State COBRA Exposure Index: measuring where losing employer health coverage hits hardest in the United States

The State COBRA Exposure Index is a state-level measure of where losing employer-sponsored health coverage hits hardest in the United States, covering all 50 states and the District of Columbia. There is no current public estimate of COBRA exposure. The most recent published take-up figure rests on 2017 data, and neither the U.S. Department of Labor nor the Centers for Medicare & Medicaid Services publishes one. This index does not close that gap - it is a relative ranking rather than a headcount - but it is the closest current public measure and it is built entirely from federal sources that anyone can check. The index combines three equally weighted terms, each expressed as a z-score across the 51 jurisdictions: median monthly layoff and discharge rate (BLS Job Openings and Labor Turnover Survey, state series, July-December 2025); a single-coverage COBRA premium as a share of median monthly household income (KFF Employer Health Benefits Survey 2025 at the statutory 102%; Census American Community Survey 5-year median household income); and the under-65 uninsured rate (Census Small Area Health Insurance Estimates, 2024). The dataset includes each jurisdiction's composite score and rank alongside all three component measures and their individual ranks, with FIPS and USPS codes for joining. All ranks are competition ranks: jurisdictions with identical values share a rank. Known limitations are stated in full in README.md and methodology.md. The most significant is that the COBRA premium term is a national average rather than a state-specific figure, so the burden term varies only through income. Refreshed annually, following the BLS State JOLTS release, which moved from a monthly to an annual cadence in 2026. Each refresh is published as a new version of this record, so the concept DOI always resolves to current data.