(Bloomberg) — Public support for the U.S. health care overhaul fell to its lowest level in a Kaiser Family Foundation survey after the Oct. 1 debut of government-run insurance marketplaces greeted consumers with breakdowns on websites, higher prices and potentially broken promises.

About 33% of Americans surveyed in the past week said they had a favorable opinion of the Affordable Care Act from 38% a month earlier, the lowest level since the law was signed in March 2010, the Menlo Park, Calif.-based nonprofit research group, said Friday.

The troubled debut of the exchanges that are a core part of President Barack Obama’s health care overhaul prevented many people from completing applications for medical coverage. That shifted public opinion and reinvigorated Republican opponents who have since held more than six congressional hearings to highlight the law’s flaws.

“In the long term really what’s going to drive the polls, what’s going to drive the public judgment, is how well the law works and whether people like the coverage,” said Drew Altman, the foundation’s chief executive officer.

While 106,185 people enrolled in plans through the government exchanges last month, almost 1 million abandoned the application process after encountering website errors, garbled data and long waiting times. Obama is now banking on a surge of enrollees near deadlines in December and March to meet projections for 7 million sign-ups in the first year.

November deadline

The online exchanges are the core of the ACA’s promise of extending medical coverage to most of the nation’s 48 million uninsured. Getting the federal exchange fixed soon is necessary because most Americans are required to have health insurance by March 31 or pay a fine of $95 or as much as 1% of their income.

Obama set a Nov. 30 deadline for the site to be repaired, allowing what his administration calls “the vast majority” of customers to enroll.

The Kaiser survey showed that 49% of Americans surveyed this month had an unfavorable opinion of the law from 44% in October. The results mirror other surveys, including a Nov. 14 Gallup poll that found 40% of Americans support the law.

Widening gap

The 16 percentage-point gap between support and opposition in the Kaiser survey is the largest the foundation has reported since October 2011, in the thick of the Republican presidential primary campaign. The gap was six percentage points in the foundation’s October 2013 poll.

“Uninsured Americans, some of whom have been shut out of the market for years, value health insurance and want to find quality, affordable health-care choices for themselves and their families,” Jessica Santillo, a White House spokeswoman, said in an e-mail. “This poll shows that Americans are more aware of the new health insurance choices under the law, and the uninsured are just as committed to enrolling as they were before the marketplaces opened.”

Republicans, who were unanimous in their opposition to the law when it passed in 2010 through a Congress controlled by Democrats, have sought to turn the troubled rollout into political advantage. In addition to hearings, they have released documents showing administration officials knew of flaws in the main insurance exchange website before it opened Oct. 1.

Policy cancellations

Obama is trying to resolve the political thicket that arose after insurers began canceling policies in the individual market and telling customers that new plans complying with the health law would cost more. The decision clashed with the president’s repeated promise that people who liked their health coverage would be able to keep it. Obama on Nov. 14 offered a compromise allowing insurers to extend substandard policies in force in 2013 for as long as a year.

Health insurers that want to keep offering the substandard plans next year are being instructed to inform customers that the substandard plans “will NOT provide all the rights and protections of the health care law.” The U.S. Department of Health and Human Services, also said Friday that insurers must inform people they “have new options” through marketplaces and may be eligible for tax credits.

States’ responses

At least 12 states have said they will enact Obama’s transitional policy for health plans that don’t meet the new standards, according to America’s Health Insurance Plans, a Washington lobby group for the industry. Four other states allowed extensions before Obama’s policy.

Washington, Minnesota, New York, Vermont, Massachusetts, Rhode Island and California have said they won’t allow extensions, according to AHIP.

In a positive development for Obama, 42% of Americans in the Kaiser survey said they had heard “a lot” or “some” about the health insurance exchanges, about twice the percentage familiar with the marketplaces in September. About 58% of uninsured people that Kaiser polled said they would obtain health insurance next year.

Republicans plan to continue congressional hearings next week. Representative Darrell Issa, a California Republican who is chairman of the House Oversight and Government Reform Committee, announced field hearings on the law in North Carolina, Georgia, Arizona and Texas to be held through Dec. 16.

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