With several hundred protesters outside the Capitol building in Sacramento Wednesday, the bill sparked a debate about individual rights and responsibilities.

Vaccine opponents, who have been relatively quiet during the measles outbreak, turned out in force. They wore American flags, and one child held a sign that said, “Force my veggies, not vaccines.” The opponents say eliminating California’s current exemption that allows parents to refuse vaccinations for their children based on personal beliefs will threaten their ability to do what’s right for their kids.

“I think that everybody should be able to make their own choice,” said Lisa Cadrain of Los Angeles, who fears vaccines would harm her daughter. “I am afraid that her big beautiful blue eyes will not focus on me anymore, and she won’t be the kid that she is.”

Some opponents fear that the vaccinations are linked to an increase in the number of cases of autism in the country, but scientific studies show between vaccines and autism spectrum disorder.

Inside the hearing, parents who support the bill also talked about protecting their kids — from children who aren’t vaccinated. Democratic state is on the Senate Health Committee and said she’s a strong proponent of vaccinations.

“Our individual rights aren’t without limits, and in this particular case, your insistence on your right really could harm my children or my grandchildren,” Wolk said.

Parents also testified in support of the bill, including Ariel Loop, whose baby son Mobius contracted measles in the Disneyland outbreak. Now 7 months old, he was too young to be inoculated when he was exposed to the virus.

“I understand being skeptical and wanting to research and do what’s best for your child,” Loop said. “I had actually looked into the alternate [vaccination] schedules myself. But there’s no science in support of it, and I’ve got to go with science. I don’t know better than all of these doctors.”

Children their first measles, mumps and rubella vaccine between 12 and 15 months of age. When enough of a given population is inoculated protects babies less than a year old and other people who can’t be vaccinated from being exposed to the diseases.

The Senate health committee passed the bill 6 to 2 on Wednesday. That was just the first step – the legislation has many more hearings before it could become law. Meanwhile, , and have also considered legislation to limit families’ rights to opt out of mandatory vaccinations, and all of those efforts have stalled. West Virginia and Mississippi are that allow no exemptions to their vaccine laws for personal beliefs or religion.

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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 , 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 — and — 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.

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Wright lives in a modest house overlooking a pasture in Indian Valley. It’s a tiny alpine community at the northern end of the Sierra Mountains, close to the border with Nevada. He lives in one of 250 zip codes where Blue Shield of California stopped selling individual insurance policies in 2014.

“That was new to us, you know, Covered California. Anthem Blue Cross was the insurance carrier. Then of course, three months later I have a heart attack,” says Wright.

More than once, he was flown across the state line to Reno for care. Wright and his wife, Kathy, now have piles of medical bills and insurance paperwork. Anthem Blue Cross covers emergencies when they happen out-of-state but not routine doctor care in another state.

But Wright says traveling to doctors within California is not as safe or as convenient for him as going to Reno.

He continues to see the Nevada doctors who put a defibrillator in his chest and saved his life. Anthem Blue Cross will pay for some of the bills, but the Wrights still don’t know if everything will be covered.

There are other insurance options for Wright, but not through Covered California. Although he didn’t need a subsidy, he was left in the same position as people in his area who do need financial help to buy insurance. Lower income people cannot take their business to a competitor, because the exchange is the only place customers can use federal subsidies to help them buy health insurance. And for those people, Anthem is the only option.

“I mean, you should have some choices, especially if you’re going to have one that’s not going to cover you in the places you choose to go,” Wright says.

Covered California Executive Director offered a different impression of choices in the marketplace last July.

“In every corner of the state, consumers will have at least two plans to choose from, and in most areas, where most of the Californians live, they can choose between five or six plans,” said Lee during an event to announce the marketplace’s 2015 plans and premium rates.

But in in Northern California, there are zip codes where there is only one choice of insurer. There are areas around Monterey and Santa Cruz on California’s Central Coast that also have only one carrier.

Blue Shield of California said it had to stop selling individual plans in areas where it didn’t have a contracted hospital nearby. It said it offered doctors certain rates to keep the premiums low, but not enough doctors accepted those payment rates.

Covered California estimates that statewide, there are 28,896 Covered California customers who have only one choice of insurance carrier, slightly more than 2 percent of the total exchange membership as of November 2014.

Lee says now, the exchange is working to increase the range of choices in places where there are none. But he says the situation existed long before the exchange.

“The challenges of northern, rural counties have been there for a long time and are still a challenge that we’re trying to address head-on,” says Lee.

Lee says the exchange is now discussing how to bring more insurer competition to these areas in 2016.

“We aren’t the solution to all the problems that have always been there in terms of challenges in rural communities, and that’s something we’re certainly looking at how to improve access and choice, and we’ll continue doing that,” says Lee.

Covered California should help increase the number of insurers, says consumer advocate Anthony Wright from . And he says policy makers should also lean on insurers and providers to participate in that market.

“Some of this is a combination of putting pressure on the insurers, and some of this is trying to do work to actually increase the number of providers on the ground in these areas, whether through more training, [or] incentives to be in some of these more rural areas,” says Anthony Wright.

Wright, the advocate, says more insurers in the marketplace makes it more likely people can get the care they need.

“At one level, we’re trying to make a functioning market, but it still means that consumers are at the mercy of the market.”

This year, people who want more choice than what Covered California offers must venture into the broader health insurance market if they can afford it.

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