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Tip cheap car insurance palatka fl

"Tip cheap car insurance palatka fl

Tip cheap car insurance palatka fl

BEST ANSWER: Try this site where you can compare quotes: : http://howmuchisinsurance.xyz/index.html?src=tumblr

RELATED QUESTIONS:

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My husband and I had tricare but he is out of the military now, so we are looking for good insurance as we are currently ttc. Thanks!""

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how much car insurance will cost me if i buy a brand new toyota vios or toyota avanza? is it more or less 30,000 pesos? am i right? please answer me. thank you.""

Home insurance cost in auburndale ny zip code 11358?

I am in the process of purchasing a new house in auburndale, queens ny. i wonder how much is the average home insurance cost in this area? it is a tudor building, 2 and half floors.""

CANT GET INSURANCE LOWER THAN 6000 !!!?

I'm really frustrated as i've just passed my test and looking into buying a car and insurance and im quoting on a Vauxhall Corsa that is in insurance group 1 and getting nothing less than 6000 how the hell am i supposed to be able to afford that even with a full time job! its ridiculous i know that im 18 and male which is high risk but even if they said between 2000 - 3000 it wouldnt be so bad for me, can someone please give me an idea of what to do next?! :/""

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If I lease a car or buy it on credit (a 2004 convertible mustang eg.) can I just buy cheap liability insurance? Please explain, I'm new to this and I need a car asap :/ please and thnx!!!""

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I'm 17 and i have my own car, dont live at home 2 hours away to be spacific, have a job and a son i turn 18 really soon and i was just wondering is it possible to get insurance in my name? Its in the baby daddys name right now but its like 200 dollars a month and i think its so high because his age sex and criminal record and his wrecks. For me i have never been in a car wreck or in trouble with the law and attending GED classes until school starts back up and then im going to take my ged at the school and get my hs diploma ive heard if your attending school or what not there are discounts. Any way please just answer my ? all rude comments will be deleted thanks!!!""

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The insurance company wants to total my car, which was in a parking lot accident. The value that they are giving it is way too low. I know some people want more than their car is worth and the insurance company would like to save themselves as much money. However, objectively looking at it.... I cannot find another car for the price that the insurance company says it's worth. Online dealer ads list some cars with somewhat higher mileage at $2,000-2,500 more. When I offer the amount that the insurance company offered, they are polite but decline the offer. The insurance company uses comparisons with cars that are all much higher in mileage, some double. I suspect those cars are beat up. The state insurance commissioner will do nothing much, according to what their website suggests. At most, they will be an informal moderator that encourages resolution. They also tabulate the number of complaints. They will not get involved unless there is a clear violation of law, not just low ball estimates. They even say that. Actually, the repair estimate plus salvage value equals the value they assign. If the value is higher, it should be repaired, which I want. I am willing to accept a fair valuation and settlement but it is not fair now. What should I do?""

Tip cheap car insurance palatka fl

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I am a very responsible driver and I DO NOT speed. I always wanted a corvette and it would really help me out if someone would be able to tell me how much the insurance is. I heard the prices can range really high, but being a student on the high honor roll would that help me out? I am over a 4.0 gpa with honors classes. Btw I live in Illinois. Would it be over $100 dollars a month. I am very confused. please help me..""

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Hey im 18 and hoping to buy my first car soon (Living inthe uk) I'll probably buy a used car too I want a car thats cheap to run, cheap insurance, etc But with a nice interior :) This cars interior is perfect! http://www.zcars.com.au/images/2009-honda-accord-euro-interior22.jpg Can you guys reccomend any?""

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Your personal experiences with Progressive Auto insurance?

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I'd like to get a cheap used car for personal use. I'd spend less than $2000 on it, so it'll be at least 10 years old, I imagine. I'm a 22-year old female. I have my Driver's Ed certificate. I live in Alberta, Canada. I have never owned a vehicle before so I have no history of accidents or tickets or anything. I've had my license for about a year now. If you know anything about insurance, can you please tell me approximately what my monthly insurance payment would be? Any help is much appreciated! Thanks in advance!""

""Im 18, how expensive would insurance be for me?""

Im 18, B average, live in Los Angeles, no tickets/crimes, and the bike im looking at is a 250cc. What do you think my rates will most likely be? I want to use it for school""

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""Does anyone know how much Plan B costs without insurance at the Flagstaff, AZ Planned Parenthood?""

Also, does anyone know, if I were to use my parents insurance, if they would find out that I got Plan B? I really can't let them know about this... please, I need helpful answers. Thanks so much.""

Who are Insurance Suppliers?

I'm doing a sort of quick reference website and I'm lost on this topic: Who are considered Insurance Suppliers, apart from the Insurance Companies or Firms themselves..? Would appreciate so much any answers for this :)""

Question to Young Drivers about Insurance.?

Hi, i am 20 and just passed my test and now i need a car and insurance, i was wondering if you young drivers have gotten any 'cheapish' car insurance recently and what car, thanks. Cheapest i've found is a Renault Clio, Peguot 107 and a Fiat Punto.""

How does and underage affect insurance?

A friend of mine was just charged with an underage but was accepted into the ARD program. We are wondering how this is going to affect her auto insurance policy.

Car insurance question?

if my tires got slashed and i called my insurance company, will they put a point on my record?""

How much would would Car Insurance be for a 17 year old male?

Im a student, want to take my test. If i pass it how much do you reckon driving insurance will be. Say if i registered it under my mums insurance. i wanit a car for university so i can drive home quickly and easily. How much would it be under my mums insurance and how much would it be if i got thee smallest engine (Vauxhal Corsa or Citroen C2) for example...""

At fault driver asks for my proof of insurance.?

I was legally parked out on the street and this person decided to park right behind me. But that persons poor maneuvers failed and crashed into my car, my car lurched forward. So i got out to see if my car was ok. I but as I get out I look at the person and she smiles and waves me off like I'm making too much of a deal about this. I was just looking for an apology or something like that. But they blurted out that it was only 2 miles per hour what possible damage can happen!? I said thats not the point and asked for insurance info, wrote the info down and asked why they were being so rude and hyper. its because i don't like being accused of damage I didn't do!! That person is a lowly fool. ANYWAY to get to my question. They mentioned they were an attorney and under California law that they must see my proof insurance, i gave it cause I have nothing to hide. But should I have given my info away? How should I report this claim to my insurance?""

""What is the cheapest motorcycle insurance for a 23 year old??? Progressive, Geico, etc??""

I have had a few blemishes on my record, some tickets and an accident, but my state requires full coverage insurance on a bike that is not paid in full, what are your suggestions??""

Are we covered with liability insurance?

if we got in a car accident no 2nd party or whatever its just us 3 in the car 2 of us got sent to the hospital .. the driver that was at fault only has liability insurance .. are we covered with the medical expenses? like if we file a complaint to their insurance can they do something about it since we goin to need therapy and such?

Recommendations for scooby car insurance?

Im 19 and am looking to buy a new car. I really want a subaru impreza, not too fussy which! wil have to be second hand, probably around 98-99 year of manufacture but insurance is scary! will prob go under my parents name but was just wondering if anyone knows of a company which insure scoobys relatively cheaply""

How will my speeding ticket affect my insurance?

I am a Florida resident. I am temporarily in Colorado for work. Today I got a ticket for 80 in a 55 (looks like it's 6 points in CO). Currently, I pay around $100 per month for insurance (125k/250k) on two vehicles (2000 Chevrolet Blazer and 2011 Subaru Forester). How will this ticket affect my insurance?""

Tip cheap car insurance palatka fl

If I ask my insurance company to fix my car will my premium increase?

I'm a beginner driver and I have my first car and a new insurance. Today I hit a standing car. My car requires some body work and the other car was not damaged at all. There was no police report filed. I'm 24 and single. I appreciate your help.

Car insurance?

how much would it cost to insure a car. if the driver was sixteen. it wouldnt be a fast car. so how much for third party insurance. and how much to get my car insured

Does anyone know how much does car insurance cost for underage Drivers?????

Im applying for my permit and im 17 years old. the only thing im missing is my insurance. Please help i asked all my friends but none have insurance. Thank you for your time, Diana****""

How much is the insurance on 50cc scooter for a 16 year old?

Please could you tell me the amount for full comp, cheers""

Difference between a deductible and co-insurance?

I am shopping for individual health insurance and I do not understand the difference between these terms. Also, if a plan has a $1000 deductible does that apply to the entire 12 month term of the plan or every single time I receive health care services? And what about co-insurance?""

What gpa do i need for a deduction on car insurance?

I just purchased a 99 grand prix gtp (supercharged) 2 door. I know that my insurance payment will go down based on good grades. I've got a 2.973, is that close enough to 3.0? to get the deduction?""

Which auto insurance company offers non-owner's insurance?

What is the cost of the insurance for the car i want ?

I want a Suzuki Ignis 1.5 sport im just about to start driving wants the insurance going to cost ?

Jason wants to buy a car. He has $2500 in his savings account. He also needs to pay $600 for insurance. How?

Jason wants to buy a car. He has $2500 in his savings account. He also needs to pay $600 for insurance. How much can Jason spend on a car? A. c < 1900 B. c > 3100 C. c < 3100 D. c > 1900

I was denied medcaid and chips for my 2yr son. Is there any other affordable insurance out there?

I was denied Medicaid which is understandable. I applied for Chips and was denied as well.......because I was $50 over the income guidelines. I don't receive any other kind of assistance. I can't afford the insurance at work. I pay my own tuition for school, my own groceries, and so on. I just would like to know if there is any other type of affordable insurance for my child.""

How much would car insurance and Tax cost?

Im 17 and I have a decent amount of money saved up and im interested in buying a 2nd hand car for around 1000 euro but i have no idea how much the tax and insurance is going to cost and how often you have to pay it, so if anyone can help me it would be great. thx u.""

Insurance for seized cars..?

Okay my Boyf was driving his dads car to mine and thought he could use it under third party. He's only driving it cos his da is on holiday an he needs to drive it around. Anyway on the way over he got pulled over by the cops and they found out he wasn't insured. Therefore they seized his car. But after phoning up the insurance company he found out the car itself wasn't insured and his dads insurance expired a few months ago. Therefor the car is in the compound with no insurance and his current insurance company won't let him insure the car for anyone if it's been seized. But to get the car out, they need valid insurance to retrieve the car. So what can he do?""

Best car to insure for a provisional driver?

I want to change my car, but the next car will have my son as a provisional driver. I have been driving for 20years, am female, and have not made any claims. Live in the uk. I have tried the insurance comparison sites, but you need to put a make and model in. Would like to know what others have found to be the cheapest. I would prefer an mpv, or crossover, but am open to suggestions. Many nanks""

I have geico insurance for Arizona. Will I still be covered if I go out of state?

I have Arizona insurance. But I might take a job in California. Will I still be covered if I move there. I don't know how long I will be. Maybe six or so. I don't want to change driver license and such over if I am not going to permanently live there. Anyone know if I will still be covered if I go out of state.

I need cheap insurance help?

i live in Dearborn Michigan insurance here full coverage starts from $2300 and up Oneway insurance is $950 i cant even afford any of that. Does anybody know any cheap insurance places or companies. I drive a 2004 hyundai Tiburon GT 120,000 miles clean title and im a college student age 20 whos never ever got a ticket or have been arrested. Iv had my drivers license since i was 16. Iv never been in any accidents im also a 3.2 GPA college student all A's and B's im asking is their any cheap insurance or no?""

If you have your driving permit in Illinois and your parents have insurance do you need insurance ?

Buying a car v.s buying car insurance?

My father doesn't have credit history because he never used credit card or anything. My credit is way better than him. I'm getting an car loan but worrying about the insurance problem. I'm only 21 in college my insurance will be extremely high so i'm just wrondering can i buy a car with my name and buy insurance with my dad's name? Are we allowed to do tat?

How much will insurance co pay us?

i was 35 wks preg and had a car accident that was other drivers fault. had to stay overnight at hospital for pre term contractions and plancental tear from seatbelt injury. out of work for about a week befor being released from scrict bed rest. had to have someone else keep kids and all. im 37wks now and just got the ok to get chiropratic care. we both have geico and they have been really nice about everything. husband doesnt want to get a laywer yet wants to see what they offer first. just wanted to know a ballpark number to look or ask for if anyone knows.also suffered chest injury which cause me to loose my voice due to sudden onset of Gerds from seatbelt injury.still in pain and not back at work had plans on working till i had the baby but cant now.already suffer pregnancy now have pain from accident just feel terrible. help.

What all does someone under 18 need to get car insurance?

I'm under 18 years old and I need to get car insurance but I dont know if I can get it on my own. My parents do not want to put me on there insurance and I don't know if I can get it by myself. I also heard that they have to co sign for insurance? If that's true will them co signing for my insurance affect there car insurance what so ever? They think that there insurance would go up if they co signed for me but I don't think that's true. Some one please help!

Drivers insurance? Car insurance?

I'm 15, going on 16. When I do get my license, will my insurance be lower because I get really good grades?""

""If you have bad grades when you buy car insurance, but you improve your grades?""

If you have bad grades when you buy car insurance, but you improve your grades later, will they still give you a discount?""

Why does a civic cost more to insure than a golf for teens?

both are 1.4 litre engine but the civic costs atleast 1500 more to insure?!? whaaat? is it because the civic has the impression of a ricer car?

""If you are a teenager with your own car, how much do you pay for car insurance???????""

i was just wondering because i want to get a car eventualy and i know that it will be very high......... also for example if your 16 and you get a car from 1991, how much would you think you would play a month for insurance?""

""Friend hit my car, wont give his insurance information, what to do?""

Two years ago, I was sitting in a parking space waiting for my friend. He pulled in on the left side, and his right front fender crashed into my rear left quarter panel, causing some ugly damage. Long story short, I didn't get his insurance information. He said he would give it to me later. It has been two years, and the past few weeks I've really gotten on his case to get the information or for him to fix the damage. It has been excuse after excuse, and he now wont answer phone calls. I can get his license number, name and address, so I'm wondering if I need to call my insurance company or the police to get this fixed. I don't need friends like this but I'm wondering if the statute of limitations in california has run out, or if I won't have any luck calling the police. I just want the car fixed, and the damage is estimated at 500 dollars. Any ideas?""

Uninsured Motorcycle Driver Question?

Recently a friend of mine wanted to purchase a motorcycle that he found a super great deal on. Because his credit is very average he asked me to purchase the cycle and he would make me payments plus interest. I agreed and took out a loan for the bike. However a few weeks later he decided it would be ok to take the bike out for a spin UNINSURED. He had a run in with several trick or treaters and their parents. Since it was an unlit road, they were in the middle, and he was going under the speed limit. The cops ruled it not his fault. However now two insurance companies are coming after me to subrogate the liabilities. Since he was the driver but I am the owner. What are my rights? Can they still blame him? Am I liable?""

Tip cheap car insurance palatka fl

What is the cHEAPEST car insurance???......?

4 a 17 year old

Can i get insurance for a week on a car ?

alright so me and my friends a having a trip from Chicago to Columbus here is the problem my Buddie that was spouse to drive lost his licence and he has no insurance on his car i cant take my car because it sucks in the winter and its a two seater , no good for 3 people ! so can we get insurance for a week ? we really don't need it longer than that , thnx in advance !!!""

Please help about car insurance?

I'm about to get my license when I turn 18. So I was wondering how much would car insurance be for an old car that's already paid off?

Will a speeding ticket affect my insurance rates?

This is my first speeding ticket and the cop claims I sped 15 mi over the 25 mph limit. If I plead guilty and pay the fine and attend traffic school, will this still be reported to my auto insurance company?""

About car insurance in virginia?

what car insurance company responsible for, what is the limit of policy, whats the liability?""

Non owners policy insurance in CA?

i'll be using my parents' car, which is in IN, in california, it already has insurance, but i'll be going to CA and probably stay there for some time (around a year) and use their car, im 18. So does buying a non owners policy insurance save me, since they will still pay for regular insurance on car plus the non owner that i'll purchase? any advice? since if i'll buy my own policy the numbers are 500/mo or more. So im thinking if i buy a non owners insurance lets say at 1200/yr, plus their regular coverage it'll save some money. any advice will be greatly appreciated or it is illegal?""

State Farm insurance ?

I work for state farm insurance, what do other insurance companies say about us? not what policy holders think but what other companies only""

Do i need to tell my insurance company that i have fitted lexus lights on my peugeot 206?

yea just want to know.... and if so how much extra it will cost? thanks

Aircraft insurance rates with DUI/DWI charge?

If one is a partner in a small aircraft, what effect does a potential DUI/DWI have on aircraft insurance rates?""

How much is auto insurance for a 16 year old male?

its in michigan if that helps and i have a perfect record and a straight a student.

Different Car insurance rates for different cars?

Alright, I'm 18 and a freshman in college this year, and I commute there 20 minutes everyday to save money (room & board is around 15k). And the car I have now is not really reliable anymore. Its a 94 Cutlass Cierra, and within the last month the Heating Core, and the Alternator have both went, and I've had to sink 600 dollars into it. I'm looking at getting a new car next summer, and I have basically narrowed it down to two choices. An Eclipse (Mitsu) or Cougar (Mercuy). I know its going to cost more to have a sports car, but what I want to know, is how much the different prices for insurance would differ for these two cars. I was going to do one online, but I saw it needed a VIN, and I don't have the car yet. I'm thinking about asking my car insurance company for quotes, but I doubt they would do it. Does anyone know the prices to insure these two cars for a 19 year old. Or a link or any information would be appreciated.""

How much do you pay for car insurance a month?

i have a 2001 Toyota Rav 4 and my parents tell me to give them $100 a month for car insurance, does that sound right? how much does car insurance usually cost?""

How strict is Humana health insurance with pre-existing conditions?

I've had acne since my teens but it's really been bothering me lately psychologically and hurting alot when trying to sleep on my back from cysts. Also sometimes minor acne on my face has been causing permanent scars. I want to go to the dermatologist and see if I can get accutane, but I just got my health insurance beginning of the year and had no creditable coverage before that. According to their written policy, I might not be eligible since I actually went to the doctor and got antibiotics for acne less than 24 months before enrollment in the health plan. I would like to say that the condition manifested itself in the past month psychologically which caused me to seek out accutane, which is true. Should I even mention my past diagnosis can they check it somehow? I really don't want to pay $3000 out of pocket for accutane, but I feel I really need to do this now for my own well being. What should I say to the doctor, how much will they investigate preexisting condition""

Is my car insurance company lying to me?

I am insured by Farmers, they told me that I can not have a choice of the estimator who will decide the value of the damage to my car. They told me that only their estimator can decide the value of the damage. Are they lying?""

""Looking for good Health Care Insurance, that covers pre-exisitng illness?""

Looking for good Health Care Insurance, that covers pre-exisitng illness?""

Do you have to have car insurance just because you have a drivers license?

My mom is bent on the idea that just because I have a drivers license I have to have car insurance as well. I go away for college and I dont drive all year long. We have a family car that I drive once or twice over the summer but other than that I don't get behind the wheel of a vehicle. I don't have any problem with just not driving at all. Am I really legally obligated to have car insurance even though I do not drive? Will it somehow make me less likely to get insured in the future if I remove myself from her insurance package now?

What is the average price of business insurance?

Insurance cost for drivers under 21?

For Car and Motorcycle. Don't need exact numbers, just a rough estimate.""

Why is my credit ratingscore brought down for getting car insurance quotes?

I'm trying to get auto and renter's insurance and I do not understand why my credit score is brought down because of this. Can't they tell I'm not our trying to get several credit cards or lines of credit or loans? How can this be dealt with and changed or stopped? If this is going to happen, how will my credit look in two years when I am ready to buy a newer vehicle?""

Window tints ticket insurance rates?

does a nonmoving window tint ticket , affect my insurance rates if i pay if off and keep the tints on, here my problem i am under my parents insurance plan and my dad would not let me keep my tints if i keep getting pulled over for them. i have alot of money and i just want to keep paying for the tickets. money is not the problem, i just want to know if i pay the tickets off will it show on my insurance or anywhere else?""

Unemployment Insurance in California?

I currently receive unemployment insurance. On the check stub it states that my claim expires on 07/2008, although the balance noted on there is less than what I usually receive. I believe its because the 6 month period has ended. My questions is, can I reopen up the claim? Am I still eligible to receive my unemployment insurance until my claim has expired which is 07/2008? I was told that you can claim unemployment insurance for a year, so I don't understand why I only received it for 6 months. I was with my previous employer for 7 years, so it's not like I worked wherever for a short period of time. And I am actively seeking a job, although I have a few expectations so I haven't accepted any offers plus I'm a single mother and I have to work around my parent's schedule cause its way too expensive to leave my daughter at a decent daycare that I can trust. Hopefully someone out there can help me with a few information.""

Motorcycle insurance with no Class C?

I live I California and the dmv gave me an only class M learners permit and I can only ride motorcycles not cars. My problem is Insurance companies keep asking for a drivers license then they cut me but I really don't want a Class C license!!! Any insurance companies bypass that?

Car insurance for men and women?

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The maternal mortality rate in the state is a third of the American average. Here's why.

Kristen Terlizzi woke up on July 16, 2014, in the intensive care unit at Stanford University to the news that the placenta connecting her to the child she'd just given birth to had spread like a cancer through her entire abdomen.

Six weeks earlier, Terlizzi, then 32, had been diagnosed with placenta accreta, a condition that can cause the placenta to grow out of control. In a normal pregnancy, the placenta develops inside the uterus, attaches to the uterine wall, and then is flushed out of the body after the birth.

In accreta, which doctors believe is most often caused by scarring from prior cesarean sections, the placenta sticks around and embeds. The condition was exceedingly rare in the 1950s, occurring in only one in 30,000 deliveries in the US. Today, because of the rise in C-sections, it shows up in about one in 500 births. One in 14 American women with accreta die, usually from hemorrhaging too much blood.

Childbirth is one of the most common reasons women go into hospitals, and yet the American health care system handles complicated pregnancies with a stunning lack of preparation and precision. Put simply, women who give birth in the US have a greater risk of dying relative to other rich countries — and the problem has been growing worse at a time when America’s peers have continued to make pregnancy safer.

Terlizzi could have died too. But the fact that she lives in California — a state that a decade ago decided to take the American tragedy of maternal death seriously — may well have saved her life.

Courtesy of Kristen Terlizzi

Terlizzi on the operating table at Stanford. More than 20 doctors and nurses shuffled in and out of her operating room to manage her complicated birth.

Terlizzi’s only risk factor for accreta was a prior C-section with her first son, Everett. Her doctors had planned to surgically remove the placenta after Leo was born.

But when the surgeons opened up her abdomen, they discovered the placenta had filled her entire pelvis. “They couldn’t see anything not affected,” she said. Hers was such a risky case, they decided not to operate, and closed her up.

Several weeks later, still in the hospital, Terlizzi developed a deadly blood clotting condition caused by the leftover tissue. Doctors attempted to remove the rogue placenta again. During the second surgery, Terlizzi began to hemorrhage as surgeons raced to cut out the placental tissue, repair her bladder and ureter, and remove her uterus, cervix, and appendix.

A mother can bleed to death in childbirth within five minutes. But Terlizzi managed to hold on, as nurses carefully measured how much blood she was losing and gave her 26 units of blood products — effectively replacing all of the blood in her body.

Courtesy of Kristen Terlizzi

Terlizzi with her son Leo.

Today, Terlizzi lives with her husband and two children in Silicon Valley, works in tech, and runs 20 miles per week. The only remnant from the surgeries is a wide, T-shaped scar across her belly.

Her pregnancy was so exceptionally complicated, it inspired a scientific journal case study. But it’s also emblematic of how unpredictably dangerous birth can be, even for healthy women — and how the deadliest pregnancy complications are survivable when hospitals prepare for them.

The Stanford doctors and nurses who treated her were ready with a precise set of steps to manage her care. Among them: hemorrhage guidelines created by a doctor named David Lagrew as part of Stanford’s California Maternal Quality Care Collaborative (CMQCC), a revolutionary initiative to make births safer for moms in the state. A decade into their project, they’ve proved that even within America’s imperfect health system, death in childbirth is not an inevitability.

California has managed to buck America’s grim maternal death trend

In the US, childbirth has been growing more dangerous recently. Maternal mortality — defined as the death of a mother from pregnancy-related complications while she’s carrying or within 42 days after birth — in the US soared by 27 percent, from 19 per 100,000 to 24 per 100,000, between 2000 and 2014.

That’s more than three times the rate of the United Kingdom, and about eight times the rates of Netherlands, Norway, and Sweden, according to the OECD.

It's a stunning example of how poorly the American health care system stacks up against its developed peers. More women in labor or brand new mothers die here than in any other high-income country. And the CDC Foundation estimates that 60 percent of these deaths are preventable.

But as the mortality rate has been edging up nationally, California has made remarkable progress in the opposite direction: Fewer and fewer women are dying in childbirth in the state.

So how did California manage to buck the trend? I was curious, particularly as American women’s health is under assault, with the GOP push to repeal and replace the Affordable Care Act.

I went to California to learn about what they were doing right, and found that all roads led to CMQCC, the multi-disciplinary health collective (based out of Stanford).

On my first day in Orange County, I met with Dr. David Lagrew, an OB-GYN and founding member of the CMQCC, at his office in St. Joseph Hospital. He’s been instrumental in helping drive down California’s maternal mortality rate, including creating the hemorrhage protocols that may have saved Terlizzi’s life.

Julia Belluz/Vox

Dr. David Lagrew, an obstetrician gynecologist who has been working to make birth safer for moms for more than 30 years, looks at data on maternal health outcomes at St. Joseph Hospital in Orange County.

A native of Kentucky, Lagrew moved to Southern California for a medical fellowship in 1984. About seven months in, he saw a placenta accreta case at Long Beach Memorial that has haunted him since.

“It was just blood everywhere,” he says, in a slow Kentucky drawl that’s softened after more than two decades in California, where he is now the medical director for women’s health for St. Joseph Hoag Health system, overseeing five hospitals in the region that do obstetrical work. This includes facilities in richer parts of the state, like Newport Beach, and low-income areas like Apple Valley, an isolated town on the edge of the Mojave Desert.

“The lady ended up getting over 50 units of blood,” he recalls. The hospital didn’t know how to the handle the bleeding, and Lagrew watched the mother go limp and die on the operating room table.

Around that time, an influential paper was published in the journal Obstetrics and Gynecology, establishing the connection between the exponential rise in C-section rates and placenta accreta cases.

Lagrew started wondering about the suffering and death he had seen in the OR that day, and how much of it was preventable, given that so many C-sections aren’t medically necessary. (Doctors sometimes perform them to wrap up cases faster — and get reimbursed — before the end of their shift. Patients also request them for reasons that have nothing to do with health.)

Lagrew, who has neatly cropped salt-and-pepper hair and wire-rimmed glasses, is obsessed with numbers, a self-professed “data geek.” He spent part of his undergraduate degree teaching himself computer programming, and coded for the Forestry Department at the University of Kentucky to pay his way through school.

He thought that if he could gather data on doctors’ C-section rates, and educate his fellow clinicians about how many they were doing and the risks of unnecessary surgeries, he might be able to reduce C-sections that aren’t medically indicated — and complications like placenta accreta.

An operating room in the labor and delivery ward at St. Joseph Hospital in Orange County.

A spot for the newborn babies along with a red “hemorrhage cart” in case a mom begins to bleed heavily after pregnancy.

By 1989, when Lagrew was appointed medical director at Saddleback Hospital in Laguna Hills, he began to test his approach. When he’d hand doctors data on their C-section rates, some would say, “What the heck is this?" Some would even scream at him, he recalls. "I didn't do this one C-section and you put it on my report!" they’d say.

Lagrew would respond: “What about the other 215?”

The approach worked. The C-section rate at Saddleback was halved within five years.

Lagrew has now managed similar feats at the eight hospitals where he’s worked since, and at hundreds more in the state through CMQCC.

His method is a microcosm for how CMQCC works: Collect data about maternal health, zero in on the complications that can be prevented, figure out what the evidence says about the steps required to prevent them, and then engage stakeholders and mentor them as they follow those lifesaving steps.

The organization, which runs as a collective and is mainly funded by the California Healthcare Foundation, California Department of Public Health, and the Centers for Disease Control and Prevention, was imagined in a Los Angeles airport hotel meeting room in 2006, a time when the state’s maternal mortality rates had recently doubled.

A group of concerned doctors, nurses, midwives, and hospital administrators, including CMQCC medical director Elliott Main, started a maternal mortality review board to pore over each death in detail and identify its root causes. Pretty quickly, hemorrhage and preeclampsia (pregnancy-induced severe high blood pressure) floated to the top of the list as the two most common — and preventable — causes of death.

It’s difficult to overstate how revolutionary this simple first step was in the arena of maternal health. About half of US states still don’t formally review the causes of maternal death on a regular basis to find out which deaths are preventable and how to stop future similar deaths from occurring. The US National Center for Health Statistics hasn’t even published an official maternal mortality rate since 2007 — that’s how low-priority this issue is.

Mothers die too often because women’s health isn’t valued in the US

One of the United Nations’ Millennium Development Goals focused on driving down the maternal mortality rate. This led to efforts in almost every country to save moms’ lives — and they were largely successful: The global maternal mortality rate dropped by 44 percent worldwide between 1990 and 2015, and by 48 percent in developed countries.

Jonas Gratzer/LightRocket via Getty Images

A maternity clinic in Bangladesh.

The US was one of only 13 countries, including North Korea and Zimbabwe, that saw its maternal death rate increase since 1990.

“We are going in opposite direction of the whole worldwide trend,” says University of Maryland researcher Marian MacDorman, who co-authored the best available national study of US maternal mortality in 2016.

“It’s a travesty,” says MacDorman. “Mongolia has a maternal mortality rate, and the US with all our wealth and health care can’t publish a maternal mortality rate.”

Part of America’s increase has to do with changes in how maternal deaths are codified on death certificates. In the 1980s, health officials realized that maternal deaths were being underreported, which led to a push for better reporting.

But that’s far from the only explanation, according to MacDorman and other researchers who study maternal health.

For one, there’s been a decline in access to contraception and abortion in many parts of the US, leading to more unplanned, unwanted — and, in some cases, more dangerous — pregnancies.

The opioid epidemic certainly hasn’t made births safer for moms, and health care access remains poor for low-income and minority women, who have among the worst maternal health outcomes. The exponential increase in C-sections, which can sometimes save moms’ and babies’ lives, has also contributed to more pregnancy complications in subsequent births, such as accreta.

American women are also heavier on average, and having babies later in life, often with more chronic health conditions, putting them at a higher risk of complications in the maternity ward.

Yet other developed countries have seen similar health trends in rising childbirth age and bodyweight — without the accompanying increased death risk for mothers.

That’s led researchers like Boston University maternal health expert Eugene Declercq to conclude that a key driver of America’s maternal mortality problem is that America doesn’t value women.

“The argument we make internationally is that [a high maternal death rate] is often a reflection of how the society views women,” he says. “In other countries, we worry about the culture — women are not particularly valued, so they don’t set up systems to care for them at all. I think we have a similar problem in the US.”

Policies and funding dollars tend to focus on babies, not the women who bring them into the world. For example, Medicaid, the government health insurance program for low-income Americans, will only cover women during and shortly after pregnancy. “Nothing has captured it better for me than that: Get on when you’re pregnant, but get off when you’re not,” Declercq said. Only 6 percent of block grants for "maternal and child health" under the Title V Maternal and Child Health Services Block Grant Program goes to moms.

In the absence of national leadership, however, there are advocates at the state level who are working on the problem. One place that stands out is California.

As of 2013, there were 7.3 deaths per 100,000 in California — bringing the Golden State in line with countries like the United Kingdom or Portugal. That’s also half of what the state’s maternal death rate was in 2006, and a third of the national rate.

Considering that more than half a million women give birth in California each year, representing one-eighth of all US births, the progress in curbing maternal mortality has been profound.

“Hemorrhage carts” have made birth safer for moms in California

To start to tackle the problem, CMQCC created “toolkits,” which are essentially evidence-based, step-by-step recipes — downloadable for free — on how teams of health care providers in hospitals can best prepare for and manage the sometimes deadly complications that arise with childbirth.

The first toolkit, which Lagrew co-chaired, focused on maternal hemorrhage — what their maternal death review revealed was one of the most common and preventable causes of death in California.

Only about 2 percent of a woman’s total blood volume flows through her uterus. During pregnancy, though, that number rises to 10 percent to nourish the placenta and the baby. The most common cause of postpartum hemorrhage is a uterine atony — when the uterus does not contract and stop bleeding after the placenta breaks off.

About 30 percent of women who experience an obstetric hemorrhage don’t have an identifiable risk factor, so it’s hard to know who might be at risk.

One key idea in the hemorrhage toolkit was to make sure hospitals were armed with all the best protocols and necessary tools that might save those moms’ lives in the event of a bleed.

At St. Joseph hospital, Lagrew showed me a simple beige, waist-high rolling cart with four drawers and red handles, known as “the hemorrhage cart.” Every hospital delivering babies should have one, the CMQCC toolkit says. The cart is filled with everything to manage a hemorrhage: medicines that slow the flow of blood, instruments that repair a tear or laceration, intrauterine balloons that can provide pressure and control bleeding from a uterus that isn’t contracting well.

Julia Belluz/Vox

The “hemorrhage cart” is filled with tools doctors and nurses need to manage a hemorrhage during or after childbirth. The idea was adapted from the “code blue cart” to treat cardiac arrest patients. “Minutes count,” Lagrew said.

“Minutes count, so you can't afford to be thinking, ‘Hey, what med do I need to use next? Where do I find a balloon catheter to stop the bleed?’” Lagrew says.

When CMQCC did their root cause analysis on what was causing moms to die in their state, they found that hospitals typically didn’t have these simple things on hand. So they borrowed the idea from the “code blue cart” that’s common in hospitals to quickly treat patients who go into cardiac arrest.

“No one had ever made the code blue for obstetrical hemorrhage,” Lagrew added. “They just said, ‘Use this drug, you need these drugs. You need to measure blood better.’”

Learning about CMQCC’s approach opened my eyes to all the places where maternal health care — managing one of the most universal experiences women go through — isn’t very precise or evidence-based.

Another piece of guidance in the CMQCC hemorrhage toolkit is that doctors and nurses need to have blood products ready for moms who bleed in childbirth, and they should carefully measure blood loss during the pregnancy to make sure the patient’s levels are being adequately replenished.

To do this, CMQCC recommends a practice called “quantitative blood loss,” Lagrew explained, “which, by the way, in all your medical school or residency, no one ever teaches you how to do.”

Doctors and nurses typically eyeball blood loss — and these estimations are notoriously inaccurate. Instead, CMQCC suggests weighing dry sponges and pads that collect blood on the operating table before a surgery, and then doing so again after they’ve been soaked to calculate how much blood a mother lost.

Lagrew is now trying to make the process even better at his hospitals. In the labor and delivery ward that day, where Brahms' Lullaby chimes whenever a baby is born alongside the ever-present hum of fetal heart monitors, I watched a training session for nurses on how to use a machine that automates quantitative blood loss.

Julia Belluz/Vox

Triton OR, a new device that helps nurses more accurately measure blood that’s lost during childbirth.

The founder of the Silicon Valley company Gauss Surgical, Siddarth Satish, noticed that every vital sign in the operating room was carefully monitored and measured, except for blood loss. So he created Triton OR, an FDA-approved blood loss monitor with an iPad interface that allows health care providers to quickly weigh their tools before they’re filled with blood and afterward. Lagrew introduced the machine at the hospital as part of a pilot — one of many things he’s constantly experimenting with to make childbirth safer.

“It's classic process improvement to the point where the doctors and nurses go, ‘Wow. We just had this placenta accreta, but everything went pretty smoothly,” he said. “We didn't lose that much blood. The patient's doing great, and didn't go in the intensive care unit.’”

Hospitals and doctors in California are now competing with one another to save moms’ lives

I wanted to see how the CMQCC approach worked in a resource-strapped area of the state, so I visited St. Joseph Health, St. Mary, a hospital that delivers nearly half of the babies born in and around Apple Valley.

Apple Valley is a town filled with hills of dusty golden rocks and strip malls in a remote region of Southern California, sandwiched between Los Angeles and Las Vegas. Here, the median household income is $47,938 — about a third of Newport Beach’s.

Julia Belluz/Vox

Labor and delivery at St. Joseph Health, St. Mary, a hospital in Apple Valley, a low-income area of Southern California.

Almost all the pregnancies nurses and doctors see here are complicated by diabetes, hypertension, addiction, or other issues that put moms and babies at a higher risk of death.

Remarkably, though, St. Mary’s hasn’t seen a maternal death in at least 23 years.

Sitting in front of a stack of charts, Mendy Hickey, a nurse, beamed about gains on maternal health measures. St. Mary’s had just won a CMQCC award for their low C-section rate — among the lowest in the state, at 21 percent. They’d massively driven down their rate of early elective deliveries, or births that happen before 39 weeks gestation, by following CMQCC’s approach.

Julia Belluz/Vox

Mendy Hickey, a nurse at St. Mary’s, which just won a CMQCC award for their low C-section rate — among the lowest in the state, at 21 percent.

Babies who are born prematurely have a higher chance of winding up in the neonatal intensive care unit and needing respiratory support, Hickey said. For moms, early deliveries mean more inductions and C-sections — and more potential complications.

Hickey and her colleagues started talking about early elective deliveries at every department meeting. They posted data about doctors’ individual rates in the units and doctor lounges. “That always works really well,” she said. “They're very competitive.”

When they spotted an early delivery that wasn’t medically necessary, the department chief would have a conversation with the physician about her decision, and suggest the doctor avoid doing so again.

Joining CMQCC also allowed St. Mary’s to access a data center where they could compare their progress on maternal health against other hospitals and doctors in the state. “The database alone has been huge,” Hickey says.

The results have been staggering. St. Mary’s started to focus on early elective deliveries in late 2014, when they were 9 percent of all births at the hospital. By 2016, 2 percent of babies were being delivered early when it wasn’t medically indicated. “Data speaks,” Hickey said. “Data speaks — big time.”

Every doctor and nurse I spoke to that day was plugged into these quality improvement efforts. They bragged about their award-winning low C-section rates and reducing hemorrhage risk like they were talking about their children’s report cards.

I could also see how it affected patients’ lives, particularly in the neediest and most complicated cases.

Skye Brooks, a 24-year-old mom, had recently given birth to her son, Onyx. Before her unplanned pregnancy, she’d worked as a package handler and sorter at an Amazon warehouse in nearby San Bernardino. She had Type 2 diabetes, which heightened her risk of pregnancy-induced high blood pressure (or preeclampsia).

Julia Belluz/Vox

Skye Brooks, 24, holds her son, Onyx. Brooks was saved from having a stroke — the result of pregnancy-induced high blood pressure — with a C-section.

At a checkup 29 weeks into the pregnancy, her doctor discovered her blood pressure had shot up to a dangerously high 253/186, and that she wasn’t responding to hypertension medication. High blood pressure can cut off the amount of blood and nutrients that reach the fetus, restricting the baby’s growth.

Brooks was quickly shuffled off for an emergency C-section that saved her life. “I would have had a stroke if I didn’t deliver,” she says, while rocking Onyx in the neonatal intensive care unit, a beige room humming with the buzz of vital sign monitors and incubators.

California could inspire the rest of the country, but the GOP health reform bill could make America’s maternal health worse

CMQCC’s toolkits have been downloaded more than 24,000 times, and more than 200 of California’s 243 maternity hospitals have joined the organization to work on improving maternal health.

In one recent study, researchers found a 21 percent reduction in severe health problems associated with hemorrhages in the California hospitals participating in CMQCC’s programs. Hospitals that didn’t join the effort saw a non-significant 1 percent reduction. Since CMQCC’s founding, California has also seen its maternal mortality rate decline by 55 percent at a time when other states are documenting increases.

Julia Belluz/Vox

Signs posted all over the labor and delivery ward at St. Joseph Hospital in Orange County remind doctors and nurses they should wait until a woman’s cervix has dilated to 6 cm instead of 4 cm before considering a C-section. The goal is to avoid unnecessary surgeries.

Large employers in California, including Disney and Apple, as well as insurance payers have recognized that making births safer saves them money. They’ve supported CMQCC by helping pressure hospitals to follow the steps to protect women in the workforce — and avoid incurring unnecessary costs that drive up insurance premiums.

CMQCC is working with other health care groups to take their work national. But today, California’s efforts are at odds with the direction the federal government is moving on women’s health. Senate Republicans are pushing to repeal and replace Obamacare with the Better Care Reconciliation Act. It could make it harder for American women to access reproductive health care and family planning services. It’ll make maternity benefits optional for private health plans, and defund Planned Parenthood — where 2.5 million Americans access family planning and maternity care services.

The Better Care Act would also gut Medicaid, which covers about half of all births in the US. If the GOP plan passes, the nonpartisan Congressional Budget Office expects it will result in more unplanned pregnancies and 22 million people losing their health care within a decade.

For a preview of what this could do to women’s health, look to Texas, which has the highest maternal mortality rate in the developed world. There, 36 moms die per 100,000 births, or five times California’s maternal mortality rate. Texas has also closed down Planned Parenthood clinics and rejected Medicaid expansion — changes the GOP would like to see ripple across the US. The state boasts the largest uninsured population in America.

But long before the GOP plan or the current health reform debate, the US lagged behind other rich countries when it comes to providing women access to the comprehensive health care necessary for safe pregnancies and deliveries.

“There are a lot of areas where America’s policies are less protective [for mothers] than they are in Canada, Europe, and other developed countries,” said Adam Sonfield, senior policy manager at the Guttmacher Institute. “Being able to take time off from work to go to the doctor, and having child care to make sure you can go to that doctor, and making sure you have affordable transportation to go to that doctor” — it’s uniformly more difficult for American moms.

In the US, we haven’t bothered to create national health policies around maternity care that are focused on improving outcomes for mothers, such as a federal maternity leave policy or universal health care.

Maternal health is also becoming more complicated. The clinical complications CMQCC has focused on so far — hemorrhage, preeclampsia — are being outpaced by lifestyle-related health issues, like cardiovascular disease and opioid addiction. There are also astounding racial disparities in maternal health: Black mothers are three times more likely to die in childbirth than white women. It’ll require more than well-meaning doctors and nurses to fix these problems.

Julia Belluz/Vox

Courtney McGuffin, 38, has Type 1 diabetes. Her pregnancy and C-section birth were considered high-risk.

Still, California has demonstrated that even in our messy and imperfect health care system, progress is possible. They’ve shown the rest of the country what happens when people care about and organize around women’s health. Policymakers owe it to the 4 million babies born in the US each year, and their mothers, to figure out how to bring that success to families across the country.

The difference between Texas and California is that California decided to take on maternal mortality, Boston’s Eugene Declercq told me.

Kristen Terlizzi, the accreta patient who started the National Accreta Foundation to raise awareness about it, has been thinking about the potential health reforms coming down.

“I’ve come to appreciate the concerns about lifetime limits. Thank God my surgery happened before this was an issue,” she said of the GOP push to reintroduce caps on how much health care costs patients can get coverage for over a lifetime. “I had this perception that maternal mortality was a faraway issue or an issue of the past. I thought this happened in other places. I had no idea healthy mothers in this country were experiencing things like this.”

Editor: Eliza Barclay Photographer: Julia Belluz Photo editor: Kainaz Amaria Copy editor: Bridgett Henwood Project manager: Susannah Locke Graphics: Javier Zarracina and Sarah Frostenson

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