Four facts have brought us to this health policy crossroads: (1) most Americans get their health insurance through some employment relation; (2) most of the uninsured are either workers or dependents of workers; (3) despite all the policy attention in the last few years, small employers are still much less likely than large firms to offer health insurance to their workers; and (4) workers in small firms are the most likely to be uninsured. These facts suggest that focusing on ways to get coverage to workers in small firms is the most important incremental reform strategy we could undertake in this country at this time.