Although nearly all large firms (200 or more workers) offer health benefits (98%), firms with fewer than 200 workers are significantly less likely to do so (59%). Since 2000, the percentage of small firms (3-199 workers) offering health benefits has dropped by 9 percentage points. While the year-to-year changes have been relatively small and not statistically significant, the cumulative effect has been a large and statistically significant change over this five-year period. This change is driven largely by a decrease in the percentage of small firms offering coverage, and may reflect several years of high premium growth combined with a sluggish job market.