When I print my cards, my routine is to open the PDF into photoshop, and copy each page into a template that I've made. After checking that the cards match the size of the template and the alignment is correct, I'll then print using custom page offset values so the card backs and fronts line up.

This way all of my health cards are the same size and the oversized card backs fit nicely over the cards so that when fluctuation does happen while printing, it is hidden.

It takes a while, setting it up and printing it out, but how often do you print decks verses play with them? Mis-sized health cards or misaligned cards are an eye sore and it bothers me so the little extra time spent printing makes me feel like good because that means I don't have to waste ink by printing it again to correct errors