Adults in Ohio are divided when it comes to whether they believe the Affordable Care Act has been good or bad for them.
And while most rate their own health care positively, far more Ohioans rate the state's overall health care system as fair or poor than rate it as excellent. Those are some of the findings in a series of recent polls by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.
Lilo Whittaker, who responded to the poll, lives on a wooded one-acre lot in rural Ohio. The setting is idyllic on a cold winter morning. Chickadees chirp outside and a pot of coffee brews in the kitchen.
But at nearly 60 years old, Whittaker says the picture isn't perfect. When Whittaker first heard about the federal health overhaul several years ago, she expected it would help.
"I thought, this is great," Whittaker says. "People will be able to afford their health insurance, get decent coverage and begin to take care of their medical issues."
But, in the past two years, Whittaker says, her husband's Parkinson's medications went from just over $150 a month to more than $400. The couple's health insurance coverage has also become less affordable.
"A lot of people like me will forgo going to a doctor even if they have a problem because you can't even afford your deductible or your copay," she says. "And I don't think your health insurance issues here are addressed properly."
Whittaker is among the 27 percent in Ohio who say Obamacare has directly hurt them. On the other hand, 21 percent of Ohioans say it has directly helped them.
At the Free Medical Clinic of Greater Cleveland, there is a steady stream of patients on a recent weekday afternoon.
Over the past two years, the clinic has seen a shift in the people it cares for. More of them have coverage, like 29-year-old Whitnie Momah.
She smiles when asked about her health care insurance. "I hear a lot of people say that for them it's gotten worse, but for me, it's gotten better," Momah says. "Before I made too much money to qualify for, like, any type of government assistance but not enough money to where I could afford my health insurance."
Momah is a nursing student. She says she would be uninsured if she hadn't called for help with HealthCare.gov, the federal insurance exchange. They walked her through the site, and she's now enrolled in a low-cost health insurance plan called Buckeye.
"It really helped me out, it really did," she says. "It was a huge blessing for me."
Momah's experience, as well as Whittaker's, are two different but very real pictures of Ohio, says Robert Blendon, a professor at the Harvard Chan School.
The polarization there is even more extreme than the nation.
"In Ohio, there are shares of people who really feel that they've been helped by the law and changes in recent years," Blendon says. "There are shares of people who actually don't feel they have been helped and actually hurt. And it's not a unified view of what is going on in Ohio. The divisions are really quite large."
Nearly 900,000 people have gained health care coverage in the past two years in Ohio – about 240,000 with federal marketplace plans and another 650,000 through Ohio's expansion of Medicaid – something Republican Gov. John Kasich did despite his party's opposition.
At the same time, people enrolled in employer-sponsored health insurance have seen a steady climb in the amount they pay out of pocket. One analysis shows that by 2014, Ohio was third in the nation for the most people enrolled in high-deductible health plans.
Reem Aly, a researcher with the nonpartisan Health Policy Institute of Ohio, says people tend to blame the Affordable Care Act for the trend toward high-deductible plans.
"It can be a very polarizing issue," Aly says. "Every person has different circumstances and health care can be very personal."
For Lilo Whittaker, the ACA is a promise left unfulfilled. She questions why some benefit so much and others, like her, don't. It's not fair, she says.
"We just go without. We don't do anything," Whittaker says. "Christmas was kind of depressing for the grandkids because I told them, I couldn't afford to do what I used to be able to do," Whittaker says she has always paid her bills. But now, to afford her husband's medication, she doesn't pay them as well as she used to.