This is my line of work, and I'm familiar with Iowa in particular. Forummm described the game pretty well. Companies ask for huge increases, it gets tons of press, and then the division of insurance cuts it back to something reasonable. State regulators must approve increases in insurance rates once a year, and each state has specific guidelines that govern what increases are approved and for how much.
One of the factors driving large increase requests right now is that the feds did not honor their risk corridor promise, which was written into the ACA. As a result some companies have sustained huge losses, or (in the case of the new Co-ops) have gone out of business. There hasn't been a reasonable explanation for why this program wasn't honored, and it completely screwed over insurance companies who based their business model on it functioning as advertised.
In terms of how you plan for it, I think other posters have described some good options. Operate based on the current law, and consider going to a more affordable country if things really fall apart.