While the risk pool can be widened, it can be a problem because Modified Community Rating has always been the norm, even before Obamacare.
In Florida, Orange County and Seminole County are right next to each other but the zip codes are different and the pricing is different because the makeup of the county is different. If you included both, you would see one county have premium increases and possible the other county have premium decreases.
That is why across state lines does not work. You can’t sign up for a Mississippi plan in New York because there are no Mississippi doctors there and the Doctors in N.Y. would not take the reimbursement that was negotiated in Mississippi and the whole health state of the population might be, and I think would be, different which is one of the ways they come up with premiums by the amount of claims.
It would also have no impact on a state that was too small to have an HMO because it is based on amount of providers within that area. The problem is that there is not enough providers that sign up for the HMO, so they can’t start an HMO. People are not going to go to the next state, in most cases, to see their provider. When an insurance company has enough providers in an area is when they start servicing an area.