"a price increase of 75% for our family.  (assuming our income is the same, and the fed subsidy is the same). so there will be a high probability we opt out of the ACA system for 2019. (go without insurance, and just pay cash to the doctor).  "  

bear, 

We did that for several years, up to the start of last year and saved tens of thousands of dollars.

Last year, I had around 70K in medical bills and my wife will be over half of that this year. Fortunately we have had insurance.

However, if we didn't have insurance during these last 2 years, we probably would have still come out ahead because of the amount that we saved over the previous years.

For the value that you get based on the risk, health insurance is probably the worst insurance on the market vs other types of insurance. The cost of medicine in the US was already off the charts.............with no government policies to address it.

How can this not end up in a train wreck?

Sadly, it appears that the only way to reign it in is the government stepping in and taking control. If there is/was a better plan, using the free market...........then why has it not emerged.

People just can't be paying 20% of their income for health care costs without it taking a toll.