The one thing you have going for you is that health insurance tends to be localized anyway, not necessarily at the city level, but at the state. One thing you

The one thing you have going for you is that health insurance tends to be localized anyway, not necessarily at the city level, but at the state. One thing you have going against you is many people will want coverage beyond this local region. The "knowing how much things will cost" is probably the biggest problem. I would love it, unfortunately it is completely different than how medical providers are used to working. That will make it very difficult to negotiate with doctors. And you will be new. Meaning that you have no current members. Meaning that they have absolutely no incentive to negotiate with you. Then there's the fact that insurance in the US will change in unknowable ways on January 1. Have you looked at how you can interact with the health exchanges in these states?