Prior to the implementation of the Affordable Care Act (ACA) known as Obamacare, the United States already had arguably the most advanced health care system in the world. There were hundreds of state-of-the-art medical centers with thousands of specialists, highly skilled in curing cancer, conducting organ transplants and resuscitating patients from the brink of death.

Since the implementation of the ACA, has anything changed?   A new poll  just released, conducted by National Public Radio, the Robert Wood Johnson Foundation, and the Harvard T.H. Chan School of Public Health, found that only one of every three Americans feel the services they receive from the health care system are considered “excellent,” and even fewer think the health care system as a whole is impressive.

The poll, conducted from September to November, also indicated that most people feel the ACA hasn’t changed the system at all, or at least very little. The numbers revealed 74 percent felt their health care had remained the same since the ACA was signed into law by President Obama in 2010, five years ago next month. Of the few who responded they had seen a change in health care, 14 percent said their plan was better now, while nine percent felt it had worsened.

Surprisingly, about 80 percent of the respondents said they received good or excellent health care themselves, despite the low ratings for the system as a whole. Just under half, at 42 percent, felt the health care system in their own state rated either fair or poor.

So, if the care is good, what is the problem? Many feel the negative view of the system overall is caused by the myriad of steps an individual is forced to go through to receive the care. The system is complex and few patients actually understand the processes that must be followed, from multiple forms that are required to be completed, understanding co-pays and deductibles, and being forced to see multiple physicians to have tests performed.

Some experts say the system was designed for the efficiency of the physicians and the health care systems to keep costs down, which is a necessary goal, but that doesn’t always mesh with the physical and emotional needs of the patient.

Another surprising find was that most people felt the implementation of the ACA had no impact on them personally, even though there are several provisions for free tests such as, mammograms and colonoscopy screenings, and the ability to purchase health insurance with a preexisting condition. Only one of six thought their benefits had increased, and one of eight actually thought they had fewer benefits than before.

And there are others, particularly among the young and healthy, that feel having to purchase insurance or pay the penalty for not being insured, is unfair to them. They argue they are being forced to buy a product they think they don’t necessarily need, in order to subsidize older, unhealthy Americans.

There are some programs still being phased into the health care system, and that process is slow with all the regulatory work that follows, but some may soon see things differently in the coming years. Of course, that all may change this November.