Law and Politics

Groups Call New Ohio 

Congressional Map 

Unconstitutional and Partisan

    COLUMBUS, Ohio -
(ACLU) - 12/3/2021 - The ACLU of Ohio, the American Civil Liberties Union, and Covington & Burling LLP filed a lawsuit on Nov. 30 challenging Senate Bill 258, which establishes new congressional districts for Ohio, giving Republicans an unconstitutional partisan advantage. This proposal was signed into law by Gov. Mike DeWine on November 20.

    The lawsuit was brought on behalf of the League of Women Voters of Ohio, the A. Philip Randolph Institute, and several individuals.

    Earlier this month, the Ohio General Assembly voted to enact the map along strict party lines, with nearly all Republicans, but no Democrat, voting in favor. The enacted plan is heavily skewed to favor the Republican Party; it awards Republicans 67%-80% of Ohio’s congressional seats, although the party receives only 55% of Ohioans’ votes. Because this proposal received no support from the minority party, it will only be in place for four years, according to the terms of Article XIX, Section 1, of the Ohio Constitution.

    This is the second Ohio redistricting lawsuit filed this year by the ACLU and plaintiffs — the first was brought in September, to challenge the state House and Senate districts, which are also severely gerrymandered. Oral arguments in that case are set for December 8.

“Our elected officials have once again flagrantly violated the will of Ohioans, who have repeatedly voted for fair districts. Judicial intervention is critical to prevent these self-serving officials from perpetuating the terrible tradition of extreme partisan gerrymandering in our state. A core principle of republican government is that the voters should choose their representatives, not the other way around,” noted Freda Levenson, legal director of the ACLU of Ohio. “For the second time in two months, we ask the state’s highest court to enforce the Ohio Constitution, and ensure that Ohio voters are able to have a voice in their government.”

    Julie Ebenstein, senior staff attorney with the ACLU’s Voting Rights Project, commented: “Here we go again. Ohio politicians are making another brazen attempt to undermine voters, who amended their state Constitution to prevent gerrymandering. Yet try as they may, politicians do not get to choose their voters — voters get to choose their politicians.”

    As stated in the lawsuit: “The map unduly splits governmental units in the urban and suburban areas of southwestern and northeastern Ohio. In particular, the Enacted Plan splits counties and communities in Hamilton, Cuyahoga, and Summit — splits that are unnecessary for any purpose other than to minimize the efficacy of Democratic votes.”

    Jen Miller, executive director of the League of Women Voters of Ohio, critized mapmakers for defying voter desire for a bipartisan map.

    “The newly adopted congressional map is an affront to the Ohio Constitution and our democracy. Despite demanding reforms at the ballot box in 2018, Ohio voters are facing an even more extreme gerrymander than the congressional districts that they've been forced to live with for the past decade,” noted Jen Miller, executive director of the League of Women Voters of Ohio. “From start to finish, mapmakers shamefully defied voter expectations of having a transparent, bipartisan, and public process that resulted in congressional districts that serve voters — not politicians. Ohioans deserve better.”

    “Under the enacted plan the Republicans can anticipate winning 67 percent to 80 percent of the congressional seats — even though they are only likely to obtain about 55 percent of the vote. The Ohio Constitution flatly prohibits that outcome,” Robert Fram of Covington & Burling LLP said.

    The case, League of Women Voters of Ohio et al v. Governor DeWine, was filed in the Supreme Court of Ohio.


Economic Analysis

Survey: Gen Z Purchasers 

Value Sustainability More 

Than Older Generations

    PITTSBURGH-- (BUSINESS WIRE) -- 11/26/2021 -- As sustainability and climate change dominate the headlines globally, new consumer research conducted by First Insight and the Baker Retailing Center at the Wharton School of the University of Pennsylvania shows the power that Gen Z consumers have over older generations to influence purchasing decisions around sustainability. Fully three-quarters of Gen Z consumers said that sustainability was more important to them than the brand name when making purchase decisions. As a result of Gen Z’s influence over their Gen X parents on this issue, Gen X consumers’ preference to shop sustainable brands increased by 24 percent and their willingness to pay more for sustainable products increased by 42 percent since 2019.

    Gen Z, the demographic cohort born after 1997, has historically been the most vocal about the health of the planet. The survey, conducted by First Insight and the Baker Retailing Center at the Wharton School of the University of Pennsylvania, found that Gen Z leads the way in sustainability. In fact, consumers across all generations—from Baby Boomers to Gen Z—are now willing to spend more for sustainable products. Just two years ago, only 58 percent of consumers across all generations were willing to spend more for sustainable options. Today, nearly 90 percent of Gen X consumers said that they would be willing to spend 10 percent extra or more for sustainable products, compared to just over 34 percent two years ago.

   “Our research points to a seismic shift in sentiment around sustainability purchasing decisions, with significant increases in just two years. When the previous study was fielded in 2019, older generations were not as sustainability-conscious as they are today. The global pandemic caused many to rethink their consumption and its impact on the health of the planet, yet Gen Z have been consistent in remaining true to their sustainability values while also educating and influencing the generations that came before them,”
First Insight CEO Greg Petro said.

    Download the report to see all the key findings from the study here.

Additional Key Findings:

    Today, the majority of respondents across every generation expect retailers and brands to be more sustainable. The survey found, however, that there is some disconnect across the generations about what sustainability actually means. Nearly half of the Boomers (44 percent), Gen X (48 percent), and Millennials (46 percent) agree that sustainability means “products made from recycled, sustainable and natural harvested fibers and materials.” Meanwhile, nearly half of the Gen Z (48 percent) respondents believe that sustainability means sustainable manufacturing. One thing most could agree on is that packaging should be sustainable. Across generations, 73 percent combined feel that sustainable packaging is very or somewhat important today, compared to only 58 percent in 2019.

    The survey found that values-based purchase decisions—whether they are personal, social, or environmental—are more likely to be made by Gen X (76 percent), Millennials (77 percent), and Gen Z (75 percent), and within those groups, men (77 percent) are more likely than women (67 percent) to make values-driven purchases.


    First Insight’s findings are based on the results of a U.S. consumer study of a targeted sample of more than 1,000 respondents, balanced by gender, geography, and generation, and was fielded between July 1, 2021, and July 10, 2021. The study was completed through proprietary sample sources among panels who participate in online surveys. Further details on the findings are available upon request.

Taxes and Wealth

More Than 200 Individuals,

 Corporate Leaders 

Support Higher Taxes on Wealthy

By Lily Bohlke
Producer / PNS

    CHICAGO - (PNS) - 9/19/2021 - More than 200 high-net-worth individuals signed a letter recently urging Congress to move forward on the $3.5 trillion budget bill - even though it includes tax-code changes that would cost them more money.

    To fund the budget plan, President Joe Biden wants to raise the income-tax rate for folks making more than $400,000 a year. The plan also would tax capital gains as income for people making more than $1 million a year, raise the corporate tax rate, close loopholes and strengthen IRS enforcement.

    "Each of these proposals is to make sure that we have a fair tax system, in which those who have the most and are benefiting the most are asked to pay the most as well," said Sandra Fluke, president of Voices for Progress, the lead organizer behind the letter.

    One Chicagoan signed the letter to House Speaker Nancy Pelosi and Senate Majority Leader Chuck Schumer.

    A recent poll showed that Americans overwhelmingly support raising taxes on the wealthy instead of borrowing and increasing the national debt. Opponents include Republicans and business groups who say it could harm post-pandemic economic recovery.

    Fluke said the Trump administration's tax cuts in 2017 has hampered the nation's revenue collection, and his gutting of the IRS to one-third of its previous size limits its ability to enforce tax policy. She said all that affects our ability to fund today's big priorities.

    "And we only have to look out of our window to see what is happening in terms of the severe weather being caused by climate change," she said. "So, we gotta make those investments and not be giving away tax cuts to corporations that are actually lower than what they even asked for."

    In her view, getting corporations and the highest-income Americans to pay higher tax rates is an opportunity to invest in child care, long-term care, health care and more. 
Story credit: Public News Service.  

Racial Justice

Graphic Novel Spotlights 

Black Wealth Before 1921 

Tulsa Massacre

By Lily Bohlke
Producer / PNS

    CHAMPAIGN, Ill. - (PNS) - 8/21/2021 - A graphic novel illustrated by a University of Illinois professor aims to serve as a primer for young people to learn about the history of the Greenwood District in Tulsa, Oklahoma, often known as Black Wall Street, destroyed by a white mob in 1921.

    It's called "Across the Tracks: Remembering Greenwood, Black Wall Street, and the Tulsa Race Massacre," by Alverne Ball of Joliet.

    Stacey Robinson, assistant professor of graphic design at the University of Illinois at Urbana-Champaign, illustrated the book. He said it is about the destruction, but also the rebuilding, of the city, and the survivors that to this day are still seeking justice.

    "The weight of this subject matter is balanced by very beautiful, very opulent colors, and there's joy in the book as well," Robinson remarked. "American history did not happen in black and white; it did not happen in sepia tones. I wanted the audience to feel this Black beauty, to feel the opulence of this town."

    Survivors and descendants of the Tulsa Race Massacre are calling on the JusticeDepartment to launch an investigation and help find the mass graves of hundreds of Black residents who were killed. They said they do not trust local and state officials to handle the remains with compassion, or to meaningfully investigate the deaths.

    Robinson noted in Tulsa before 1921, it is said dollars circulated more than 20 times before leaving the Black community, which is a key component of wealth-building. He argued kids and teens should be aware of the history to help understand the racial wealth gap that exists today. The net worth of the average white family is ten times more than the average Black family.

    "If you know Black Panther, there's the nation of Wakanda, right? Well, Black people have had our Wakandas, we've had our Black liberated, autonomous spaces," Robinson explained. "And when we have these spaces, they are destroyed because we are Black and affluent."

    Robinson added while the Tulsa Race Massacre is not often taught in schools, more and more people are learning about it with its 100-year anniversary. He noted the HBO series Watchmen and Lovecraft Country, set in Tulsa, are also boosting awareness, and hopes the graphic novel can serve as another entry point.

Letter Justice for Greenwood 08/13/2021
Wealth gap report Brookings Institution 02/27/2020

Story credit: Public News Service.

Medicare Fraud

 Company Owner Indicted for 

$784 Million Health Care 

Fraud Scheme

     (DOJ) - 8/16/2021 - A federal grand jury in Newark, New Jersey, returned a superseding indictment on Aug. 10 charging a Florida owner of multiple telemedicine companies with orchestrating a health care fraud and illegal kickback scheme that involved the submission of over $784 million in false and fraudulent claims to Medicare. This is one of the largest Medicare fraud schemes ever charged by the Justice Department. The superseding indictment also charges the defendant with concealing and disguising the proceeds of the scheme in order to avoid paying income taxes.  

    Creaghan Harry, 53, of Highland Beach, Florida, is charged in the superseding indictment with one count of conspiracy to commit health care fraud and wire fraud, and four counts of income tax evasion. Harry previously was charged in an indictment along with co-conspirators Lester Stockett and Elliot Loewenstern with one count of conspiracy to defraud the United States and to pay and receive kickbacks, four counts of receipt of kickbacks, and one count of conspiracy to commit money laundering. Stockett and Loewenstern previously pleaded guilty. If convicted, Harry faces a maximum penalty of 20 years’ imprisonment for the conspiracy to commit health care fraud and wire fraud, five years’ imprisonment on each count of tax evasion, five years’ imprisonment for the conspiracy to defraud the United States and pay and receive kickbacks, 10 years’ imprisonment for each count of receipt of kickbacks, and 20 years’ imprisonment on the conspiracy to commit money laundering.  

    A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

    According to allegations in the superseding indictment, Harry and his co-conspirators solicited illegal kickbacks and bribes from durable medical equipment (DME) suppliers and marketers in exchange for orders for DME braces and medications. Harry’s telemedicine companies then allegedly paid physicians to write medically unnecessary orders for these braces and medications. Harry’s telemedicine companies provided orders to DME suppliers that fraudulently billed Medicare over $784 million. Medicare ended up paying over $247 million. 

    In order to conceal and disguise the health care fraud and illegal kickback scheme, the superseding indictment alleges, Harry directed DME suppliers and marketers not to directly pay his telemedicine companies and instead to pay shell companies that had been opened in the names of straw owners in the United States and foreign countries, such as the Dominican Republic. Harry then transferred the funds from the shell companies to his telemedicine companies in order to pay physicians to write the unnecessary orders.

    The superseding indictment alleges that Harry falsely claimed to prospective investors, lawyers and others that his telemedicine companies had not received any kickbacks. Harry instead falsely represented that the telemedicine companies had been receiving revenue of “about $10 million per year” from fees paid by patients to receive telemedicine services, when in fact the revenue of the telemedicine companies was derived from illegal kickbacks and bribes.

    The superseding indictment further alleges that Harry committed income tax evasion in the calendar years between 2015 and 2018 by receiving the proceeds of the illegal scheme in the accounts of shell companies belonging to nominee owners and using those proceeds to live a lavish lifestyle. Harry did not file an income tax return or pay taxes on this income. 

    Assistant Attorney General Kenneth A. Polite of the Justice Department’s Criminal Division; Acting U.S. Attorney Rachael A. Honig for the District of New Jersey; Special Agent in Charge George M. Crouch of the FBI’s Newark Field Office; Special Agent in Charge Scott J. Lampert of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG); and Special Agent in Charge Michael Montanez of IRS-Criminal Investigations, Newark, made the announcement.

    HHS-OIG, the FBI and IRS-Criminal Investigations are investigating the case.

    Assistant Chief Jacob Foster of the Criminal Division’s Fraud Section’s National Rapid Response Strike Force and Trial Attorney Darren Halverson of the Newark Strike Force are prosecuting the case.

    The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 federal districts, has charged more than 4,600 defendants who have collectively billed federal health care programs and private insurers for approximately $23 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. 

    The Fraud Section uses the Victim Notification System (VNS) to provide victims with case information and updates related to this case. Victims with questions may contact the Fraud Section’s Victim Assistance Unit by calling the Victim Assistance phone line at 1-888-549-3945 or by emailing To learn more about victims’ rights, please visit:  

    An indictment is merely an allegation, and the defendant is presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

Law and Justice


Former DEA Special Agent

Sentenced to 13 Years in Prison

     (DOJ) - 8/15-2021 - A former Drug Enforcement Administration (DEA) Special Agent was sentenced on Aug. 12 to 160 months in prison for nine crimes related to official misconduct, including perjury, obstruction of justice, and theft.

    According to court documents, Chad Allan Scott, 53, of Covington, Louisiana, perjured himself and directed others to commit perjury to obtain a conviction against an alleged drug dealer. He also falsified forms so that he could take possession of a truck bought for him by a drug dealer. When he and two other law enforcement officers began to worry that they would be investigated, Scott and the others conspired to throw evidence of their wrongdoing into the swamps outside New Orleans. Scott also stole money and possessions from defendants his DEA group had arrested. Scott was found guilty in August 2019 and June 2021 after his case was severed into two separate federal trials by Federal District Court Judge Milazzo.

    “Chad Scott took an oath to serve his community with integrity, but rather than use his badge to protect his community, he used it to break the law,” said DEA Administrator Anne Milgram. “This goes against everything that the Drug Enforcement Administration stands for. Scott betrayed the very people he was entrusted to protect and today he is being held accountable for his crimes.”

    The case was initially investigated by the Louisiana State Police and later by the FBI, DEA Office of Professional Responsibility (OPR), and DOJ-OIG.

    Assistant Deputy Chief Timothy A. Duree of the Justice Department’s Fraud Section and Trial Attorney Charles A. Miracle of the Justice Department’s Narcotic and Dangerous Drug Section prosecuted the case.

    “While he was a law enforcement agent, Scott compromised cases and conspired to steal from the people he arrested,” said Special Agent in Charge Douglas B. Bruce of the Justice Department’s Office of the Inspector General (DOJ-OIG) Denver Field Office. “His actions were antithetical to the oath he swore to uphold. Now, he will rightly serve time for his many crimes.”

Economic Analysis

House Price Index Shows Decline 

In Affordability for 

Third Month in a Row

    SANTA ANA, Calif. - (BUSINESS WIRE) - 8/12/2021 - First American Financial Corporation (NYSE: FAF), a leading global provider of title insurance, settlement services and risk solutions for real estate transactions, released the May 2021 First American Real House Price Index (RHPI) on July 27. The RHPI measures the price changes of single-family properties throughout the U.S. adjusted for the impact of income and interest rate changes on consumer house-buying power over time at national, state and metropolitan area levels. Because the RHPI adjusts for house-buying power, it also serves as a measure of housing affordability.

Chief Economist Analysis: Record Nominal House Price Appreciation Outpaces House-Buying Power Growth in May

    “Housing affordability declined on a year-over-year basis for the third month in a row in May, following a two-year streak of rising affordability,” said Mark Fleming, chief economist at First American. “The decline in May occurred even as two of the three key drivers of the Real House Price Index (RHPI), household income and mortgage rates, swung in favor of greater affordability relative to one year ago.

    “House-buying power increased by 8 percent in May compared with a year ago, propelled by lower mortgage rates and higher household income. The affordability gains from house-buying power, however, were offset by the third component of the RHPI, nominal house price appreciation, which reached a record 18 percent in May, surpassing the previous peak from 2005,” said Fleming. “As always, real estate is local and national affordability trends are not necessarily reflected in local trends, as house-buying power and nominal house price gains vary greatly from city to city.”

Affordability Declined in 49 of the 50 Major Markets

    “The drop in affordability was broadly felt as affordability declined year over year in 49 of the 50 markets we track,” said Fleming. “The five markets with the greatest year-over-year decline in affordability were:

  1. Phoenix (-22.7 percent)
  2. Seattle (-20.1 percent)
  3. Kansas City, Mo. (-19.6 percent)
  4. Tampa, Fla. (-17.8 percent)
  5. Las Vegas (-17.2 percent)

    “Mortgage rates are generally the same across the country, so a decline in mortgage rates boosts affordability equally in each market,” said Fleming. “Household income growth and nominal house prices, on the other hand, differ from market to market, so the affordability dynamic varies as well.

    “In May, Phoenix had the greatest year-over-year decrease in affordability. While annual income growth was steady at 1.9 percent, Phoenix experienced the biggest annual increase in nominal house prices of any major market – 29.3 percent. The steep increase in nominal house prices overshadowed any affordability gains from increased house-buying power,” said Fleming. “A similar dynamic played out in Tampa as year-over-year nominal house price appreciation of 25.6 percent outpaced house-buying power.

    “In Seattle and Las Vegas, house-buying power ticked up as the positive impact of falling mortgage rates offset a decline in household incomes. However, like Phoenix and Tampa, nominal house price growth in Seattle (20.7 percent) and Las Vegas (19.9 percent) overshadowed the house-buying power gains,” said Fleming. “Kansas City was the only one of the five markets where house-buying power declined, combining with faster house price appreciation to drive a decline in affordability.”

Where Are Nominal House Prices Headed?

    “Declining affordability may cause potential home buyers on the margin to be priced out, prompting fewer or less intense bidding wars and causing house price appreciation to moderate. The increase in housing inventory may likewise ease pressure on nominal house price growth, though the increase remains small relative to historic levels and the broader housing supply shortage is likely to take years to reverse,” said Fleming. “Affordability trends in the coming months will depend on the supply and demand dynamics behind nominal house price appreciation – dynamics which will play out differently in each market.”

May 2021 Real House Price Index Highlights

  • Real house prices increased 0.7 percent between April 2021 and May 2021.
  • Real house prices increased 8.9 percent between May 2020 and May 2021.
  • Consumer house-buying power, how much one can buy based on changes in income and interest rates, increased 1.4 percent between April 2021 and May 2021, and increased 8.4 percent year over year.
  • Median household income has increased 4.7 percent since May 2020 and 78.0 percent since January 2000.
  • Real house prices are 19.9 percent less expensive than in January 2000.
  • While unadjusted house prices are now 30.1 percent above the housing boom peak in 2006, real, house-buying power-adjusted house prices remain 43.8 percent below their 2006 housing boom peak.

May 2021 Real House Price State Highlights

  • The five states with the greatest year-over-year increase in the RHPI are: Arizona (+19.4 percent), Vermont (+17.0 percent), Washington (+16.6 percent), Nevada (+16.3 percent), and Connecticut (+15.4 percent).
  • There were no states with a year-over-year decrease in the RHPI.

May 2021 Real House Price Local Market Highlights

  • Among the Core Based Statistical Areas (CBSAs) tracked by First American, the five markets with the greatest year-over-year increase in the RHPI are: Phoenix (+22.7 percent), Seattle (+20.1 percent), Kansas City, Mo. (+19.6 percent), Tampa, Fla. (+17.8 percent), and Las Vegas (+17.2 percent).
  • Among the Core Based Statistical Areas (CBSAs) tracked by First American, the only market with a year-over-year decrease in the RHPI is San Francisco (-0.1 percent).

Next Release

    The next release of the First American Real House Price Index will take place the week of August 30, 2021 for June 2021 data.


First American Data & Analytics
Freddie Mac
Census Bureau


    The methodology statement for the First American Real House Price Index is available at

Note: Original release date, July 27, 2021.

Voting Rights

Groups Urge Lawmakers to Protect,

Not Restrict, Voting Rights

By Lily Bohlke
Producer / PNS 
    INDIANAPOLIS - (PNS) - 8/4/2021 - Voting-rights advocates applauded a recent federal appeals-court decision to prevent Indiana from purging some voters from the rolls without notifying them first. However, they said there is more work to do to ensure everyone has access to a ballot.

    Two Indiana state laws, Senate Bill 442 in 2017 and Senate Bill 334 in 2020, aimed to remove a voter's registration if it appears they'd registered in another state.

    Barbara Bolling-Williams, Indiana state conference president for the NAACP, said neither held up in court, because they violated the National Voter Registration Act.

    "The federal act requires that there is contact with the voter, you know, to say, 'It appears that you're registered in Ohio, is that you? Have you moved to Ohio; are you no longer going to be registered to vote here in Indiana?'" Bolling-Williams explained.

    If a voter does not respond, officials need to give notice that the person is set to be removed from the rolls, and then wait two federal election periods.

    Bolling-Williams pointed out other policies, like same-day registration, have increased access in other states, but Indiana's voter registration period ends 30 days before Election Day.

    Legal battles around voter purges and other laws to restrict voting access, especially for historically marginalized communities, are not unique to Indiana.

    As of July 14, 18 states had passed 30 laws in 2021 alone, making it harder to vote, according to the Brennan Center for Justice. Proponents argued they are meant to prevent fraud, but Bolling-Williams countered lawmakers are not taking voters' needs into account.

    "In this climate of not wanting people to vote, basically, we understand that if everybody has an opportunity to vote, then the will of the people will reign, and not the dictatorship of a few," Bolling-Williams contended.

    Sen. Mike Braun, R-Ind., and Sen Todd Young, R-Ind., were among those who blocked federal legislation, the "For the People Act," which would have prevented many of the new, more restrictive state laws from going into effect.

Medical Malpractice

Report: Medical Malpractice is Not

A 'Frivolous' Matter

Accusations of Lawsuit Abuse Fall Flat

By Steve Rensberry
RP News

    EDWARDSVILLE, Ill. - (RP NEWS) - 7/21/2021 - Nearly 10 percent of patients with symptoms caused by major vascular events, infections or cancers will be misdiagnosed in the United States, with more than half of those suffering death or permanent disability as a result. That's the conclusion of a 2020 study by John Hopkins University School of Medicine Director Professor David E. Newman-Toker, along with others involved with the analysis. (1)

    It's a sobering statistic, as are a long list of others involving medical malpractice cited in the latest report by the national consumer organization, Center for Justice and Democracy (CJ&D). See: Medical Malpractice Briefing Book.

    "Among the 15 diseases analyzed, spinal abscesses was the disease most often missed (62.1%). More than one-on-four aortic aneurysms and dissections have a critical delay in diagnosis (27.9%) and more than one in five (22.5%) lung cancer diagnoses are also meaningfully delayed," the John Hopkins study notes.

    Research by the Emergency Care Research Institute (ECRI) in 2020 points to similar results, concluding that "missed and delayed diagnosis" were a top patient safety concern. Diagnostic errors contributing to death were found in about 10 percent of autopsies, they said, leading to 40,000-80,000 deaths annually. Based on outpatient studies, approximately 1 in 20 adults experience a diagnostic error. (2)

More insights from the CJ&D's briefing book:

  • Despite the Emergency Medical Treatment and Labor Act (EMTALA), which requires emergency departments to treat emergency patients regardless of ability to pay, hundreds of violations of the Act are seen each year. An analysis of 10 years of EMTALA violations (2008-2018), showed more than 4,300 violations involving 1,682 hospitals, roughly 1/3 of the nation's hospitals. (3)
  • Approximately 1 in 12 errors involved women who were pregnant or in labor, while 1 in 7 involved people who were having a mental health crisis, including thoughts of suicide. "Yet experts say the raw numbers belie both the scope and severity of the problem they see. That's because enforcement of the law depends on someone filing a complaint. Although anyone can file a complaint, it's most often a doctor, nurse, or hospital administrator," the report notes.
  •  A study by Professor Ziad Obermeyer of Harvard Medical School, et al, of early death after discharges from emergency departments, using U.S. insurance claims data, shows a significant number of deaths from people on Medicare soon after discharge. "In this national analysis, we found over 10,000 Medicare beneficiaries each year died within seven days after being discharged from emergency departments, despite mean age of 69 and no obvious life limiting illnesses," the report stated. (4)
  •  A 2019 study by University of Michigan School of Public Health candidate Jun Li et al, looked at the amount of data available made available by the U.S. Centers for Medicare and Medicaid Services on 1 million U.S. doctors. Its conclusions: Three quarters of clinicians had no information about their quality of care, 99 percent had no data tied to individual job performance, and lax reporting requirements do not require that every outcome be considered, meaning clinicians may be selective in which cases to submit information on. (5)
  • Diagnostic errors are the most common and costly errors, according to an 2020 analysis by Coverys Inc. of data from 2010-2019, with death and high-severity injury making up approximately 52 percent of events and 74 percent of indemnity paid; emergency department-related events accounts for 66 percent of indemnity paid.

    The bottom line, as stated in Part I of the CJ&D's briefing book, is that medical malpractice litigation, and the cases that are filed on account of it, are not fundamentally "frivolous," despite the allegations.

    As stated in the book: "According to averages calculated from the most recent data release by the National Center for State Courts (2019): 1) Medical malpractice cases represented only 0.15 percent of state civil caseloads in 2019. This rate is consistent with NCSC data from the previous seven years. 2) Medical malpractice cases represented only 3.9 percent of state tort caseloads in 2019. This rate is consistent with NCSC data from the previous seven years."

    A 2014 study, "Medical Harm: Patient Perceptions and Follow-up Action," by Johns Hopkins University School of Medicine Professor of Surgery Martin A. Makary and others, showed lawsuits being filed following patient harms in just 1 out of every 5 cases, or 19.9 percent. "This is similar to the Harvard Medical Practice Study, which reported an estimated ratio of adverse event to malpractice claim of 7.6 to 1. Other studies have estimated that as few as 2% - 3 % of patients pursue litigation. These findings all suggest that the vast majority of patient harms never result in a lawsuit." (6)

    The argument that patient lawsuit increase medical and insurance costs also is weak, given the data.

    According to the group Americans for Insurance Reform, claims per physician were at their lowest level in four decades in 2016, when adjusted for medical care inflation. When adjusted according to the Consumer Price Index, claims are at their lowest since 1982. (7)

    “Even aside from COVID-19, the briefing book includes a number of new studies that undercut the medical industry’s principal argument for so-called ‘tort reform’ laws: cost savings. It is clear that health care and insurance costs fail to decrease when ‘tort reforms’ are enacted, meaning there is no reason for patients to lose their legal rights.” CJ&D Executive Director Joanne Doroshow stated in a March 2021 press release.


1) Medical Liability Monitor (Feb. 2021) "Rate of diagnostic errors and serious misdiagnosis-related harms for major vascular events, infections, and cancers: toward a national incidence estimate using the 'Big Three.'" ECRI Executive Brief, "Top 10 Patient Safety Concerns 2020 (March 2020).

2) ECRI, "Diagnostic Errors: Why Do They Matter, and What Can You Do?" (2019).

3) Brenda Goodman and Andy Miller, "Deprived of Care: When ERs Break the Law," WebMD and Georgia Health News, Nov. 29, 2018.

4) Ziad Obermeyer et al, "Early death after discharge from emergency departments: analysis of national US insurance claim data," BMJ, Feb. 2, 2017.

5) Lena M. Chen, Anup Das and Jun Li, "Assessing the Qualithy of Public Reporting of US Physician Performance," Jame Intern. Med, May 6, 2019; University of Michigan, "System Grading Doctors is Inefficient, Needs Revisions," May 7, 2019; Lisa Rapaport, "U.S. government website for comparing doctors lacks data on most MDs," Reuters, May 6, 2019.

6) Heather G. Lye et al, "Medical Harm: Patient Perceptions and Follow-up Actions," Journal of Patient Safety, November 13, 2014.

7) Americans for Insurance Reform, "Stable Losses/Unstable Rates 2016" (November 2016).

Cyber Security

Report: Healthcare, Manufacturing

Top Targets for Cyber Attacks

    NEW YORK -- (BUSINESS WIRE) -- July 5, 2021 - Avanan, a leader in Cloud Email and Collaboration Security, announced on June 30 the release of the company's 1H 2021 Global Phish Cyber Attack Report, which analyzes today’s threat landscape, phishing vectors, and industry-based attacks, exposing healthcare and manufacturing as two of the top industries being targeted by hackers in the first half of the year.

    “With hospitals around the world being hit with ransomware attacks and manufacturers experiencing supply chain disruption due to cyber-attacks, the Avanan research shows that hackers are using one of the most basic tactics to get in ‒ phishing attacks,” said Gil Friedrich, CEO and Co-Founder of Avanan.

    According to Avanan’s security research and analysis, the most attacked industries are IT, healthcare, and manufacturing. IT saw over 9,000 phishing emails in a one-month span, out of an average of 376,914 total emails; healthcare saw over 6,000 phishing emails out of an average of 451,792 total emails; and manufacturing saw just under 6,000 phishing emails out of an average of 331,184 total emails.

    These industries are the most targeted because they hold incredibly valuable data from health records to social security numbers, combined with the fact that healthcare and manufacturing tend to use outdated tech and often have non-technical board of directors. In healthcare, in particular, the industry is largely unprepared. Though every industry gets attacked, the ones that hold the most data are the most at risk.

    For this report, Avanan security researchers analyzed over 905 million emails spanning a six-month period. Since Avanan works as a layer of security behind Microsoft’s EOP, ATP/Defender, Google Workspace, or any SEGs, this analysis only looks at the emails these other layers did not quarantine. The report reflects an analysis of the most sophisticated and evasive attacks in use today.

    Key Findings:

  • Because threats have gotten so advanced, AI is required to stop the majority of attacks missed by legacy solutions. Without the use of sophisticated AI, 51% of attacks would be missed and reach end-users.
  • Impersonation and credential harvesting attacks remain top phishing vectors. Credential harvesting, 54% of all phishing attacks, has risen by nearly 15% when compared to 2019; 20.7% of all phishing attacks are Business Email Compromise (BEC); and only 2.2% of phishing attacks are extortion.
  • Hackers are starting to target lower-hanging fruit rather than C-level executives. Now, 51.9% of all impersonation emails attempted to impersonate a non-executive in the organization. In fact, non-executives are targeted 77% more often.
  • Misconfiguration is playing a rising role in phishing. Over 8% of phishing emails ended up in the user’s inbox simply because of an allow or block list misconfiguration, a 5% increase from last year, and 15.4% of email attacks are on an Allow List.
  • The most commonly used tactic is using non-standard characters and limited sender reputation. Non-standard characters are used in 50.6% of phishing links and 84.3% of phishing emails do not have a significant historical reputation with the victim.

    Avanan anticipates that cyberattacks will continue to explode with healthcare and education being hit hardest, predicting that attacks on the education sector will surge over the next six months with massive increases when school returns in the fall. In addition, Avanan predicts COVID related phishing emails will decrease, while office place related phishing emails will increase. As workers around the globe return to the office, there will be a spike in phishing attacks leveraging services like fax, scanners, copiers, targeting the things used in office life that sat dormant for the last year and a half.

    For more information and to download the report, please visit:


The Political Divide

 New Studies Confirm 

Perceptual Differences Between

Political Parties

WASHINGTON -- (BUSINESS WIRE) -- June 27, 2021 -- The 2020 election was unique in American politics. For the first time, an incumbent president lost the popular and electoral college votes but refused to concede the election, claiming without evidence that widespread fraud tainted the results. Yet U.S. history is rife with examples of contested election results and fraud claims. Was 2020 different in significant ways, and does that raise serious concerns about the health of our democracy?

The Democracy Fund Voter Study Group releases two reports on June 24 that shed light on these crucial questions. The reports – “Theft Perception: Examining the Views of Americans Who Believe the 2020 Election was Stolen,” by Lee Drutman of New America, and “Crisis of Confidence: How Election 2020 Was Different,” by Robert Griffin and Mayesha Quasem of the Democracy Fund Voter Study Group – suggest that 2020 was indeed unique and that faith in our democracy has been shaken to an unprecedented degree.

    “Free and fair elections are a cornerstone of our democracy, but it’s also important that the public trusts the results of those elections. Unfortunately, the 2020 election cycle and actions of former President Trump have shaken that trust,” Voter Study Group Research Director Robert Griffin said. “These reports provide details that help us understand how Americans perceive the electoral process, which may help policymakers address this serious crisis in confidence.”

    “It’s not uncommon to have some claims of voter fraud and lower trust among the losing party after elections, but 2020 stands out for the intensity and scale of mistrust in the election,” said Mayesha Quasem, research associate at Voter Study Group. “All of this raises serious concerns about the stability of our democracy going forward."

    Key findingsCrisis of Confidence

  • A week after the 2020 presidential election, the overwhelming majority (93%) of Biden voters said that they were confident that the election was conducted fairly and accurately, but only 29% of Trump voters said the same. There was almost no difference in confidence between these groups in the week before Election Day.
  • The percentage of Trump voters in 2020 who said they were not at all confident that their vote was tallied accurately was more than four times as high as the percentage of Clinton voters who said the same in 2016 (35% vs 8%).
  • Fifty nine percent of Americans said that permanent harm had been done to the United States as a result of the election process.

    Theft Perception takes a closer look at the rise of the Stop the Steal movement sparked by former President Trump’s claims of a stolen election.

    “Republican politicians across the country have continued to support the narrative of a stolen election,” said Lee Drutman, senior fellow in the Political Reform program of New America. “While the sentiment is not necessarily surprising, in practice, we’re seeing a doubling down of this narrative, which is driving a new wave of state laws that restrict voting access.”

    Key findingsTheft Perception

  • Republicans widely support Donald Trump and believe his claims about a stolen election. While Republicans support all elements of the “Stop the Steal” narrative in high numbers, the overall electorate largely rejects these claims and propositions.
  • Among Republicans, 85% believe it was appropriate for Trump to file lawsuits challenging election results in several states, and the same proportion believe that vote-by-mail increases voter fraud.
  • Republicans most committed to both Trump and the narrative of election fraud share a few other views in common: extreme antipathy toward Democrats and immigrants, belief that racism is not a problem, support for nationalism, belief in traditional family values and gender roles, and preference for a very limited role for government in the economy.

    Throughout the summer, Voter Study Group will release reports examining other Trump-era topics with implications for the future of American democracy including views on race, populism, trust in institutions and issue prioritization and the change and stability of the American electorate. The reports show the consequences and dangers of our leaders being irresponsible and spreading mis- and dis-information.

Interactive Data on Voter Views: Nationscape Insights

    From July 2019 to January 2021, the Democracy Fund + UCLA Nationscape survey asked hundreds of thousands of Americans in every region of the U.S. about some of the nation’s biggest issues — including the economy, guns, healthcare, and climate change — and it tracked changes over time.

    First launched in partnership with USA TODAY, Nationscape Insights makes week-by-week Nationscape survey data available with interactive visualizations you can sort by race, gender, income, geography, education level, and political leanings. With Nationscape insights, it’s possible to dive deep on the policy preferences of groups once too small to examine but who were pivotal to election outcomes — to help make sense of an era, and election, like no other in America’s history.

    Refreshed with the final Nationscape dataset fielded November 12, 2020, through January 12, 2021, Nationscape Insights is now available on

About Democracy Fund Voter Study Group

    The Democracy Fund Voter Study Group is a research collaboration of more than two dozen analysts and scholars from across the political spectrum. Created in the wake of the 2016 election, the Voter Study Group’s goal is to better understand the American electorate by examining and delivering insights on the evolving views of American voters. Research and analysis from Voter Study Group members can be found at and on Twitter @democracyfund.

Illinois Politics

J.B. Pritzker Has Brought 

Sanity and Leadership to Illinois

Governor Gets High Marks For Handling of Pandemic, Economy

By Steve Rensberry
Opinion / Analysis

    EDWARDSVILLE, Ill. - 5-31-2021 - The year 2018 was a good one for J.B. Pritzker, but more importantly, for the state of Illinois.

    As you might recall, Pritzker, a Democrat, all but trounced former governor and Republican Bruce Rauner in that year's gubernatorial election, garnering a decisive 54.5 percent of the vote to Rauner's 38.8 percent. It was a big change from 2014, in which Rauner beat former Illinois Governor Pat Quinn with 50.27 percent of the vote compared to Quinn's 46.35 percent.

Illinois ranks No. 5. Source: statista. Click to enlarge.

    Proving that politics has indeed become a rich man's game, Rauner (a multi-millionaire) dumped some $26 million of his own money into the 2014 race, and another $70 million into the 2018 campaign. (1) But even with such an enormous investment in one's own election, it wasn't enough to fend off Pritzker (a billionaire), who spent $171 million of his own money to get elected. (2) This isn't counting all the additional campaign revenue raised by the two men.

    However, it wasn't just big money that decided the 2018 race, but the fact that the Republican's front-man simply failed at governing. "Rauner Deficit Increased 52% in FY17 to $14.7 Billion," one news release from Pritzker's election team reads (3). Talk is cheap, and Rauner, like most Republicans, was under the naive delusion that all the state needed to do was lower taxes and cut spending and its problems would be solved. One of his worst decisions was refusing to sign a budget for two years, essentially holding the state hostage until lawmakers approved a list of partisan demands. The fallout was felt by school districts, service organizations, and others all across the state, ultimately leading to a downgrading of the state's bond rating. (4)

    Bottom line: neither tax increases alone nor tax cuts alone are likely to solve the state's fiscal problems, we need both. That's what most economic experts I've read insist. But Republicans have been myopic and uncompromising on the issue -- and consequently have made the situation worse. (5)

    The scary part is that Rauner was not conservative enough for some, like his challenger Jeanne Ives, who narrowly lost to Rauner in the 2018 Republican Primary. Ives claimed she was motivated to run after Rauner signed into law HB-40, a bill that ensured abortion would remain legal in the state, and allow coverage for women with Medicaid or state-employee insurance coverage. (6)

    Pritzker, meanwhile, has stayed the course and acted as a governor should, with integrity, all the while taking a responsible lead on the pandemic and approving extended aid to unemployed workers. Nor has he dwelt on his losses, or become vindictive when rejected, as Rauner was prone to do. When voters gave Pritzker's graduated income tax proposal a thumbs down, he moved on to the task of governing and looked for other ways to balance the budget, including cuts. As luck would have it, the economy did better than expected and it was ultimately determined that no income tax increase would be needed to close a projected $3 billion budget deficit. (7)
    "Before JB became governor, for over two years a dysfunctional state government couldn’t even pass a budget. Services were cut, schools suffered, and families throughout the state paid the price because of a governor who didn’t get the job done," the governor's campaign site reads.

    One big disappointment in the 2018 state election was that the Illinois Chamber of Commerce still gave Rauner its endorsement, despite his dismal performance on the economy, citing opposition to Pritzker's "support for a graduated income tax, a $15 minimum wage, support for trial lawyers' agenda and lack of a meaningful commitment to reforming pensions and restoring fiscal integrity to our finances." (8)

    The Chamber's position on such contested issues was revealing in terms of showing its ideological biases, and unfortunately fits a pattern of siding against Illinois families, against poor and underpaid workers, and against people injured through medical malpractice or negligence.

    So here we are, a year and a few months away from the next gubernatorial election, set for Nov. 8, 2022. The opposition is ready with their "Pritzker Sucks" signs, their accusations that Illinois' population is "dramatically" shrinking because of a high tax burden and Democratic policies, and claims that Pritzker's tax policies will destroy businesses and hurt downstate residents. None of it is true, but I'm not sure the opposition cares because in their minds winning is everything. It's the new paradigm.

    What has Pritzker done while in office? Does he deserve a second chance? Consider the following list of achievements, as posted on Pritzker's official campaign site, here.


  • Passed a balanced, bipartisan budget that begins to pay down debts from the prior administration.
  • Improved our bond outlook to “stable” for the first time in years.
  • Passed a public safety pension consolidation bill to help lower property taxes and reduce future budget pressure.
  • Reduced state pension liabilities with an employee pension buyout program.

The Economy

  • Launched the bipartisan Rebuild Illinois capital plan, the largest in state history, to rebuild roads, bridges, and communities and create and support hundreds of thousands of good-paying jobs.
  • Prepared our children for the jobs of the future by expanding skills development and focusing community college programs on the fastest growing industries.
  • Raised the minimum wage to a living wage for all Illinois workers.
  • Made college more affordable for Illinois students by expanding in-state scholarships and making more merit scholarships available for high-performing students.
  • Created a minority business loan fund.


  • Launched an effort to bring high-speed broadband internet to every corner of the state
  • Created a minority business loan fund.
  • Developed new incentives for job creation on new construction and renovations in underserved communities.
  • Refocused community college workforce development programs to concentrate on high-growth industries.
  • Signed the most equity-centric cannabis legalization plan in the nation to invest in communities hit hardest by the war on drugs.
  • Encouraged new job creation and workforce development with an apprenticeship tax credit for businesses.
  • Extended the film industry tax credit, creating and supporting thousands of entertainment industry jobs in Illinois.
  • Elevated the innovation economy with new business incubators and an extension of the research and development tax credit for manufacturers.

Early Education

  • Expanded child care assistance eligibility to 10,000 more children.
  • Strengthened early childhood education and child care with the biggest investment ever in Illinois into early childhood programs and facilities.

K-12 Education

  • Provided historic funding levels for K-12 students across the state.
  • Raised the minimum salary for teachers.
  • Expanded skills development with new investments in vocational training in high school.

    Illinois is a lot of things, and by no means perfect, but to call it a failed state, never mind a haven for "judicial hell holes," is pure partisanship. It is often compared to surrounding states as though there were any real parity, but considering the state's contribution to the nation's overall GDP, Illinois is a powerhouse of productivity and opportunity by comparison, ranking No. 5 nationwide and outranked only by Florida, New York, Texas, and California. Neighboring Indiana is ranked No. 18, Wisconsin No. 21, and Missouri No. 22. (9)

    Although Pritzker has not yet officially announced his candidacy for re-election, the Chicago Sun-Times reported this past March that he had already made a $35 million campaign contribution, so it seems likely. (10)

    I don't think I'm alone in recognizing that the Republican Party has a problem on its hands, not just because of Pritzker's popularity and success, but because of the growing influence of extremists within its ranks.

    A May 14 story written by Sarah Nardi for WGLT is insightful. Reporting on a meeting of the Lincoln Club of McLean County, in which former Gov. Jim Edgar, Rep. Dan Brady, and former Illinois Republic Party Chairman Pat Brady served as panel members, Nardi writes: "Edgar said the problem facing Republicans in a gubernatorial race is the growing chasm between a state that's moving left and a party that's moving right . . . . To reclaim the governor's office, Edgar said Republicans will have to unite behind a moderate candidate -- something hard-line conservatives will resist. But a shifting electorate means that in the Chicago suburbs, a once reliable source of GOP votes, people aren't casting ballots for Republicans the way they once did." (11)

    Nardi writes that Edgar acknowledged the shifting political landscape, and how much things have changed. "My definition of a moderate (Republican) is what would've been an extreme conservative 20 years ago," Edgar is quoted as saying.

    So there you have it. An admission, by at least one prominent Republican, that Illinois' second major political party is definitely not what it used to be, is conflicted, and has essentially normalized its most extreme elements.

    Is that the kind of leadership we need in Illinois? I think not.

    Illinois has had bad luck with governors, both Republican and Democratic, but today's Democratic Party -- and Pritzker specifically -- have earned my confidence. He is what Illinois has needed. If Pritzker goes the way of Ryan, Blagojevich, or Rauner, making things worse instead of better, then he should be held accountable, but in today's climate of extremism, I wouldn't hold my breath waiting for a Republican challenger worth considering. 

1) Rauner 2018 Race Campaign Finance (politico)
2) Rauner, Pritzker Spending For Governor (NBC Chicago)
3) How Bad is the Illinois Deficit (politico)
4) Fitch Downgrades Illinois (Fitch Ratings)
5) Governor's Budget Cuts Costs, Corporate Tax Breaks (Bloomberg)
6) Jeanne Ives (wikipedia)
7) No Income Tax Hike Needed (WTTW)
8) Illinois Chamber Endorses Rauner (Effingham Radio)
9) States and Territories Ranked by GDP (wikipedia)
10) Pritzker Re-election Campaign Contribution (Chicago Sun Times)
11) GOP Leaders Say Moderate Governor Candidate Key (WGLT)

Economic Trends

 Home Price Appreciation Rises 

Prices at Highest Levels Since Before Lockdowns Began

    PHILADELPHIA - (BUSINESS WIRE) - 5-22-2021 - Home prices in the U.S. rose again in April, albeit at a slightly lower rate than recorded in the prior month. According to Radian Home Price Index (HPI) data released May 21, 2021 by Red Bell Real Estate, LLC, a Radian Group Inc. company (NYSE: RDN), home prices nationally rose from the end of March 2021 to the end of April 2021 at an annualized rate of 10.4 percent. The company believes the Radian HPI is the most comprehensive and timely measure of U.S. housing market prices and conditions available in the market today.

    For the prior twelve months, the Radian HPI rose 9.2 percent (April 2020 to April 2021), the fastest annual rate recorded since before the COVID outbreak. While the April month-over-month rate was slightly lower than the prior month, the twelve-month rate increased compared to March. Recent annual increases are benefiting from the more distanced months of lower appreciation recorded during the early days of the national shut-down. The Radian HPI is calculated based on the estimated values of more than 70 million unique addresses each month, covering all single-family property types and geographies.

    “As we are now a full year from the initial COVID induced national closures of 2020, the U.S.’s strong national housing market continues to chug along in April,” noted Steve Gaenzler, SVP of Data and Analytics. 

    Gaenzler added: “Pent-up demand for homes, improving economic activity, a strong labor market and low mortgage rates have been strong tailwinds for housing. However, as the U.S. starts to see growing considerations for ending or reducing government stimulus (monetary and fiscal) in the coming months, and concerns of higher potential inflation making headlines, there is a need to keep a very close eye on housing in the coming half year,”

National Data and Trends

  • Median home price in the U.S. rose to $277,356
  • Active supply of homes well below long term average

    The national median estimated price for single-family and condominium homes rose to $277,356. Since the start of the COVID lockdowns in March 2020, the average home in the U.S. has appreciated by more than $20,000. Home price appreciation over the past year has increased homeowner equity levels by more than $1.5 trillion dollars.

    Gains in home prices are partially due to a continued lack of supply. After falling for 10 of the prior 12 months, active listings have now increased three consecutive months—although only by 32,000 properties from the prior month. In April, more than 881,000 residential properties were for sale, the fifth month with less than one million properties listed nationally. Over the last decade, the U.S. has had an average of 1.4 million homes on the market each month. At the current count of active listings, the U.S. has 40 percent fewer homes on the market, on average, than at any time over the past decade.

Regional Data and Trends

  • All Regions reported solid appreciation from prior month.
  • Three Western states consistently demonstrate strong home price appreciation

    While all six Regional indices reported higher 12-month rates of home price appreciation, only two Regions (Mid Atlantic and Northeast) reported higher rates of appreciation compared to March. In April, the Northeast narrowly edged out the South Region for the highest appreciation rate (+11.9 percent). All Regions showed strength in the month with the worst performing Region (Midwest) still recording a very impressive 9.1% increase from the prior month.

    Looking at trends from the last six months, the Radian HPI can identify some state-level winners and losers. The states showing the greatest increase in appreciation trends include a combination of South, Southwest and Midwest states including NE, AZ, AR, and MS. The most consistently strong states for appreciation in the last half year include ID, MT, GA, and WA. While these states showed increasing or consistently steady rates of appreciation, eleven of the 50 states plus DC, recorded lower monthly appreciation rates than the average appreciation over the last six-months including NC, ND, WV and KY.

Metropolitan Area Data and Trends

  • Boise got stronger in April
  • Large metro areas median price outpace nation

    Across the largest or most important metro areas of the U.S., the last three-months have been some of the faster appreciating on record with an average annualized rate of 9.6 percent appreciation. The strongest metro markets over the last quarter include Boise, ID, which continues to rise rapidly, Phoenix, AZ and Charlotte, NC. Some of the slower appreciating larger cities and metro areas over the last quarter include Boston, MA, Fargo, ND, and Burlington, VT.

    The average median estimated home price of homes in the 50-largest metros ended April at $295,259. However, just the top 20-largest metros topped an average median home price of more than $385,000. Compared to the national median estimated price, the largest cities continue to outpace the nation. In April, the largest metros median stood more than $100,000 higher than the national median.