For 60 years, the so-called “tax exclusion” for employer-paid group health insurance has treated the portion of an employee’s health insurance premium that is paid by his or her employer as a tax-free benefit. It is not subject to any federal and state income taxes that an employee pays, and it is not reported as income on the employee’s W-2 form. Because employer-paid health insurance benefits are not considered taxable wages, they also are not subject to federal payroll taxes imposed on employers and employees. This tax policy helped foster rapid growth of employer-sponsored group health insurance in the United States, but it also created unintended consequences for the structure, cost, and availability of both private health insurance and health care that continue today.