Americans’ approval of the Affordable Care Act is at a record low yet those uninsured who purchased coverage through the exchange are overall pleased with the quality of coverage they obtained.

Thirty-seven percent of 862 Americans surveyed by national polling organization Gallup Nov. 6-9 – right after the midterm elections – said they approve of the law, one percentage below the previous low in January 2014. Fifty-six percent disapprove of the law, a record high by one point.

Meanwhile, in a separate Gallup poll conducted Oct. 22-Nov. 22, 74% of Americans who newly obtained insurance through the ACA in 2014 say the quality of the health care they’ve received is “excellent” or “good”. Further, 75% of those who obtained coverage through an exchange say they are satisfied with the total cost they pay for health care.

“Until people really go in and sign up for insurance coverage and use it, they are likely to hate it until they try it,” explains Laura Adams, senior analyst at Most of those who signed up through the exchanges never had insurance before, so it’s a “very foreign product for them,” she says. “Thirteen to fourteen percent of Americans are still uninsured. That is a lot of people and they don’t understand how any of this works.”

Since under the ACA nearly all Americans must obtain coverage there is a “real knowledge gap here and no matter if people like it or not, the law is the law,” Adams adds. “People need to start understanding there are financial penalties.”

The reason the law continues to be viewed unfavorably is based more on political philosophy rather than an understanding of the contents of the law, explains Frank Newport, Gallup’s editor-in-chief.

“Overall evaluations of the ACA are not based so much on the specifics, or how it is being implemented or what its impact is,” he says. “We know the uninsured rate has gone down and people are getting coverage. People with insurance are happy with it … but attitudes are so hardened that these specifics don’t seem to affect them.”

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