As "Obamacare" is entering its second year of implementation, and open enrollment is currently upon us, Healthline — a provider of intelligent health information and technology solutions — has released the results from a new survey showcasing consumer's thoughts about the Patient Protection and Affordable Care Act (ACA) and health insurance.

Conducted ahead of the 2015 open enrollment, the survey shows health insurance issues, including factors impacting health plan selection, satisfaction with current plan options, consumer understanding of the ACA, perceived impact of the ACA and overall thoughts about the U.S. health insurance system.

The results show that nearly five years after the law passed, Americans still are unsure about the ACA about 25 percent of Americans still don't have a firm understanding of the law and how it affects them.

The Healthline study reported major findings in the areas of cost, transparency, the desire for better care and the willingness to switch health plans. It also revealed the state of health insurance in the U.S.

Specific results include:

Cost trumps health when it comes to making health decisions: When asked whether consumers would pay a larger premium or a higher deductible for "better" health insurance, almost 70 percent of respondents said they would not or are not sure. More than half of consumers (50.8 percent) said they would forgo medical treatment because of high costs or coverage limitations from their health plans. Of those who would forgo medical treatment, 57 percent currently have health insurance through their employers.

Americans are still unclear about the ACA: 25 percent of respondents said they have a poor understanding or no understanding at all of the ACA and what it involves. Nearly 40 percent of those without health insurance and 26 percent of those enrolled in an ACA plan said they have a poor understanding or no understanding at all of the law; fewer than a third of respondents said that ACA will have a positive impact on U.S. healthcare.

There's room for improvement: When asked to grade the U.S. health insurance and open enrollment system, more than 80 percent gave it a "C" or below, including almost 20 percent who rated the system an "F."

Despite issues, most not planning to switch health plans: More than 75 percent of survey respondents said they are satisfied with their current health insurance plans. The majority said the deductible in their current plan is reasonably priced or inexpensive. Nearly 84 percent of those with an ACA plan are satisfied with their current plan and only about 9 percent of consumers plan to switch to a different health insurance during the upcoming open enrollment season.

"These survey results highlight persisting consumer confusion about health plan enrollment in general and the Affordable Care Act in particular," Dean Stephens, CEO of Healthline, said in a statement. "With the ACA in full swing, it is critical for consumers to understand the impact that the ACA will have on their health coverage and prepare to make intelligent decisions around health plan options.

"Through Healthline's survey, the issue of cost emerged as an important factor beyond health insurance selection decisions, playing a big role in medical and treatment decisions as consumers take on more responsibility for the cost of care."

ACA open enrollment began on Nov. 15. Ahead of that date, Healthline surveyed about 500 U.S. consumers to determine the above results.