimated to suffer from the chronic disease, according to a new report from the California State Auditor.

Using only federal grants, California spent just 3 cents per person on diabetes prevention in the 2012-2013 fiscal year, compared to New York’s 42 cents per person in state and federal money that year, the report noted.

No state funding is available for diabetes prevention in California, although the Department of Public Health has solicited the federal grants for programs in some counties, according to the report. The audit takes the agency to task for not doing more.

A California Department of Public Health spokesman said no one was available for comment on Friday.

Because of declines in federal funding, California in 2012 shuttered nine regional centers devoted to reducing gestational diabetes. Now it has just website with information on the condition, which can affect nearly 10 percent of pregnancies.

But the state is not alone in underfunding prevention efforts, according to advocates.

“I know we’re on the bottom of the pile on this, but what money is out there for diabetes is just a pittance across the country, when you look at the size of the problem of diabetes,” said Michael Chae, executive director of the American Diabetes Association’s regional office in Oakland, Calif. “I’d say you could take this report for most large states and it would read similarly.”

Diabetes is a chronic disease that occurs when the body either cannot make enough insulin to control blood sugar (type 1) or cannot process insulin normally (type 2). Although diabetes can be controlled with medications and lifestyle changes including diet and exercise, the yearly health care and related costs of the disease have been estimated at $27.5 billion in California alone, according to the American Diabetes Association.

The state auditor’s report acknowledged that the state public health agency appropriately spends its federal dollars. It also recently received new federal grants for diabetes prevention efforts in four counties. But the report faulted the agency for not doing more to identify additional funding and for not expanding programs to other counties with high diabetes rates. Auditors were able to identify two additional federal grants totaling $1 million that the state could have applied for but did not.

The auditor described the public health agency’s stated goal of preventing diabetes in 380,000 people by 2022 as “lofty.” It concluded, however,  that the agency “will need to do more than it has been able to in the past with its limited funding.”

Nationwide, nearly 30 million Americans live with diabetes and about 1.7 million people are newly diagnosed each year, according to the U.S. Centers for Disease Control and Prevention. More than 2.3 million California adults report they have been diagnosed with diabetes and many others are considered to have the disease but do not know it. Still others are considered to be at high risk, or “prediabetic,” based on their blood sugar levels.

Chae and other diabetes advocates said they have tried repeatedly over the years to persuade  lawmakers to devote state money to diabetes prevention, to little avail.

It’s challenging to convince lawmakers and the public to devote more money to diabetes prevention, Chae said, because the disease is often unfairly characterized as a lifestyle problem caused by poor choices such as unhealthful eating and inadequate exercise. In addition, it progresses slowly, and symptoms are often invisible for years.

However, years of state reliance on federal grants alone has resulted in uncoordinated programs and staffers who come and go as the grants do, said Joan Werblun, a retired nurse and longtime advocate who helped found the Diabetes Coalition of California.

“When you get these grants, you’re so tied into the specifics of the grants, and most of the time, it’s about data collection on how the grant is going,” Werblun said. “That’s where the money’s going. The state’s very happy to point at their projects, but they’re very small and there’s no continuation when the money’s gone. What we need are more people in the communities doing the work.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

When Florida workers promoting President Barack Obama’s health law marketplace want instant feedback, they go to an online “heat map.” The map turns darker green where they’ve seen the most people and shows bright red dots for areas where enrollment is high.

“The map shows us where the holes are” and what communities need to be targeted next, said Lynn Thorp, regional director of the Health Planning Council of Southwest Florida. She hands out information about the health law’s marketplace at rodeos, farmers markets, hockey games —almost any place where people gather.

That mapping strategy is one reason why a Republican-controlled state like Florida, whose leaders have criticized the health law at every turn, is leading the nation in signing people up for private Obamacare health plans. With two weeks to go until the deadline for 2015 enrollment, Florida’s tally exceeds that of even Democratic-led California, which has embraced the law building its own online marketplace and has twice the population and uses three times as much federal funding for outreach.

“It’s surprising Florida has done as well compared to other states, and they will be looked at by folks who want to learn lessons to promote enrollment,” said Joel Ario, managing director for Manatt Health Solutions, a consulting firm, who worked for the administration setting up the exchanges soon after the law was passed.

As of mid-January, 1.27 million Floridians had enrolled in exchange plans, according to federal data, compared to 1.2 million Californians. Texas, which has 6 million more people than Florida, enrolled about 919,000 people in private plans. Both Florida and Texas have a 22 percent uninsured rate. California’s rate is 17 percent, according to latest Census data.

“It is truly ironic that Florida leads the nation in enrollment … with leadership that has actively opposed the law,” said Leah Barber-Heinz, executive director of Florida CHAIN, an advocacy group involved in outreach efforts. “It shows true commitment on the part of many and it portrays an extremely high need for affordable coverage.

There are other reasons cited for Florida’s robust enrollment —including intense competition among insurers in several big counties and the high degree of coordination among the nonprofits and community groups which received federal grants to sign people up.

Another key factor is the state’s decision not to expand Medicaid under the law. That’s left consumers with incomes above the federal poverty level of $11,600 per year with no coverage option other than to buy a private plan — with help from sliding-scale government subsidies.  About 800,000 Floridians who make less than the federal poverty level are shut out altogether because they make too little to qualify for subsidies for private plans, but too much to qualify for Medicaid. In Florida, adults with children qualify for Medicaid only if their income is below 34 percent of the poverty level. Childless adults are ineligible. Florida is one of 22 states that chose not to expand Medicaid after the U.S. Supreme Court made that provision optional for states.

In contrast, California expanded Medicaid to those making up to 138 percent of the poverty level, or $16,100 for an individual. The program has grown by 2.3 million people since fall of 2013, boosted partly by publicity for the online marketplace.

Covered California spokesman James Scullary said the exchange is not allowed to enroll people in private plans if their incomes fall between 100 and 138 percent of the federal poverty line, because they qualify for Medicaid.

Jon Urbanek, senior vice president of Florida Blue, the state’s dominant insurer, credits Florida’s strong enrollment in private plans, in part, to the state’s decision not to expand Medicaid.  He also points to the intense outreach by thousands of the carrier’s insurance agents. Florida Blue has conducted about 3,000 “town-hall” style meetings at its 18 retail centers. “We knew going in that this was going to be a face-to-face, get in the community type of action to build trust with people,” he said.

Florida has also gained from having an older population which is more likely to buy coverage than younger people, Ario said.  That population is centered in a handful of urban areas such as Miami, Orlando and Tampa, making them easier to target, he said.

In contrast, many uninsured Texans live outside the big markets of Dallas, Houston and San Antonio. Texas also has a higher proportion of Hispanics who have been more challenging to enroll because of language barriers.

Then there’s the unusual effort to coordinate outreach. John Gilbert, national field director for Enroll America, a nonprofit doing outreach in 10 states, said Florida has benefitted from having several large nonprofits with experience signing up children for Medicaid.  They have worked together closely  – helped in part by the heat map.

Thorp of the Southwest Florida Health Planning Council describes how every time she hands out Obamacare flyers at a fair, or counsels at a local library, the action get entered into a computer log, which immediately changes the heat map. That way, other outreach workers see where contacts have been made.

Data from actual enrollment in the Obamacare health plans is added using dots, although that information lags because it is controlled by the U.S. Department of Health and Human Services.

The darker the dots on the map, the more saturated the enrollments in that zip code. When users hover over a dot, it pulls up a box showing how many residents in that zip code received outreach, including how many got one-on-one help filling out an application.

“We can then make sure we are appropriately allocating resources,” said Melanie Hill, executive director of the Tampa-based Family Health Care Foundation, which devised the mapping tool. Her group is working with the University of South Florida, which received a $5.4 million federal grant to help people anywhere in the state enroll. In all, Florida nonprofits received $6.8 million in federal “navigator” grants.

Perhaps another, harder-to-measure factor is how advocates have been fired up by the opposition of many of the state’s political leaders, said Barber-Heinz of Florida CHAIN.

“Stakeholders that didn’t work together in the past are working together on this,” she said. “It drives us to work even harder.”

Barbara Feder Ostrov contributed to this story.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

After the insurance exchanges set up under the Affordable Care Act first went live in late 2013, Lori Lomas started combing the website of Covered California on a hunt for good deals for her clients. Lomas is an agent at Feather Financial, in the Sierra Nevada mountain town of Quincy, California; she’s been selling health policies in rural communities for more than 20 years.

But in 2013, she noticed a troubling change that surprised her: For many clients, insurance options decreased.

“I just started running quotes for people,” Lomas says, “and began realizing that in [some] zip codes, the only thing that shows up is Anthem.”

In addition to Anthem Blue Cross, Blue Shield of California used to sell policies to individuals in every county in the state, according to the Department of Managed Health Care, one of California’s two teams of health insurance regulators. But by 2014’s open enrollment period, Blue Shield had pulled out of 250 zip codes throughout the state, including four entire counties: Alpine, Monterey, Sutter, and Yuba.

The gaps are particularly felt in the top third of the state, where thousands of residents now have only one choice of insurer if they want to buy a health plan on the exchange.

That’s in contrast, Lomas says, to other spots, like the San Francisco Bay Area, where she’s also been helping clients find policies on the state exchange. “I’d do it for them,” she says, “and, wow, there are six insurance companies or seven insurance companies. I think that was when I first realized how, truly, we were getting the shaft up here.”

Blue Shield of California declined an interview with NPR. But in a written statement, the company reported that it’s not selling in certain areas of California because it could not find enough health providers willing to accept a level of payment that would keep premiums low. According to the statement, the company also is not selling in areas where there is no contracted hospital within 15 miles.

Because of the broad changes in the individual health insurance market under the Affordable Care Act, “there is no accurate apples-to-apples comparison between the individual market in 2013 and the individual market in 2014 and beyond,” Blue Shield said, adding that “coverage areas were designed to meet regulatory guidance and with patient access to care in mind.”

Blue Shield of California is acting within the law, says Shana Alex Charles, director of health insurance studies at UCLA’s Center for Health Policy Research. She says Blue Shield could have offered to pay health care providers more. But, at the same time, she adds, insurance companies can’t be forced to operate at a loss.

“There’s no public charge that says they have to be in those zip codes,” she says. “If they determine that it’s not within their company’s best interests to remain there and sell their product there, then they won’t be there.”

That’s generally allowed under the federal health law — plans don’t have to sell throughout an entire state, for example. Consumer advocates say there is often a lack of doctors in rural areas, and agree that insurers shouldn’t sell plans where there isn’t a good network. But UCLA’s Charles says consumers lose when there are not many insurers to choose from.

“Competition breeds choice,” she says, “and people that are competing against each other, work to keep the consumer as happy as possible, so that the consumer will chose them. Competition in the marketplace is a good thing, in that it does keep companies, in some sense, honest.”

Two other companies — Assurant Health and Moda Health — are selling health policies in Northern California, but not on the state exchange. So if consumers choose to buy those plans, they can’t get the subsidies offered under the federal health law.

Assurant Health says it sells individual policies in every California zip code and covers out-of-state care. Moda Health just started selling individual policies in California for 2015.

This story is part of reporting partnership that includes Capital Public Radio, NPR and Kaiser Health News.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Consumers who received too much in federal tax credits when buying insurance on the health law’s marketplaces last year got a reprieve of sorts from the Internal Revenue Service this week. Although they still have to repay some or all of the excess subsidies, the IRS won’t ding them with a late payment penalty if they don’t repay it by the April 15 tax deadline.

“They’re trying to make this work,” says Timothy Jost, a law professor at Washington and Lee University who’s an expert on the health law.

Under the law, people with incomes between 100 and 400 percent of the federal poverty level ($11,670 to $46,680 for an individual in 2014) who did not have insurance through their job could qualify for tax credits to make premiums more affordable. They could elect to have these subsidies paid in advance directly to the insurance company, and many did. A typical tax credit was about $3,000 annually.

The amount people received was based on an estimate of their 2014 income. At tax time, that amount has to be reconciled against consumers’ actual income on IRS Form 8962. If consumers or the marketplace underestimated their 2014 income, they may have received too much in tax credits and have to pay back some or all of it.

How much people have to repay is based on their income and is capped at $2,500. People with incomes over 400 percent of the poverty line have to repay the entire amount, however.

This penalty reprieve only applies to the 2014 tax year. The IRS will allow people to repay what they owe on an installment basis. But be forewarned: Interest will continue to accrue until the balance is paid off.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.