There is nothing to stop congress from combining low population states into a single pool so that Americans in all states can enjoy lower cost. Additionally, the participants in these state combined pools would be allowed to use healthcare providers in each of the states of their choosing.
This isn't going to happen unless our congressional delegation restrict access to their office from special interests and lobbyist first. 
If this bill doesn't lower the rise in premiums significantly then I think a more creative approach is needed because health care is every bit as important as our state's fiscal situation.