It is hard to imagine that after three years of acrimony and debate we could still be so confused about President Obama's Affordable Care Act.

Is it actually possible Americans know less about Obamacare now than they did three years ago? Apparently that is the case, and the news comes just as the most sweeping effects of the law are about to kick in.

According to a new poll by the Kaiser Family Foundation, 80 percent of people don't know whether their state is going to expand Medicaid under the law, a huge piece of the health care changes coming down the pike.

Half of people don't know whether their states are going to be setting up so-called health exchanges, and half of people think the law gives undocumented immigrants health care subsidies -- it doesn't. The poll also shows that 40 percent of people still think the government is going to set up death panels to decide if someone gets heath care when they're dying -- it won't.

To further illustrate confusion about the law, 70 percent of people said they like the initiatives in the law when they were asked specifically about each one, but only 37 percent of people said they liked the law itself.

Where Are We Now?

NPR's health policy correspondent Julie Rovner says a lot of the confusion regarding the Affordable Care Act comes, in part, from a commanding "misinformation and disinformation" campaign.

"It has worked better than the people who were trying to put the law into effect, who have been working to put the law into effect rather than messaging about it," Rovner tells weekends on All Things Considered guest host Laura Sullivan.

There are essentially three big pieces to the Affordable Care Act: the insurance reforms (also known as the patients' bill of rights), quality and cost measures, and the health care mandate.

The insurance reforms portion has mostly taken effect, Rovner says, and includes things like allowing adult children to stay on their parents' health insurance until they are 26, and not letting health plans cancel coverage after you get sick. These are things she says most polls show Americans back.

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Three Years On, States Still Struggle With Health Care Law Messaging