In September 2013, as the nation prepared for the launch of the Affordable Care Act’s Health Insurance Marketplace, Texans were surveyed to learn about their recent experiences with health care and health insurance and their expectations going forward. This Issue Brief describes Texans’ experiences obtaining and paying for a variety of health services during the preceding year and the satisfaction levels of insured Texans with the quality and cost of their health plans. These data show that, on the eve of the launch of healthcare.gov, many Texans were struggling to pay for basic health services. Even those with health insurance reported dissatisfaction with the cost and availability of services. And most Texans expected 2014 to be more of the same.