The its 2019 State of Healthcare and Politics Report from unveils Americans’ knowledge, views and predictions surrounding the ACA, President Trump’s impact on the law, and the state of healthcare between now and 2020.

According to the report, 41% of Americans say they do not know what healthcare open enrollment is.

Other survey findings include: 38% are unaware that the ACA is still in effect; 24% of Americans say they view the ACA less positively after the 2016 election; and 18% say their view on the ACA have been “more favorable” since the election.