With the end of the initial open enrollment period for new insurance options under the Affordable Care Act (ACA), The New York Times Upshot/Kaiser Family Foundation Polls In Four Southern States examines public opinion on the health care law and the upcoming midterm elections in Arkansas, Kentucky, Louisiana, and North Carolina. These four southern states have each taken different approaches to ACA implementation, and they all feature close midterm races for Senate and/or Governor in which the health care law is likely to be a prominent issue.

The poll finds that the health care law gets low approval ratings in each of these states, where majorities disapprove of the way President Obama is handling health care.

Despite this, a majority in Kentucky, Louisiana, and North Carolina want their representative in Congress to work on improving the law rather than repealing and replacing it. In Kentucky, which has received national attention for the success of its state-run health insurance exchange, a majority of state residents say the marketplace is working well. A plurality of Arkansans also feel the state-federal partnership exchange is working well in their state, while views of the federal exchange are more mixed in North Carolina and tilt negative in Louisiana. The poll also points out confusion about the status of Medicaid expansion in these states. Just three in ten Kentucky residents know that their state has expanded Medicaid under the law, and only one in five in Arkansas know their state has opted for the so-called “private option,” using federal funds to purchase private coverage for low-income people through the health insurance exchanges in lieu of expanding Medicaid. The poll finds that over half the public in Arkansas, Louisiana, and North Carolina support Medicaid expansion in their own state.

The poll also captures state residents’ perceptions of how the law has impacted them and their families, and finds that three in ten adults in Louisiana and four in ten in Arkansas, Kentucky, and North Carolina say they know someone who was able to get coverage because of the law. About three in ten in each of these states say they know someone who lost their insurance because of the law.

The survey was designed and analyzed by public opinion researchers at the Kaiser Family Foundation and The New York Times, and was conducted from April 8-15 among a nationally representative random digit dial telephone sample of 4,152 adults, including 1,027 in Arkansas, 1,026 in Kentucky, 1,075 in Louisiana, and 1,024 in North Carolina. Telephone interviews conducted by landline and cell phone were carried out in English and Spanish. The margin of sampling error for results in each state is plus or minus 4 percentage points.

The Kaiser Family Foundation, a leader in health policy analysis, health journalism and communication, is dedicated to filling the need for trusted, independent information on the major health issues facing our nation and its people. The Foundation is a non-profit private operating foundation, based in Menlo Park, California.