Exposure is not the same thing as uninsurance
Indiana ranks first — on an uninsured rate of 9.0%, which is 24th of the 51 jurisdictions and about as unremarkable as a number can be. What puts it top is the highest sustained layoff rate in the country at 1.60% a month, combined with COBRA consuming 13.6% of median monthly household income.
Texas has the worst uninsured rate in the nation at 19.1% and still ranks only sixth, because its layoff rate of 1.00% a month sits below the 1.10% median. The places where people are most likely to face the COBRA decision are not the places with the most uninsured people. Uninsurance and exposure are different problems, and they need different answers.
Exposure index, all 51 jurisdictions
Composite of layoff rate, COBRA cost as a share of median income, and under-65 uninsured rate. Zero is the mean across the 51 jurisdictions, unweighted by population — bars to the right sit above that mean. Hover or focus any state for its components.
View as a table
| Rank | State | Index | Layoff rate | COBRA % of income | Uninsured <65 |
|---|---|---|---|---|---|
| 1 | Indiana | +3.16 | 1.60% | 13.6% | 9.0% |
| 2 | Nevada | +3.09 | 1.40% | 12.6% | 13.7% |
| 3 | Montana | +2.75 | 1.40% | 13.6% | 11.1% |
| 4 | Mississippi | +2.71 | 1.00% | 17.3% | 12.1% |
| 5 | Idaho | +2.60 | 1.45% | 12.7% | 11.1% |
| 6 | Texas | +2.57 | 1.00% | 12.5% | 19.1% |
| 7 | Tennessee | +2.55 | 1.30% | 14.2% | 11.3% |
| 8 | Oklahoma | +2.29 | 1.00% | 15.0% | 14.4% |
| 9 | New Mexico | +2.14 | 1.00% | 15.3% | 13.4% |
| 10 | Arkansas | +1.89 | 1.00% | 16.2% | 11.3% |
| 11 | South Carolina | +1.72 | 1.15% | 14.2% | 11.2% |
| 12 | Wyoming | +1.67 | 1.20% | 12.7% | 12.5% |
| 13 | Louisiana | +1.60 | 1.10% | 15.8% | 9.2% |
| 14 | South Dakota | +1.58 | 1.30% | 13.1% | 9.9% |
| 15 | Alaska | +1.47 | 1.35% | 10.6% | 12.5% |
| 16 | Florida | +1.22 | 1.00% | 13.3% | 13.7% |
| 17 | Georgia | +1.06 | 1.00% | 12.7% | 14.0% |
| 18 | Kentucky | +0.94 | 1.10% | 15.2% | 8.1% |
| 19 | West Virginia | +0.72 | 1.00% | 16.4% | 7.3% |
| 20 | Kansas | +0.53 | 1.10% | 13.1% | 10.1% |
| 21 | Arizona | +0.53 | 1.00% | 12.4% | 12.9% |
| 22 | Michigan | +0.51 | 1.30% | 13.4% | 6.2% |
| 23 | Alabama | +0.50 | 0.90% | 15.3% | 10.0% |
| 24 | North Carolina | +0.26 | 1.00% | 13.6% | 10.2% |
| 25 | Maine | +0.22 | 1.20% | 13.3% | 7.2% |
| 26 | North Dakota | +0.22 | 1.30% | 12.5% | 6.6% |
| 27 | Illinois | -0.01 | 1.25% | 11.6% | 8.1% |
| 28 | Ohio | -0.12 | 1.05% | 13.7% | 8.1% |
| 29 | Colorado | -0.29 | 1.25% | 10.3% | 9.3% |
| 30 | Rhode Island | -0.40 | 1.40% | 11.0% | 5.3% |
| 31 | Vermont | -0.43 | 1.30% | 12.2% | 5.1% |
| 32 | Nebraska | -0.56 | 1.05% | 12.7% | 8.2% |
| 33 | New York | -0.64 | 1.30% | 11.2% | 5.9% |
| 34 | Pennsylvania | -0.70 | 1.10% | 12.5% | 7.2% |
| 35 | Utah | -0.77 | 1.15% | 10.4% | 9.4% |
| 36 | Missouri | -0.79 | 0.85% | 13.8% | 9.2% |
| 37 | Connecticut | -0.83 | 1.30% | 10.1% | 7.0% |
| 38 | Wisconsin | -0.93 | 1.10% | 12.6% | 6.4% |
| 39 | New Jersey | -1.09 | 1.20% | 9.4% | 9.0% |
| 40 | New Hampshire | -1.31 | 1.30% | 9.9% | 5.8% |
| 41 | Delaware | -1.40 | 1.00% | 11.5% | 8.3% |
| 42 | Virginia | -1.42 | 1.10% | 10.5% | 8.1% |
| 43 | Oregon | -1.78 | 1.00% | 11.8% | 6.6% |
| 44 | Iowa | -1.81 | 0.90% | 13.0% | 6.4% |
| 45 | California | -2.10 | 1.10% | 9.9% | 6.9% |
| 46 | Minnesota | -3.00 | 0.90% | 10.9% | 6.0% |
| 47 | Maryland | -3.35 | 0.90% | 9.4% | 7.2% |
| 48 | Washington | -3.38 | 0.80% | 10.0% | 7.8% |
| 49 | Massachusetts | -4.05 | 1.00% | 9.4% | 3.3% |
| 50 | Hawaii | -4.47 | 0.85% | 9.7% | 4.1% |
| 51 | District of Columbia | -4.88 | 0.80% | 8.9% | 4.8% |
Method
Three things must be true at once for someone to face the COBRA decision: they lose a job, the coverage they lose is expensive relative to what they earn, and their state offers a thin safety net if they go without. The index standardizes and sums exactly those three.
- Layoff rate — median of six monthly layoffs-and-discharges rates, total nonfarm, seasonally adjusted. BLS JOLTS Table 5, July–December 2025.
- COBRA burden — monthly COBRA premium ÷ median monthly household income. KFF 2025 Employer Health Benefits Survey — $9,325 average annual single premium, taken monthly at the statutory 102% ($793); Census ACS 5-year table B19013 for median household income.
- Uninsured rate — under-65 uninsured, all incomes. Census SAHIE 2024, released August 2026.
Use it
Published under a CC BY 4.0 license. Download the full dataset as CSV. Refreshed annually, following the BLS State JOLTS release each July. If you are writing about this and want the calculations, or the figures for a particular state, get in touch — we will send them.
Cite this dataset
The dataset is archived on Zenodo with a permanent DOI, so a citation stays valid even after the figures refresh.
CobraScout (2026). State COBRA Exposure Index [Data set]. Zenodo. 10.5281/zenodo.22009257
That is the concept DOI: it always resolves to the most recent version. Cite it rather than a version-specific DOI unless you deliberately need to pin to the figures as they stood on a particular date.
Common questions
What does the index measure?
Exposure to the COBRA decision — how likely people in a state are to lose employer coverage, how unaffordable continuing it would be relative to local incomes, and how thin the safety net is if they go without. It is a composite of three standardized federal measures.
Why is the top state not the one with the most uninsured people?
Because they measure different things. A state can have good coverage overall and still put a lot of people through job loss. Indiana ranks first on the highest layoff rate in the country while sitting 24th of 51 on uninsurance; Texas has the worst uninsured rate in the country and ranks only sixth.
Can I use this data?
Yes. It is published under a CC BY 4.0 license — cite us and it is yours. The CSV is linked above and we are happy to share the underlying calculations.
How often is it updated?
Annually. BLS moved the State JOLTS series from a monthly to an annual release in 2026 — the first annual release covering state data landed in July 2026 — so the layoff term can only refresh once a year. The uninsured and income terms are annual series in any case.
Why is there no county-level version?
There will be. County-level COBRA cost requires state employer premium data we are still assembling, and we would rather publish nothing than publish an estimate we cannot defend.
Is this an official government statistic?
No. It is our own analysis built from public federal datasets. We are not a government agency. The underlying sources are official; the index is ours.
Talk it through with a licensed agent
Which option is right depends on your state, your income and which doctors you need to keep. A licensed agent can walk through it with you in about eight minutes.
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Sources
- U.S. Bureau of Labor Statistics, Job Openings and Labor Turnover Survey, state layoffs and discharges, July–December 2025
- U.S. Census Bureau, Small Area Health Insurance Estimates, 2024 (released August 2026)
- U.S. Census Bureau, American Community Survey 5-year estimates, median household income
- KFF, 2025 Employer Health Benefits Survey (cited, not redistributed)