Healthcare spending varies sharply across states, functioning as a hidden line item in the cost of living
Healthcare spending is a relocation blind spot in the United States. When Americans talk about the cost of living, they compare housing prices, food, and utility bills. What doesn’t factor into the conversation is healthcare. Yet where Americans live determines more about their health spending than any other variable.
America First Healthcare’s new analysis, which scored all 50 states across several cost factors including per capita health expenditures, average cost of doctor visit, average dental care cost, prescription drug prices, average optometrist cost without insurance, and income levels using state-level data, finds that the gap between the highest- and lowest-burden states is not marginal. New York ranks as the most expensive state in the nation with a spending score of 69.5, whereas Utah sits at the opposite end at 34.0, a spread that reflects not just price differences, but fundamentally different relationships between what residents earn, what care costs, and how much of it they can actually access.
Current data reveals three tensions that national headlines on healthcare tend to miss:
- High coverage does not guarantee affordability;
- High spending does not reliably predict high coverage, and
- In multiple states, demand for medical insurance is outpacing the ability to provide it.
The 5 States Where Healthcare Costs Hit Hardest
Ranked by overall spending burden score, combining out-of-pocket costs, drug affordability, and income context.
New York
New York holds the highest healthcare cost burden and the lowest affordability ranking in the nation. Insurance coverage sits at 95.10%, among the highest nationwide, and physician availability scores a solid 68.9%, but the problem isn’t access, it’s price. Drug price affordability is just 17.7, one of the lowest in the country, and per-capita healthcare spending of $14,007 erodes the state’s income advantage even with $88,847 in income per capita.
Alaska
Unlike New York, the Last Frontier’s access problem drives higher-than-average prices. With only 2,367 physicians serving the entire state and a healthcare workforce of just 44,490, physician availability is among the worst in the nation at 0.6, leaving many residents no option but to pay or go without care. Per-capita spending of $13,642 is the second-highest in the US, against income per capita of $80,175.
North Dakota
North Dakota’s score would look different without one outlier: average dental care costs $263, the most expensive in the country, and no other state comes close. A dental score of 0.0, the worst nationwide, is extreme enough to push an otherwise unremarkable cost profile into the high-spending tier. Drug affordability (44.4), average Rx cost ($27.10), and doctor visits ($116) all sit in the middle of the pack.
Louisiana
Louisiana pairs below-average per-capita income ($63,940) with above-average costs across several categories. None of the individual figures is extreme, but with less room to absorb the blow, a low drug affordability score of 32.8 hits harder here. Insurance coverage is solid at 92.40%, showing most residents are in the system even as costs outpace what income can comfortably cover.
West Virginia
West Virginia mirrors, and sharpens, Louisiana’s profile. Income per capita of $57,932 is the second-lowest in the nation, while insurance coverage is strong at 94.10%. With doctor visits at $113, dental care at $191, and prescriptions at $25.30, no single cost looks alarming on its own. But against the state’s low-income base, the burden lands disproportionately on residents already stretched thin.
The 5 States Spending the Least on Healthcare
Ranked by overall spending burden score — affordable drugs, reasonable provider costs, and income levels that give families room to breathe.
Utah
Utah holds the lowest healthcare spending in the nation, and its position at the top of the affordability list is no coincidence. Drug price affordability is the second-highest nationally at 97.6, with an average prescription cost of just $19.50 — among the lowest in the US. Healthcare expenditure per capita is $7,522, and insurance coverage is a solid 91.7%. A near-perfect drug pricing score anchors a cost structure that gives residents real room to manage healthcare expenses.
Colorado
Colorado backs up its low spending with consistently strong scores across the board. The average doctor visit costs $115, well below the national average, and dental care averages $167, the third-lowest in the country. Drug price affordability scores 72.7, well above the national midpoint, with average prescription costs of $23. A healthcare workforce of 305,370 is large enough to sustain provider competition, likely contributing to those low-cost visits.
Idaho
Idaho’s low spending leans heavily on affordable prescriptions. Its drug price affordability score of 74.3 is among the strongest in the country, with average prescription costs of $22.80, and a doctor’s visit averages just $106 — among the most affordable nationwide. That strength offsets a real strain in provider availability: a physician availability score of just 2.3, spread across 4,541 physicians and a healthcare workforce of 109,750.
Virginia
Virginia pairs above-average income with reasonable drug pricing, a combination that keeps its overall spending burden low without relying on any single standout metric. The average doctor visit costs $113, dental care averages $171, and prescriptions run $24.50 on average, with a drug affordability score of 62.1. With per-capita income of $80,291 — among the highest in the country — Virginia’s low-spending profile is the most income-supported of the five states on this list.
Iowa
Iowa shares Virginia’s spending score but earns it differently. Rather than income-supported costs, Iowa’s affordability comes from genuine price moderation: the lowest average doctor visit cost in the nation at $100 flat, an average prescription cost of $22, and a drug price affordability score of 79.9. Insurance coverage is high at 94.3%, the strongest among the five lowest-spending states, while per-capita income of $68,326 sits below both Virginia’s and Colorado’s.
When “Spending” and “Coverage” Tell a Different Story
Most states show spending and coverage moving in the same direction: higher spending tends to coincide with broader coverage, and lower spending with thinner coverage. The pattern holds well enough, but a closer look at the outliers and at where consumer interest in marketplace or private health insurance plans is highest reveals which states are managing healthcare access efficiently and which are facing real, measurable gaps.
The distinction matters because a state that buys high coverage at high cost is doing something fundamentally different from one that achieves the same coverage at half the price.
The Efficiency States: High Coverage Without the High Spending
Seven states break the assumed relationship between cost burden and coverage in a positive direction. Iowa, Virginia, Oregon, Illinois, Michigan, Washington, and Wisconsin achieve insurance coverage rates of 91%–94%, on par with states that show the highest healthcare cost burden, including several that rank among the most expensive. Yet all seven sit in the bottom half of the national cost burden ranking. Five of the seven also rank in the top 12 for overall affordability.
Instead of a single policy lever, what these states share is a combination of structural advantages:
- Prescription drug markets with genuine competition
- Provider cost structures that don’t place outsized pressure on any single visit type
- Coverage infrastructure that has scaled without the pricing distortions that typically accompany it
Illinois, for example, has the highest drug price affordability score in the nation at 100.0, with an insurance coverage rate of 93.2% and a spending ranking of 46th. Michigan achieves a 95% insurance coverage rate, on par with New York, but has a spending score of 49.1, much better than the Big Apple’s 69.5.
Meanwhile, Alaska sits at the opposite extreme: 88.9% coverage (near the bottom nationally) paired with the second-highest cost burden score in the country, proof that a lower coverage rate doesn’t correspond to a low cost burden.
Where Unmet Demand Is Highest: The Demand Gap Score
The demand gap is the distance between the coverage Americans are actively seeking and the coverage they can actually access. It is the problem that America First Healthcare was built to close.
To capture the missing dimension for this list, we layered in proprietary data reflecting the relative level of plan inquiries and enrollment activity by state, used here as a proxy for consumer-level demand for coverage. The result identifies three “critical” demand gap states, all in the South.
Critical Demand Gap States
Highest Inquiry Volume
Florida
Florida ranks first nationally for plan inquiry activity; more residents are actively seeking health insurance in Florida than in any other state. But insurance coverage sits below the median at 89.1%. The state’s demand is not as severe as Texas’s, but it has the highest volume of unmet demand.
Most Extreme Case
Texas
The most extreme case: it has the lowest insurance coverage rate in the entire dataset, 83.2%, combined with the second-highest plan inquiry activity nationally, producing a demand gap score of 8.4, the highest in the country.
Regional Pattern
Georgia
Georgia ranks higher than Florida in affordability, placing 25th. The state combines below-median coverage (88%) with elevated inquiry activity (ranking 6th), in a pattern consistent with the broader Southern regional profile.
Demand Gap Score at a Glance
The table below maps every state by spending tier, coverage tier, and demand gap score.
| State | Expenditures / Capita | % Insured | Affordability Rank | Search Rank | Expenditures Tier | Coverage Tier | Demand Gap Score | Corr. Spending & Coverage | Demand Gap Rank |
|---|---|---|---|---|---|---|---|---|---|
| Alabama | $9,280 | 91.8% | 33 | 17 | Low spend | Low coverage | 2.9 | Low spend – Low coverage | Moderate |
| Alaska | $13,642 | 88.9% | 50 | 44 | High spend | Low coverage | 0.9 | High spend – Low coverage | Low |
| Arizona | $8,756 | 89.8% | 20 | 5 | Low spend | Low coverage | 4.8 | Low spend – Low coverage | Moderate |
| Arkansas | $9,338 | 90.7% | 11 | 25 | Low spend | Low coverage | 2.5 | Low spend – Low coverage | Moderate |
| California | $10,299 | 94.1% | 29 | 3 | High spend | High coverage | 2.9 | High spend – High coverage | Moderate |
| Colorado | $8,583 | 92.2% | 2 | 24 | Low spend | Low coverage | 2.2 | Low spend – Low coverage | Moderate |
| Connecticut | $12,489 | 94.3% | 35 | 33 | High spend | High coverage | 1.1 | High spend – High coverage | Low |
| Delaware | $12,899 | 93.1% | 46 | 37 | High spend | High coverage | 1.0 | High spend – High coverage | Low |
| Florida | $9,865 | 89.1% | 45 | 1 | Low spend | Low coverage | 5.6 | Low spend – Low coverage | Critical |
| Georgia | $8,758 | 88.0% | 25 | 6 | Low spend | Low coverage | 5.5 | Low spend – Low coverage | Critical |
| Hawaii | $10,291 | 96.7% | 39 | 40 | High spend | High coverage | 0.4 | High spend – High coverage | Low |
| Idaho | $8,148 | 91.0% | 3 | 34 | Low spend | Low coverage | 1.6 | Low spend – Low coverage | Low |
| Illinois | $10,190 | 93.2% | 6 | 7 | Low spend | High coverage | 3.1 | Low spend – High coverage | Moderate |
| Indiana | $10,517 | 92.6% | 24 | 19 | High spend | High coverage | 2.4 | High spend – High coverage | Moderate |
| Iowa | $9,789 | 94.3% | 5 | 32 | Low spend | High coverage | 1.1 | Low spend – High coverage | Low |
| Kansas | $9,408 | 91.4% | 19 | 29 | Low spend | Low coverage | 2.0 | Low spend – Low coverage | Low |
| Kentucky | $10,257 | 93.1% | 15 | 20 | High spend | High coverage | 2.2 | High spend – High coverage | Moderate |
| Louisiana | $10,515 | 92.4% | 48 | 23 | High spend | Low coverage | 2.2 | High spend – Low coverage | Moderate |
| Maine | $12,077 | 94.4% | 43 | 41 | High spend | High coverage | 0.6 | High spend – High coverage | Low |
| Maryland | $10,839 | 93.8% | 31 | 38 | High spend | High coverage | 0.9 | High spend – High coverage | Low |
| Massachusetts | $13,319 | 97.2% | 36 | 42 | High spend | High coverage | 0.3 | High spend – High coverage | Low |
| Michigan | $9,897 | 95.0% | 28 | 11 | Low spend | High coverage | 2.1 | Low spend – High coverage | Moderate |
| Minnesota | $10,846 | 94.7% | 37 | 21 | High spend | High coverage | 1.6 | High spend – High coverage | Low |
| Mississippi | $9,394 | 90.3% | 13 | 30 | Low spend | Low coverage | 2.1 | Low spend – Low coverage | Moderate |
| Missouri | $9,921 | 92.4% | 27 | 13 | Low spend | Low coverage | 3.0 | Low spend – Low coverage | Moderate |
| Montana | $10,212 | 91.4% | 26 | 48 | High spend | Low coverage | 0.3 | High spend – Low coverage | Low |
| Nebraska | $10,514 | 92.4% | 8 | 31 | High spend | Low coverage | 1.6 | High spend – Low coverage | Low |
| Nevada | $8,348 | 88.6% | 9 | 26 | Low spend | Low coverage | 3.0 | Low spend – Low coverage | Moderate |
| New Hampshire | $11,793 | 95.3% | 21 | 35 | High spend | High coverage | 0.8 | High spend – High coverage | Low |
| New Jersey | $11,868 | 92.3% | 44 | 14 | High spend | Low coverage | 2.9 | High spend – Low coverage | Moderate |
| New Mexico | $8,902 | 89.8% | 7 | 46 | Low spend | Low coverage | 0.6 | Low spend – Low coverage | Low |
| New York | $14,007 | 95.1% | 51 | 16 | High spend | High coverage | 1.8 | High spend – High coverage | Low |
| North Carolina | $8,917 | 91.4% | 16 | 4 | Low spend | Low coverage | 4.1 | Low spend – Low coverage | Moderate |
| North Dakota | $11,301 | 94.0% | 49 | 39 | High spend | High coverage | 0.8 | High spend – High coverage | Low |
| Ohio | $10,478 | 93.3% | 30 | 8 | High spend | High coverage | 2.9 | High spend – High coverage | Moderate |
| Oklahoma | $9,444 | 88.3% | 41 | 22 | Low spend | Low coverage | 3.5 | Low spend – Low coverage | Moderate |
| Oregon | $10,071 | 94.8% | 10 | 27 | Low spend | High coverage | 1.3 | Low spend – High coverage | Low |
| Pennsylvania | $11,603 | 94.1% | 42 | 10 | High spend | High coverage | 2.5 | High spend – High coverage | Moderate |
| Rhode Island | $11,694 | 95.2% | 38 | 47 | High spend | High coverage | 0.2 | High spend – High coverage | Low |
| South Carolina | $8,766 | 90.9% | 22 | 12 | Low spend | Low coverage | 3.6 | Low spend – Low coverage | Moderate |
| South Dakota | $12,495 | 92.1% | 32 | 43 | High spend | Low coverage | 0.7 | High spend – Low coverage | Low |
| Tennessee | $9,336 | 90.3% | 23 | 9 | Low spend | Low coverage | 4.2 | Low spend – Low coverage | Moderate |
| Texas | $8,406 | 83.2% | 14 | 2 | Low spend | Low coverage | 8.4 | Low spend – Low coverage | Critical |
| Utah | $7,522 | 91.7% | 1 | 28 | Low spend | Low coverage | 2.0 | Low spend – Low coverage | Low |
| Vermont | $12,756 | 95.7% | 40 | 45 | High spend | High coverage | 0.3 | High spend – High coverage | Low |
| Virginia | $9,195 | 93.2% | 4 | 18 | Low spend | High coverage | 2.3 | Low spend – High coverage | Moderate |
| Washington | $9,265 | 93.5% | 12 | 36 | Low spend | High coverage | 1.0 | Low spend – High coverage | Low |
| West Virginia | $12,769 | 94.1% | 47 | 50 | High spend | High coverage | 0.1 | High spend – High coverage | Low |
| Wisconsin | $9,982 | 94.6% | 18 | 15 | Low spend | High coverage | 2.0 | Low spend – High coverage | Low |
| Wyoming | $10,989 | 90.3% | 17 | 49 | High spend | Low coverage | 0.3 | High spend – Low coverage | Low |
Regional Patterns
When mapped regionally, the state-by-state data reveals three distinct healthcare affordability profiles.
Northeast states present the most consistent pattern of high cost burden paired with high coverage. Drug costs, per-capita expenditures, and overall spending scores in this region are among the highest in the nation. The challenge in this region is not access but price containment.
States include Connecticut, Delaware, Maine, Massachusetts, New York, Rhode Island, and Vermont,
Mountain/Plains states demonstrate the opposite profile: cost burden is low, affordability is high, and demand gap is generally low. This region combines competitive drug markets, lower provider costs, and, in several cases, income levels high enough to absorb spending that does exist.
States include Idaho, Iowa, Kansas, Utah, Colorado, and Nebraska,
South/Southeast states present the starkest access mismatch. Cost burden scores are generally lower here than in the Northeast, suggesting a more affordable environment. But incomes in several states are below the national midpoint, and demand gap scores are the highest in the nation.
States include Alabama, Florida, Georgia, Louisiana, and Texas.
What All This Means for Residents and Policymakers
The data in this report tells a story of geography, about the extent to which where Americans live determines what they pay, what they can access, and how far their income stretches against the cost of staying healthy.
For residents, the implication is that healthcare costs are a cost-of-living variable. As such, it must be treated as one. The spread between the highest- and lowest-burden states is not a rounding error. It is wide enough to materially affect household financial stability over time.
For policymakers, the efficiency states (e.g., Iowa, Virginia, Washington) present the most instructive evidence. States can achieve near-universal coverage without creating an expensive system to deliver it. The competitive drug markets, adequate provider supply, and income levels give residents in these states genuine absorptive capacity,
The demand gap adds a layer that spending and coverage figures alone cannot provide. Residents in Texas, Florida, and Georgia are actively seeking coverage but not finding it. Improving affordability programs in a state where Americans are not looking for coverage is a different intervention than expanding access in a state where thousands of residents are seeking coverage they can’t yet access.
Conclusion
Healthcare affordability in America is a collection of distinctions; state-level realities that the national conversation flattens into averages. And averages can obscure as much as they reveal. America First Healthcare’s report surfaces a map of those realities.
The geography of healthcare affordability in America is neither fixed nor arbitrary. It is the cumulative result of decisions (by legislatures, insurers, providers, and markets) that have compounded over time into the state-by-state landscape this report documents. That means it can change. The efficiency states prove it.
The coverage gap has a solution.
America First Healthcare provides education-first guidance, customizing plans for individuals and families across the country.
Book a Free Healthcare Review| State | Avg. Doctor Visit | Avg. Dental Care | Optometrist Cost | Physician Availability | Health Care Employment | Insurance Coverage Rate | Income / Capita | Health Exp. / Capita | Avg. Rx Cost | Doctor Cost Score | Dental Cost Score | Optometrist Score | Physician Avail. Score | Employment Score | Insurance Score | Income Score | Health Exp. Score | Drug Price Score | Weighted Affordability Score | Affordable Rank | Weighted Spending Score | Spending Rank |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Utah | 118 | 203 | 136 | 8,616 | 175,350 | 91.70% | 69,991 | 7,522 | 19.5 | 58.3 | 54.5 | 72.3 | 5.6 | 7.4 | 60.7 | 25.1 | 100.0 | 97.6 | 66.0 | 1 | 34.0 | 51 |
| Colorado | 115 | 167 | 137 | 18,815 | 305,370 | 92.20% | 86,181 | 8,583 | 23.0 | 64.3 | 87.3 | 71.1 | 13.6 | 14.0 | 64.3 | 51.4 | 84.5 | 72.7 | 65.5 | 2 | 34.5 | 50 |
| Idaho | 106 | 199 | 139 | 4,541 | 109,750 | 91.00% | 64,846 | 8,148 | 22.8 | 85.7 | 58.2 | 68.7 | 2.3 | 4.1 | 55.7 | 16.7 | 90.9 | 74.3 | 63.2 | 3 | 36.8 | 49 |
| Virginia | 113 | 171 | 132 | 27,237 | 441,900 | 93.20% | 80,291 | 9,195 | 24.5 | 70.2 | 83.6 | 77.1 | 20.2 | 20.8 | 71.4 | 41.8 | 75.6 | 62.1 | 62.3 | 4 | 37.7 | 48 |
| Iowa | 100 | 222 | 119 | 9,263 | 184,440 | 94.30% | 68,326 | 9,789 | 22.0 | 100.0 | 37.3 | 92.8 | 6.1 | 7.9 | 79.3 | 22.4 | 66.9 | 79.9 | 62.3 | 5 | 37.7 | 47 |
| Illinois | 121 | 181 | 126 | 43,617 | 728,000 | 93.20% | 77,772 | 10,190 | 19.1 | 51.2 | 74.5 | 84.3 | 33.1 | 35.2 | 71.4 | 37.7 | 61.1 | 100.0 | 60.5 | 6 | 39.5 | 46 |
| New Mexico | 105 | 225 | 123 | 6,575 | 102,570 | 89.80% | 61,645 | 8,902 | 20.8 | 88.1 | 34.5 | 88.0 | 3.9 | 3.8 | 47.1 | 11.6 | 79.9 | 88.6 | 60.2 | 7 | 39.8 | 45 |
| Nebraska | 108 | 210 | 122 | 6,584 | 125,320 | 92.40% | 75,858 | 10,514 | 19.8 | 82.1 | 48.2 | 89.2 | 4.0 | 4.9 | 65.7 | 34.6 | 56.4 | 95.2 | 60.0 | 8 | 40.0 | 44 |
| Nevada | 114 | 187 | 137 | 7,436 | 135,430 | 88.60% | 73,156 | 8,348 | 24.6 | 67.9 | 69.1 | 71.1 | 4.6 | 5.4 | 38.6 | 30.2 | 88.0 | 61.9 | 58.8 | 9 | 41.2 | 43 |
| Oregon | 118 | 190 | 147 | 15,072 | 234,960 | 94.80% | 73,678 | 10,071 | 20.9 | 57.1 | 66.4 | 59.0 | 10.6 | 10.4 | 82.9 | 31.1 | 62.8 | 88.0 | 58.5 | 10 | 41.5 | 42 |
| Arkansas | 104 | 205 | 116 | 8,202 | 162,170 | 90.70% | 61,752 | 9,338 | 24.1 | 90.5 | 52.7 | 96.4 | 5.2 | 6.8 | 53.6 | 11.7 | 73.5 | 65.1 | 58.3 | 11 | 41.7 | 41 |
| Washington | 125 | 166 | 155 | 25,847 | 380,730 | 93.50% | 89,396 | 9,265 | 24.7 | 40.5 | 88.2 | 49.4 | 19.1 | 17.8 | 73.6 | 56.6 | 74.6 | 61.3 | 58.2 | 12 | 41.8 | 40 |
| Mississippi | 107 | 194 | 120 | 7,107 | 141,070 | 90.30% | 54,531 | 9,394 | 23.0 | 83.3 | 62.7 | 91.6 | 4.4 | 5.7 | 50.7 | 0.0 | 72.7 | 72.6 | 57.5 | 13 | 42.5 | 39 |
| Texas | 113 | 227 | 126 | 77,228 | 1,579,050 | 83.20% | 72,364 | 8,406 | 19.7 | 70.2 | 32.7 | 84.3 | 59.6 | 78.0 | 0.0 | 29.0 | 87.1 | 96.0 | 57.1 | 14 | 42.9 | 38 |
| Kentucky | 106 | 168 | 123 | 12,560 | 254,570 | 93.10% | 60,673 | 10,257 | 25.8 | 85.7 | 86.4 | 88.0 | 8.7 | 11.4 | 70.7 | 10.0 | 60.1 | 53.7 | 57.0 | 15 | 43.0 | 37 |
| North Carolina | 104 | 198 | 126 | 32,859 | 586,420 | 91.40% | 68,511 | 8,917 | 28.6 | 90.5 | 59.1 | 84.3 | 24.7 | 28.1 | 58.6 | 22.7 | 79.7 | 34.0 | 56.8 | 16 | 43.2 | 36 |
| Wyoming | 115 | 170 | 130 | 1,569 | 27,320 | 90.30% | 89,806 | 10,989 | 22.4 | 64.3 | 84.5 | 79.5 | 0.0 | 0.0 | 50.7 | 57.3 | 49.5 | 76.9 | 56.8 | 17 | 43.2 | 35 |
| Wisconsin | 119 | 213 | 127 | 19,831 | 342,770 | 94.60% | 70,570 | 9,982 | 21.2 | 56.0 | 45.5 | 83.1 | 14.4 | 15.9 | 81.4 | 26.0 | 64.1 | 85.2 | 56.7 | 18 | 43.3 | 34 |
| Kansas | 104 | 226 | 118 | 8,398 | 179,420 | 91.40% | 69,510 | 9,408 | 25.5 | 91.7 | 33.6 | 94.0 | 5.4 | 7.6 | 58.6 | 24.3 | 72.5 | 55.4 | 56.5 | 19 | 43.5 | 33 |
| Arizona | 119 | 212 | 136 | 21,405 | 403,250 | 89.80% | 68,283 | 8,756 | 22.1 | 54.8 | 46.4 | 72.3 | 15.6 | 18.9 | 47.1 | 22.3 | 82.0 | 79.3 | 55.8 | 20 | 44.2 | 32 |
| New Hampshire | 114 | 153 | 143 | 4,957 | 84,150 | 95.30% | 86,959 | 11,793 | 25.1 | 66.7 | 100.0 | 63.9 | 2.7 | 2.9 | 86.4 | 52.7 | 37.7 | 58.2 | 55.3 | 21 | 44.7 | 31 |
| South Carolina | 111 | 171 | 126 | 14,895 | 256,800 | 90.90% | 63,179 | 8,766 | 29.9 | 73.8 | 83.6 | 84.3 | 10.5 | 11.5 | 55.0 | 14.0 | 81.9 | 24.5 | 54.7 | 22 | 45.3 | 30 |
| Tennessee | 104 | 184 | 123 | 20,698 | 392,550 | 90.30% | 69,131 | 9,336 | 29.9 | 90.5 | 71.8 | 88.0 | 15.1 | 18.4 | 50.7 | 23.7 | 73.6 | 24.5 | 54.7 | 23 | 45.3 | 29 |
| Indiana | 110 | 247 | 121 | 18,902 | 414,320 | 92.60% | 66,292 | 10,517 | 20.9 | 76.2 | 14.5 | 90.4 | 13.7 | 19.5 | 67.1 | 19.1 | 56.3 | 87.8 | 53.3 | 24 | 46.7 | 28 |
| Georgia | 109 | 204 | 124 | 29,688 | 545,330 | 88.00% | 65,382 | 8,758 | 28.4 | 79.8 | 53.6 | 86.7 | 22.2 | 26.0 | 34.3 | 17.6 | 82.0 | 35.3 | 52.6 | 25 | 47.4 | 27 |
| Montana | 110 | 236 | 135 | 3,284 | 64,870 | 91.40% | 72,340 | 10,212 | 23.3 | 76.2 | 24.5 | 73.5 | 1.4 | 1.9 | 58.6 | 28.9 | 60.8 | 70.5 | 52.1 | 26 | 47.9 | 26 |
| Missouri | 106 | 229 | 119 | 22,065 | 368,360 | 92.40% | 67,587 | 9,921 | 27.8 | 85.7 | 30.9 | 92.8 | 16.2 | 17.1 | 65.7 | 21.2 | 65.0 | 39.2 | 51.4 | 27 | 48.6 | 25 |
| Michigan | 119 | 218 | 124 | 38,017 | 582,170 | 95.00% | 66,556 | 9,897 | 26.2 | 54.8 | 40.9 | 86.7 | 28.7 | 27.9 | 84.3 | 19.5 | 65.4 | 50.5 | 50.9 | 28 | 49.1 | 24 |
| California | 131 | 206 | 166 | 128,452 | 2,016,030 | 94.10% | 91,116 | 10,299 | 23.7 | 27.4 | 51.8 | 36.1 | 100.0 | 100.0 | 77.9 | 59.4 | 59.5 | 68.2 | 49.9 | 29 | 50.1 | 23 |
| Ohio | 109 | 223 | 122 | 42,555 | 764,370 | 93.30% | 67,291 | 10,478 | 27.7 | 79.8 | 36.4 | 89.2 | 32.3 | 37.1 | 72.1 | 20.7 | 56.9 | 40.2 | 49.6 | 30 | 50.4 | 22 |
| Maryland | 125 | 201 | 159 | 25,070 | 352,860 | 93.80% | 81,834 | 10,839 | 23.2 | 40.5 | 56.4 | 44.6 | 18.5 | 16.4 | 75.7 | 44.3 | 51.6 | 71.2 | 49.5 | 31 | 50.5 | 21 |
| South Dakota | 104 | 210 | 125 | 2,766 | 63,960 | 92.10% | 79,297 | 12,495 | 25.7 | 91.7 | 48.2 | 85.5 | 0.9 | 1.8 | 63.6 | 40.2 | 27.5 | 53.9 | 48.2 | 32 | 51.8 | 20 |
| Alabama | 105 | 223 | 113 | 12,797 | 252,410 | 91.80% | 59,677 | 9,280 | 33.4 | 88.1 | 36.4 | 100.0 | 8.8 | 11.3 | 61.4 | 8.4 | 74.4 | 0.0 | 47.4 | 33 | 52.6 | 19 |
| Connecticut | 126 | 194 | 143 | 15,970 | 228,120 | 94.30% | 98,879 | 12,489 | 24.4 | 39.3 | 62.7 | 63.9 | 11.3 | 10.1 | 79.3 | 72.0 | 27.6 | 63.0 | 46.8 | 35 | 53.2 | 17 |
| Massachusetts | 129 | 178 | 164 | 35,110 | 504,910 | 97.20% | 97,456 | 13,319 | 22.5 | 31.0 | 77.3 | 38.6 | 26.4 | 24.0 | 100.0 | 69.7 | 15.5 | 76.1 | 46.6 | 36 | 53.4 | 16 |
| Minnesota | 134 | 194 | 129 | 20,414 | 407,250 | 94.70% | 78,538 | 10,846 | 25.5 | 19.0 | 62.7 | 80.7 | 14.9 | 19.1 | 82.1 | 39.0 | 51.5 | 55.5 | 46.5 | 37 | 53.5 | 15 |
| Rhode Island | 130 | 186 | 139 | 4,818 | 71,440 | 95.20% | 73,992 | 11,694 | 24.0 | 28.6 | 70.0 | 68.7 | 2.6 | 2.2 | 85.7 | 31.6 | 39.2 | 65.8 | 46.1 | 38 | 53.9 | 14 |
| Hawaii | 110 | 223 | 196 | 5,014 | 62,190 | 96.70% | 76,592 | 10,291 | 31.0 | 77.4 | 36.4 | 0.0 | 2.7 | 1.8 | 96.4 | 35.8 | 59.6 | 17.2 | 46.0 | 39 | 54.0 | 13 |
| Vermont | 115 | 183 | 146 | 2,675 | 38,840 | 95.70% | 74,580 | 12,756 | 25.9 | 64.3 | 72.7 | 60.2 | 0.9 | 0.6 | 89.3 | 32.6 | 23.7 | 52.3 | 45.9 | 40 | 54.1 | 12 |
| Oklahoma | 116 | 227 | 117 | 10,357 | 203,630 | 88.30% | 66,660 | 9,444 | 28.7 | 61.9 | 32.7 | 95.2 | 6.9 | 8.9 | 36.4 | 19.7 | 72.0 | 32.8 | 45.8 | 41 | 54.2 | 11 |
| Pennsylvania | 122 | 198 | 131 | 51,098 | 858,360 | 94.10% | 74,231 | 11,603 | 26.2 | 48.8 | 59.1 | 78.3 | 39.0 | 41.8 | 77.9 | 32.0 | 40.5 | 50.3 | 45.8 | 42 | 54.2 | 10 |
| Maine | 106 | 226 | 140 | 5,424 | 91,120 | 94.40% | 71,662 | 12,077 | 26.8 | 85.7 | 33.6 | 67.5 | 3.0 | 3.2 | 80.0 | 27.8 | 33.6 | 46.3 | 45.7 | 43 | 54.3 | 9 |
| New Jersey | 138 | 194 | 153 | 33,184 | 551,530 | 92.30% | 88,223 | 11,868 | 20.6 | 9.5 | 62.7 | 51.8 | 24.9 | 26.4 | 65.0 | 54.7 | 36.6 | 89.7 | 44.9 | 44 | 55.1 | 8 |
| Florida | 115 | 210 | 136 | 70,239 | 1,252,290 | 89.10% | 76,440 | 9,865 | 31.1 | 64.3 | 48.2 | 72.3 | 54.1 | 61.6 | 42.1 | 35.6 | 65.8 | 16.4 | 44.8 | 45 | 55.2 | 7 |
| Delaware | 123 | 207 | 135 | 3,632 | 67,620 | 93.10% | 71,357 | 12,899 | 20.3 | 46.4 | 50.9 | 73.5 | 1.6 | 2.0 | 70.7 | 27.3 | 21.6 | 91.6 | 44.7 | 46 | 55.3 | 6 |
| West Virginia | 113 | 191 | 125 | 5,743 | 112,220 | 94.10% | 57,932 | 12,769 | 25.3 | 70.2 | 65.5 | 85.5 | 3.3 | 4.3 | 77.9 | 5.5 | 23.5 | 57.2 | 44.1 | 47 | 55.9 | 5 |
| Louisiana | 118 | 221 | 127 | 14,084 | 262,810 | 92.40% | 63,940 | 10,515 | 28.7 | 58.3 | 38.2 | 83.1 | 9.9 | 11.8 | 65.7 | 15.3 | 56.4 | 32.8 | 43.8 | 48 | 56.2 | 4 |
| North Dakota | 116 | 263 | 124 | 2,530 | 53,660 | 94.00% | 75,157 | 11,301 | 27.1 | 61.9 | 0.0 | 86.7 | 0.8 | 1.3 | 77.1 | 33.5 | 44.9 | 44.4 | 42.6 | 49 | 57.4 | 3 |
| Alaska | 142 | 174 | 165 | 2,367 | 44,490 | 88.90% | 80,175 | 13,642 | 23.6 | 0.0 | 80.9 | 37.3 | 0.6 | 0.9 | 40.7 | 41.6 | 10.8 | 69.0 | 31.2 | 50 | 68.8 | 2 |
| New York | 130 | 209 | 142 | 89,054 | 1,429,800 | 95.10% | 88,847 | 14,007 | 30.9 | 28.6 | 49.1 | 65.1 | 68.9 | 70.5 | 85.0 | 55.7 | 5.5 | 17.7 | 30.5 | 51 | 69.5 | 1 |
Methodology
To rank U.S. states by healthcare cost burden, we built a composite scorecard combining eight factors:
- Healthcare expenditures per capita
- Income per capita
- Insurance coverage rate
- Prescription drug costs
- Doctor visit costs
- Dental care costs
- Physician availability
- Optometrist/eye exam costs
Each factor was scored on a 0–100 scale, with lower costs and higher income, coverage, and physician availability all receiving higher scores. These scores were then weighted accordingly and combined into a final affordability score.
Category Weights
- Expenditures per capita: 25%
- Drug costs and doctor visit costs: 15% each
- Income, insurance coverage, and physician availability: 10% each
- Dental care: 10%
- Eye care: 5%
States with higher scores have a relatively lower overall healthcare cost burden, whereas lower-scoring states face greater cost pressure.
We also examined how each state’s cost burden relates to its insurance coverage rate, grouping states into four categories based on whether they fall above or below the national median for each measure.
Finally, we calculated a “demand gap” score for each state by comparing plan inquiry activity (based on proprietary data from America First Healthcare against the uninsured population rate, to highlight states where interest in health coverage appears to outpace actual coverage.
