More than 18 months after passing health reform, Democrats are struggling to educate the country on what’s actually in it. A new Kaiser Family Foundation poll out this morning finds most Americans think it includes a government-run health plan (it doesn’t), that it won’t eliminate co-pays for preventive care (it will) and that, for many, the actual content of the law may not even matter: Americans don’t like health reform because they don’t like Washington.

Let’s start with what Americans think is in the health reform law. The majority of Republicans and Democrats believe it includes a government-run health plan. Despite a lengthy debate over a public option, no such insurance plan was part of the law Congress passed. The country does not, however, seem to know that:

Why don’t Americans know what’s in the law? One common explanation has to do with most of the law not being implemented. But the above chart shoots a bit of a hole in that explanation: Many of the least known parts of the law have been implemented. That includes no co-pays for preventive care, the gradual closing of the donut hole and new abilities to appeal health plan decisions. Some of those came online just six months after the Affordable Care Act passed last March, and have been in effect for over a year now.

Two other charts from Kaiser suggest some different explanations. One is that Americans don’t know about the law because they’re not seeing, or not reading, much news coverage about it. The majority of those polled had heard “nothing” or “only a little” about the health reform law in the past month:

Another factor at play could be that the actual content of the law doesn’t really matter that much in how Americans feel about the health reform law. Nearly half of those who don’t like the Affordable Care Act say that’s mostly because they don’t like Washington, or the direction our country is headed in:

After the health reform law passed last year, many Democrats predicted that the law would become increasingly popular as new benefits rolled out. This Kaiser poll suggests that may not be the case. Many benefits have, so far, rolled out unnoticed. And even if they do get noticed, they might not matter: A lot of the negative opinions about health reform have less to do with the law itself.