WASHINGTON (AP) - A new survey says Americans aren't feeling any more secure about their medical care after enactment of President Barack Obama's health overhaul.

The Robert Wood Johnson Foundation says consumer confidence spiked in April after Obama signed landmark legislation to expand coverage and try to control costs. But confidence levels have since fallen back to what they were last year at the start of an epic congressional debate.

It's another sign of ambivalence over Obama's historic accomplishment as Democrats campaign to preserve their congressional majorities in the midterm elections. The ho-hum attitude may be because the law's major benefits don't take effect until 2014.