Nearly five years after the signature law passed, Americans are still unsure about the ACA.

The Affordable Care Act (ACA) was passed by Congress and signed into law by President Barack Obama in 2010, and then upheld in 2012 by the U.S. Supreme Court, but a new study from Healthline shows that about 25 percent of Americans still have a poor understanding of the law. When it comes to health insurance, it pays to be in the know. For those who already have an insurance plan because of the ACA, nearly 84 percent said they are satisfied with it.

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Open enrollment in online ACA health insurance exchanges for 2015 begins on Nov. 15. Ahead of that date, Healthline examined the health insurance issues affecting Americans in a survey of nearly 500 U.S. consumers.

“These survey results highlight persisting consumer confusion about health plan enrollment in general and the Affordable Care Act in particular,” said Dean Stephens, CEO of Healthline, in a press release.

The study reported four major findings in the areas of health plan selection and perception of impact: cost, transparency, the desire for better care, and the willingness to switch health plans.

“With the ACA in full swing and open enrollment season approaching, it is critical for consumers to understand the impact that the ACA will have on their health coverage and prepare to make intelligent decisions around health plan options,” Stephens said.

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For nearly 70 percent of respondents, cost trumps good health when it comes to healthcare decisions. When asked whether they would pay a larger premium or a higher deductible for better insurance, 69 percent said they would not or are not sure. Nearly 51 percent said they would forgo medical treatment because of financial issues or the limitations of their insurance plans. Of those who would forgo treatment, 57 percent have health insurance coverage through their employers.

A quarter of survey respondents, equivalent to nearly 59 million Americans, said they have little or no understanding of what the ACA is, and less than one-third of those surveyed feel that the ACA will have a positive impact on U.S. healthcare. Among people without insurance, 40 percent do not understand the ACA, and even one-quarter of people who bought insurance on ACA exchanges admit confusion.

The U.S. health insurance and open enrollment systems were graded by about 82 percent of respondents at a “C” or below. For almost 20 percent, the U.S. health system earned an abysmal “F.”

Despite the above issues, nearly 77 percent of respondents reported satisfaction with their current health insurance plan. Nearly 84 percent with an ACA plan say they are satisfied. Only about 9 percent said they intend to switch plans in the coming open enrollment season.

For full survey results and an infographic illustrating key findings, visit

To make sure you’re ready for open enrollment, visit

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