The nonprofit HMO, based in Oakland, Calif., will open the Kaiser Permanente School of Medicine in 2019. No specific site has been selected.

“This is a natural evolution for us,” Kaiser’s CEO Bernard Tyson said in an interview. “We are very motivated in being part of the transformation of the entire health care ecosystem.”

Kaiser says it will base physician training ��on “strategic pillars,” including providing care beyond traditional medical settings, emphasizing collaboration and teamwork and addressing health disparities.

Kaiser, which serves 10.2 million members, is known for providing coordinated care in a technology-driven environment. It was an early adopter of electronic health records and uses its system to reach patients with basic and complex medical needs.

Kaiser says it is committed to attracting a diverse pool of students��“to better reflect the communities we serve,” said Dr. Edward Ellison, executive director of the Southern California Permanente Medical Group.

In a����last year, Kaiser was cited as closing the race gap in managing heart disease and diabetes, diseases which account for much of the reason African Americans have shorter life expectancies than Caucasians.

The HMO��has long been involved in medical education — but at the residency level. It trains more than 600 residents every year.

Kaiser’s move is unusual. The nation’s 145 medical schools are mostly affiliated with universities, although the Mayo Medical School campus operates within the Mayo Clinic in Rochester, Minnesota.

“There are precedents, but this will be different,” John Prescott, chief academic officer with the American Association of Medical Colleges, said of Kaiser’s new school. “It’s an integrated health care system that’s looking at developing a medical school. I think there will be some surprises as the school unfolds.”

Prescott said the school will need to be accredited and that process could take several years. Twenty new medical schools have opened in the U.S. since 2002, he said, and many of them feature “innovative models,” he said.

Still, building a new medical school is “fraught with risk,” said John Deane, president of Advisory Board Consulting and Management. He said it could be a “huge waste of money” if Kaiser were to replicate the existing model of specialty-focused academic medical centers.

“On the other hand,” he said, “they have an opportunity to do this in a new and different way that could be a form of disruptive innovation that could become a new standard for teaching doctors.”

Tyson and Ellison both seemed focused on innovation.

“I’m as interested and motivated and part of the sponsorship of this 21st century new medical school if I were a physician myself,” Tyson said.

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“This is another year of good news for California’s consumers and further evidence that the Affordable Care Act is working,” said Covered California executive director Peter Lee.

Consumers who live in . In Southern California, consumers who stay in their plan will see their premiums increase to an average of $296 per month — an increase of just 1.8 percent. But in Northern California, where health care costs are typically higher due to greater consolidation among doctors and hospitals, the increase is an average 7 percent��— raising the average monthly premium to $284.

In the Santa Cruz area specifically, premiums will rise 13 percent. Peter Lee blamed providers focused on their bottom line.

“Is it the case that health care really costs that much more in Santa Cruz and Monterey? Are people sicker? I don’t think so,” Lee said. “I’ve seen folks surfing in Santa Cruz; they look pretty healthy. (The increase) is not because of the health plans, it’s because of the underlying health care system.”

Covered California also announced that two new insurers will join the marketplace. UnitedHealthcare, the largest health insurer in the country, will offer plans in some parts of the state, including the counties that start north of Sacramento and stretch to the Oregon and Nevada borders. Where some people had a choice of only one plan, now they will have two or three.

“Covered California did the right thing by targeting the new additions to the places where more choice is needed,” consumer advocate Imholz said.

Under the UnitedHealthcare plan, people who live near the Oregon and Nevada borders will also be able to cross state lines to see a doctor, a practice that was in other plans.

“Sometimes people were driving many hours in order to get care,” said Beth Capell, an advocate with Health Access. People who live in Susanville, for example, were accustomed to getting care in nearby Reno, Nevada. But through Covered California, they had to drive several hours to Sacramento. “They will now have the choice of another carrier that will be offering them coverage beyond the borders of California.”

UnitedHealthcare will also offer plans in Santa Cruz, San Benito and Monterey counties, as well as several Central Valley counties.

Parts of Los Angeles County and Orange County will see new insurer Oscar Health Plan of California, which currently sells insurance only in two states, New York and New Jersey.

In a call with reporters, representatives of both companies stressed technology tools that could help consumers get better care.

Lee said that new additions to the marketplace were chosen ��because they have good networks and are good for consumers.

“Covered California does not think more plans are always better. In 2014 and 2015 we turned plans away,” he said. “We’re not adding plans just because they knock on our door.”

In addition to the two new plans, all plans from last year were renewed for 2016: Anthem Blue Cross, Blue Shield, Chinese Community Health Plan, Health Net, Kaiser Permanente, Molina Healthcare, Sharp Health Plan, Valley Health Plan, LA Care Health Plan and Western Health Advantage.

The rates announced Monday are preliminary and��will be reviewed by state regulators over the next 60 days.

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The , had already cleared the state Senate, but faced opposition in the Assembly Health Committee.

Among those expected to vote against the bill were , almost all of whom are Latino, after the Archdiocese of Los Angeles increased its lobbying�� efforts. Church officials argued that some poor residents could feel pressured into ending their lives prematurely if they couldn’t afford expensive medical treatment. have also fought against the legislation.

Under the bill, mentally competent adults who are terminally ill with less than six months to live could request lethal medication from a physician.

“We’re going to review our options,” Monning said in an interview later. “We walk away from the decision today knowing that we’re going to have to spend more time cultivating our colleagues in the Assembly.”

The aid-in-dying issue was brought home to Californians last year after 29-year-old resident moved to Oregon so she could get a lethal prescription under that state’s death with dignity law. Maynard was terminally ill with brain cancer and died last November. A she recorded 19 days before she took life-ending drugs was shown at a Senate hearing in March.

Last month, a found that 69 percent of Californians and 70 percent of Latinos supported the bill. The poll was conducted by the advocacy group Compassion and Choices.

The bill also got a boost after the California Medical Association changed its stance from opposed to neutral.

It was modeled after a 1994 Oregon law that permits aid in dying. Four other states — Washington, Montana, Vermont and New Mexico — have similar laws.

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After Jarett filed the form with Medi-Cal — a death notice as required — the state sent a bill for a hefty $76,349. Jarett was stunned. It was for the cost of health, vision and dental insurance, she said.

The bill was part of Medi-Cal’s “estate recovery program.” Under a federal law not widely known to consumers, states can seize assets of Medicaid beneficiaries after they die. “I was never aware of this wrinkle that they could recover for health insurance,” Jarett said.

Jarett’s clients did not want to speak to reporters, but Jarett said they insisted their mother had not been to the doctor in years and had even died at home. But Jarett said the charges included a breakdown by month of the state’s payments to a managed care plan as part of Medi-Cal.

While a 1993 federal law mandates that states recover assets for nursing home care, the law makes it optional that states recover for medical services — doctor visits, hospital stays and the like — for people 55 and over. Advocates say , but it isn’t clear that the other states pursue the assets as aggressively as California.

Last year, a similar bill , but was ultimately vetoed by Gov. Jerry Brown.��Still, in a statement last September when he vetoed the bill, Brown left an opening. He said estate protection might be a “reasonable policy goal,” but that the cost “needs to be considered alongside other worthwhile policy changes.”

Figuring out that cost is a challenge. In 2013 and 2014, the state recovered $61 million in 3,900 cases, said Carol Sloan with the Department of Health Care Services. But the state does not break down how much of that $61 million is for nursing home care and how much of it is for medical services.

For perspective, $17.8 billion in state general fund dollars went to Medi-Cal last year. The total budget for Medi-Cal is significantly more than that after adding in federal dollars and various taxes— $85.7 billion.

‘Leery’ of Medi-Cal

Like the attorney Jarett, Anne-Louise Vernon, 60, of Campbell, had never heard of estate recovery. She had been “so looking forward,” she says, to signing up for insurance under the Affordable Care Act. Her income was too low for her to qualify for subsidies to purchase insurance on the Covered California marketplace. Instead, she qualified for Medi-Cal.

Vernon said she was “leery,” and asked if there were strings attached. “I was told, ‘No, no, it’s completely free.’” She said it was some time later, when she was looking around online, that she found a reference on an FAQ page about assets being seized. She was furious.

“So you’re breaking the law if you don’t have health insurance,” Vernon said, referring to Obamacare’s “individual mandate” that everyone have health insurance. She said she felt forced into Medi-Cal: “They don’t tell people it’s a loan.”

Vernon held onto her home years ago after a divorce, but said she was “involuntarily retired” and has been living on savings. She knows she could shelter her home but doesn’t want to take that step. “I’m 60! I’m not going to sign my house over to my kids at this age.”

For other people, attorneys’ fees to take the legal steps to shelter a property are a big issue. “People who end up on Medi-Cal are poor people,” said McGinnis. “They’re the ones that usually cannot afford to pay an attorney $300 to $400 an hour.”

‘Collection Agency for the Feds’

Estate recovery has become a much bigger issue since the rollout of Obamacare started more than a year ago. Under the expansion of Medicaid, people earning up to 138 percent of the federal poverty level are eligible (in states like California that are participating in the expansion). But for those people, 100 percent of the cost of their health coverage is borne by the federal government for the first three years, drifting down to 90 percent after that, and any recovered money would be returned to the federal government.

“What are we? A collection agency for the feds?” asked McGinnis, who also says CANHR is hearing from consumers who will disenroll from Medi-Cal if the policy has not changed. Other advocates believe the policy is a barrier to enrollment for some people.

For now, Vernon is staying on Medi-Cal. Like 80 percent of Medi-Cal beneficiaries in California, she is enrolled in a managed care plan. When she wanted to know what her Medi-Cal coverage cost, she spent “hours and hours on the phone” calling both her managed care plan and the state, she says, and got the runaround from both of them. No one could tell her what her coverage cost.

Finally, an advocate sent her a link to the exact page on a state website where she could find out how to file a request for information — with a $25 fee. She finally got an answer: $578.71 a month. If she stays on Medi-Cal for another five years until she’s 65, when she becomes eligible for Medicare, the state will have paid almost $35,000 for her managed care premium. After she dies, the state could bill her estate for that amount — or more, if she continues on Medi-Cal.

Ironically, if Vernon, and others like her, earned just a bit more money, they would qualify for heavily subsidized private insurance through the Covered California exchange. The state estimates that the “per member per month” premium for those newly eligible for Medi-Cal is $620.98, or nearly $75,000 over 10 years.

Vernon plugged her age and ZIP code into the Covered California insurance calculator, but increased her income to $17,000 to see what would happen.

She found she could get a plan for as little as $31 a month, “estate recovery free,” she noted. These plans come with a $2,250 out-of-pocket limit, but even if a 55-year-old maxed that out every year, the 10-year total of deductible plus premium is $26,220 — about $50,000 less than what would be accrued on Medi-Cal, with no estate recovery.

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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��.

But Rhett lives in Marin County, Calif., a county with the����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��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.

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Across the bay in San Francisco, however, a similar proposal failed to get the two-thirds supermajority it needed.

More than 30 cities and states across the country have attempted but failed to enact such a tax, at least in part because of well-funded opposition from the soda industry.

Berkeley’s Measure D needed only a simple majority to pass. It will levy a penny-per-ounce tax on most sugar-sweetened beverages and is estimated to raise more than $1 million per year. Proceeds will go to the general fund; Measure D calls for the creation of a health panel to advise Berkeley’s City Council on appropriate health programs to receive funding.

Campaign Co-Chair Josh Daniels called Berkeley’s win a tipping point. “I think you will now see many, many other cities and communities around the country looking at this as a genuine public policy to address the diabetes and obesity crisis that we face,” he said.

While the San Francisco proposition did not pass, supporters there declared a victory of their own: More than half the voters approved the tax despite millions spent by the American Beverage Association to defeat it.

“So the fact that we were able to overcome $10 million,” said Proposition E coauthor Scott Wiener, a member of the San Francisco Board of Supervisors, “and it looks like a majority of San Franciscans – despite that $10 million – will vote ‘yes,’ is pretty extraordinary.”

The opposition campaigns, funded primarily by the beverage association, argued that the measures were riddled with loopholes and wouldn’t accomplish their health goals. Roger Salazar, a spokesman for the campaigns, pointed to the 30 failed measures from around the country and called Berkeley “an anomaly.” He said that to expect to pass such a tax elsewhere in California was “foolhardy.”

Advocates are convinced he’s wrong. Harold Goldstein, executive director of the California Center for Public Health Advocacy, called the measure’s passage “remarkable.”

“What we learned here in Berkeley,” he said, “is that when voters learn the truth about sugary beverages, when they learn that they are one of the central causes of the growing diabetes epidemic, they want to tax it, they want to regulate these products.”

Sodas are the primary source of added sugar in the American diet and that added sugar is linked to increasing rates of diabetes.

Berkeley has a history of being first to a new cause that’s later embraced more broadly, said Lori Dorfman, executive director for the Berkeley Media Studies Group. “In the mid-70s, Berkeley made the first ‘curb cut,’ and now people in wheelchairs all over the country are not trapped in their homes anymore.” She noted that Berkeley was also the first city to pass a clean indoor air ordinance.

Mexico enacted a national soda tax on January 1, and by summer, consumption had dropped 10 percent.

Kelly Brownell, dean of Duke University’s school of public policy in the early 1990s. He called the votes in both Berkeley and San Francisco “historic” and, like other advocates, predicted other cities will soon follow suit and that soda companies are bracing for that.

“My guess is that inside their boardrooms, they know very well these taxes are the beginning of the future,” he said. “This is a wave starting to crest.”

Brownell said that half the costs of diabetes and obesity are born by taxpayers, through government health insurance programs Medicare and Medicaid. Those public costs “justify the government getting involved, just like tobacco taxes,” he said.

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Researchers reviewed two years of claims data from nearly 200,000 Californians, including a group ��who had enrolled in public programs well in advance of the expansion of Medi-Cal,the state’s version of Medicaid, in January. These programs were designed to ease the expansion of Medicaid by providing insurance to low-income adults��who were not eligible for Medi-Cal at that point but would be when the health law’s expansion went into effect earlier this year. The researchers�� divided the group into four categories, based on the researchers’ assessment��of each group’s pent-up demand for health care.

In July 2011, after being enrolled in California’s , the so-called “bridge to reform,”��the group with the highest pent-up demand had a rate of costly emergency room visits triple — or more — that of the other groups. But from 2011 to 2013, that high rate dropped by more than two-thirds and has remained “relatively constant,” according to the analysis.

“We were hoping that this would be the case,” said lead author Jerry Kominski, director of the UCLA Center for Health Policy Research, “because we think that that’s what access to care does for low-income individuals … that there’s an additional increase in demand for services and that that demand, or utilization, drops off pretty rapidly.”

Rates of hospitalization for the “highest pent-up demand” group also started high and dropped by almost 80 percent over the two-year period. Curiously, if ER and hospitalization rates were dropping, it’s reasonable that outpatient visits might rise. But that wasn’t the case; the rate of outpatient visits was largely unchanged during the two-year period.

Kominski said that one of the fears of the Medicaid expansion was the potential high cost of low-income patients. He argued that this analysis should ease those fears: “What our findings say to the country is (that) concerns about Medicaid expansion being financially unsustainable into the future are unfounded.” Under the Affordable Care Act, the federal government provides 100 percent of the cost of the newly eligible under the Medicaid expansion, but in 2017 that contribution will phase down until it reaches 90 percent in 2020.

Twenty-seven states and the District of Columbia are implementing the Medicaid expansion; 21 have not, and in two states, Indiana and Utah, the question of expansion is an “open discussion,” from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of KFF.)

Matt Salo, executive director of the National Association of Medicaid Directors, said the study was “certainly consistent with what we hope to do” by expanding health insurance access.��He said insurance is “just the first step, the next step is health care homes so that the individual can actually get better care.”

One factor in helping drive down the higher rates of use, Kominski said, is better efforts at coordination for��Medi-Cal beneficiaries. For example, virtually all Medi-Cal beneficiaries are now enrolled into a Medi-Cal managed care plan.��“To the extent that other states don’t have adequate coordinated care mechanisms in place for their Medicaid populations, then the kinds of drop off that we observed in California may not occur there,” Kominski said.

The UCLA analysis makes explicit reference to — and rebuts — a similar study, the . In Oregon in 2008, 10,000 residents literally won Medicaid coverage in a lottery, creating a true randomized controlled trial opportunity for researchers who compared those who won coverage with those who didn’t, rarely possible to do in social policy research. Researchers later��reported in the 18 months after that expansion.

Kate Baicker, a health economist at the Harvard School of Public Health, was one of the researchers in the Oregon experiment. She said they did not find “any evidence of utilization tailing off over that 18-month window” and stands by her results.

Still, Baicker said that an increase in use of health care services, such as emergency room visits or hospitalizations, “does not mean that Medicaid should not be expanded. Part of the goal is to increase access to health care.”

The UCLA study was funded by the California Department of Health Care Services and Blue Shield of California Foundation, (which helps fund KHN’s coverage of California health care issues).

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A��majority of the state’s voters support extending current health insurance programs to all low-income Californians, including undocumented immigrants, according to a released today.

The poll was commissioned by The California Endowment, a foundation that has been actively working to expand health insurance access to all people, regardless of immigration status. The Affordable Care Act expressly bars undocumented immigrants from receiving any of its benefits, including subsidies to purchase health insurance. (Note: The California Endowment funds some of KHN’s��coverage.)

In the poll, 54 percent of those surveyed said they support covering the undocumented. Support was strongest among younger voters as well as Latino and African-American respondents.

Pollsters drilled down on��specific aspects of��coverage. Total support for those issues was:

• 86 percent support important access to preventive care to reduce overall health costs and prevent spread of disease
• 69 percent support ensuring that working undocumented immigrants can purchase affordable health insurance
• 56 percent support expanding Medi-Cal, the state’s version of Medicaid, to undocumented residents
• 54 percent support making subsidies to purchase Covered California plans available to working undocumented immigrants. Covered California is the state’s Obamacare marketplace.

In conducting the poll, the California Endowment retained two polling firms, FM3, which generally handles Democratic campaigns, and GS Strategy Group, which generally handles Republican campaigns. The stated goal was to reflect the perspective of both parties.��Liberal and moderates from both parties��strongly supported access to preventive care and ensuring that undocumented immigrants can purchase affordable health insurance.

The surveyed voters were read a statement that explicitly referenced unreimbursed health care costs:

“Currently, health care providers are required by law to provide emergency care to all Californians, including those who are undocumented, whether or not they have health insurance coverage. The costs of this care are currently passed on to other patients and taxpayers.”

This explanation of costs seemed to have made an impact on respondents, especially when seen in light of the 86 percent support for access to preventive care. “We’ve seen this in a lot of other research,” said Dave Metz with FM3, “that voters think investments in prevention make a great deal of sense both from an economic and public health perspective, and that’s true for this policy as well.”

Respondents were also presented with statements explicitly opposed to the proposal of expanding access to health insurance, including that “undocumented immigrants are breaking the law and should not be rewarded.” Total support actually went up slightly, from 54 to 56 percent, after respondents heard the negative messages.

Daniel Zingale, senior vice president for the Endowment pointed to the strong support in young voters for expanding health programs to the undocumented. Those 18-29 showed 68 percent support and people 30-39 had 61 percent support. Zingale said there seems to be a “generational shift under way in California and attitudes around these particular questions seems to even transcend the partisan divide.”

Earlier this year, state Sen. Ricardo Lara (D-Bell Gardens) introduced , which would have expanded Medi-Cal to undocumented immigrants and created a new insurance exchange for the undocumented to obtain subsidized insurance. The bill ultimately stalled in the senate.

Anthony Wright, executive director of Health Access, a consumer advocacy group said the poll results give “hope and momentum” to efforts to pass a bill next year. “We had a lot of energy and enthusiasm and coalition support last year, and with the findings that this is getting increasing public support, we fell like we have momentum to win this year,” he said.

Pollsters noted that they conducted an additional 154 interviews among African American voters. The purpose was to oversample and ensure a more accurate position of the group.

“There’s some perception out there that there’s an African American vs. Latino divide on this issue,” Zingale said, explaining the reason for the oversample. In the poll,��69 percent of Latinos support expanding access to undocumented, and 68 percent of African Americans support the proposal.

“We’re pleased to see in this survey,” Zingale said, “there seems to be zero evidence” of such a divide.

The poll was a survey of 800 registered California voters. Interviews were conducted in English and Spanish on landlines and wireless phones. Phone calls were made August 24-31.

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Wiener wrote about his experience in :

Each morning, I take a pill called Truvada to protect me from becoming infected with HIV. This strategy, also known as pre-exposure prophylaxis, or PrEP, reduces the risk of HIV infection by up to 99 percent if the pill is taken once a day. This makes PrEP one of the most effective HIV-prevention measures in existence. …

As an elected official, disclosing this personal health decision was a hard but necessary choice. After all these years, we still see enormous stigma, shame, and judgment around HIV, and around sexuality in general. That is precisely why I decided to be public about my choice: to contribute to a larger dialogue about our community’s health.

“My hope is that by disclosing my PrEP use publicly that I can help move the conversation forward and get more people thinking about PrEP as a possibility, and encouraging people to consult with their medical provider,”��Wiener said��in an interview at his office in San Francisco’s City Hall.

Truvada combines two different drugs into a single pill that, when taken daily, can reduce the risk of HIV infection by more than 90 percent. It was approved by the FDA in 2012. Both the ��and the ��recommend its use by people who are at high risk of HIV infection. Still, it is the subject of debate, especially within the gay community.

Wiener, 44, was first elected to the Board of Supervisors in 2011. He says��he started coming��out as a gay man in 1990, at the height of the AIDS epidemic.

“Coming out in that environment was challenging and stressful,” he said. “Immediately associating sex with illness and death was very stressful, and many, many people, I think, had that same experience.” He spoke of friends who have started using PrEP recently who “have told me that their general anxiety level around intimacy has gone down significantly.”

Wiener said that only a few people had known that he was taking PrEP. James Loduca, vice president of philanthropy for the San Francisco AIDS Foundation, called Wiener’s disclosure “incredibly courageous.”

“We need more people like Supervisor Wiener,” Loduca said. “In my own personal network, many of my HIV-negative gay male friends are on PrEP. None of them talk about it publicly, and that is a reflection of the enormous stigma and shame that we still have around sex, around a desire to have intimacy. … It’s an important watershed moment for our community that someone so visible steps forward and says ‘PrEP is helping me.’”

Wiener spoke about the importance of employing��all options to prevent acquiring the virus, including the use of condoms and being tested regularly. If someone becomes infected with HIV, identifying the infection sooner yields more immediate treatment, which has positive long-term health outcomes.

Wiener’s announcement comes on the eve of a rally to be held Thursday, coordinated��by San Francisco Supervisor David Campos. Campos is calling for San Francisco to make PrEP available to San Franciscans regardless of income. New York Gov. Andrew Cuomo has made a ��for his state.

Nationally, there have been 50,000 new HIV infections every year for the last 20 years. “PrEP is the first new tool in our fight to protect ourselves from HIV since the epidemic began,” Campos said in a release.

Wiener backs the effort. “In order for PrEP to be successful, we have to do three things,” he said. “We need to raise awareness about it, make sure people know about it. … We need to secondly remove the stigma around it, so people are able to talk about it, are able to consider it, and finally, we need to expand access.”

But that kind of community-wide campaign is exactly the wrong idea, some advocates say.

“To deploy (PrEP) as a community-wide preventive is a public health disaster in the making,” said Ged Kenslea, spokesman for AIDS Healthcare Foundation, a global advocacy group. He stressed the organization is not opposed to the use of PrEP on a case-by-case basis.

“The crucial problem is adherence to the medication,” he said. He also pointed out that condoms are not only effective against protecting against HIV infection, but also against other sexually transmitted diseases “for which PrEP does nothing.” Kenslea said that he’s worried that people “seem to be throwing condoms out the window.”

Dr. Robert Grant with the UCSF Gladstone Institute that ultimately showed Truvada’s effectiveness as a preventive agent against HIV and has followed it since.

He said that there’s no link between ��He also supports efforts to make PrEP available more widely and compared having a variety of tools to fight HIV with having a variety of methods of birth control available.

“Just like contraception,” he said. “We’re happy to have people using different methods. Same way with HIV. We have to have lots of different methods for people to use, so people can find one that’s attractive to them.”

Grant said that in his research “we have not seen anyone become infected who has taken PrEP daily or nearly daily.”

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It’s good news for consumers, but two of the top insurance officials in the state disagree about why it’s happening.

Covered California’s��executive director and other analysts pointed to specific factors for this moderate increase. For starters, enrollment was very strong in 2014, more than a million people. In addition, healthy people signed up, spreading the risk.

But the state’s insurance commissioner, Dave Jones, sees a different force in play. He believes that a statewide ballot measure, Proposition 45, has insurers scared.

“Health insurers have hit the pause button” on rate hikes, Jones said Thursday, just hours after Covered California announced its 2015 rates.

Proposition 45, which voters will consider in November, would give his office the authority to reject excessive rate hikes. Jones believes insurers held their fire on 2015 premium increases so as not to create a backlash from consumers and enable the passage of Prop. 45.

“There’s no guarantee insurers will continue to” keep rate increases low without Prop. 45, Jones said. “That’s authority we still need.”

Peter Lee dismissed the idea that 2015 premiums are artificially low, saying that he had been involved in “deep actuarial reviews” with insurers and said that “the last thing we want is rebound rate hikes” in future years.

As part of the rate review process, regulators at the Department of Managed Health Care and Jones’ Department of Insurance will review rates in the coming weeks to ensure they are neither too high, nor too low, Lee said. If premiums were set too low, an insurer might not have sufficient resources to cover the health care costs of its customers.

Jones confirmed that his staff would look at this issue, but said he “can’t imagine that these rates are inadequate.”

When rates were introduced in May 2013 for Covered California’s opening year many experts��said they were surprisingly low and thought those low rates might be a “loss leader” strategy, said UCLA health policy professor Jerry Kominski. There was a concern that rates were low to get people into the market and then “jack up prices” later, he said.

“That didn’t happen,” Kominski said. He doesn’t think it’s happening now, either. “I don’t think the insurers are lying in wait, waiting to spring enormous increases on the public next year.”

Earlier this week, Jones����done by his staff, looking at 2014 vs. 2013 individual plan rates and found average increases of 22 to 88 percent for people who bought non-subsidized policies.

But those 2013 pre-ACA plans existed in a fundamentally different insurance market, Kominski argued. “In 2013, premiums were artificially lower, and prior to the ACA, premiums could be held down by excluding high-risk patients from the market and by offering skinny benefits.”

Covered California was created as an “active purchaser” and negotiates directly with insurers.��Some officials����that if Proposition 45 passes, its additional layer of rate review might create delays in approving plans for the exchange.

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