A new NPR / Robert Wood Johnson Foundation / Harvard T.H. Chan School of Public Health poll finds that although a majority of Americans are satisfied with the health care they receive, many still experience significant problems with health care costs, insurance coverage, and accessing care when they need it.

While a strong majority of adults reflect positively on their health insurance coverage, with 33% rating theirs as “excellent” and 41% as “good,” one in four Americans rates their insurance as just fair (20%) or poor (5%). More than a quarter of adults in the U.S. also say health care costs have caused serious financial problems for them or their family. Experiences among patients differ by state of residence, but as many as one in five adults in some states say they could not get the health care they needed at some point in the past two years.

The poll surveyed more than 1,000 adults nationwide and more than 1,000 adults in each of seven states — Florida, Kansas, New Jersey, Ohio, Oregon, Texas, and Wisconsin — about their personal health care experiences and perceptions of the state in which they live. Those seven states were selected to represent a geographically diverse group of states that have and have not expanded Medicaid, as well as the only state in the nation that did not have to, as Wisconsin’s pre-ACA health insurance coverage levels already matched or exceeded those passed by health reform. Polling was conducted last fall, after an additional estimated 17.6 million people acquired health insurance in the United States.

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