Co-published by the Economic Hardship Reporting Project and The Nation.

He might not be able to work here any longer.”

These were the words that made me want to report on injury in the retail industry. I was working as a cashier in a supermarket when a manager commented casually that a 57-year-old colleague might have to quit. For six years, the cashier had been picking up grocery items and moving them across the scanner. The motion had led to a sharp pain in his elbow that forced him to stop working multiple times during a shift. The manager seemed resigned to the fact that with no health insurance and unable to afford long-term leave, the cashier might have to quit the job that he could no longer perform.

I remembered my former colleague’s situation when I interviewed Parker, an employee in a Utah outlet of a national supermarket chain. (At Parker’s request, to protect his job, The Nation is not using his full name or naming his employer.) One day last summer, the 25-year-old picked up a case of cauliflower. “I felt something slip in my back,” he told me. “I tried to stand but couldn’t. There was so much pain.” Employed in the service industry since high school, when he bagged groceries at a different chain, he was used to the physical toll of retail work. But this was no ordinary back ache. In too much pain to finish his shift, he went home early that day.

Parker knew from experience that it could take weeks to get an appointment with his primary care doctor. And since he worked in a non-union store in a right-to-work state, he had no union to turn to for support, leaving him to advocate for himself. “I told my boss that I wanted to apply for workers’ comp because the pain was not stopping,” he said. His manager told him that he would first have to call a “nurses’ line” about his injury.

The person who answered his call did not work for Parker’s employer or an insurance company. She was a representative from a third-party administrator, or TPA. Intermediaries between workers and employers, TPA firms play a large role in our healthcare system: About 60 percent of workers are covered by plans that partner with them. In Parker’s case, he was dealing with Gallagher Bassett, a subsidiary of Arthur J. Gallagher and Co., a global insurance brokerage and risk-management firm that handles liability claims for companies from retailers to healthcare providers to educational institutions.

The Gallagher Bassett representative told Parker that she did not think he needed to see a doctor. When he insisted on being checked out by a physician, she said that the clinic the firm preferred to send workers to was closed on the weekend. Could he wait until Monday? When Parker refused to delay his care, Gallagher Bassett issued a temporary insurance card that allowed him to seek treatment at an urgent care facility.

Gallagher Bassett declined to be interviewed for this article. In an e-mail, a spokesperson for the company explained that she could not answer questions unless I provided the name of the employee and the name of his employer.

The day Parker injured his back, he became one of the 2 million employees per year who get hurt or become ill on the job. He was never formally diagnosed with a musculoskeletal disorder. But MSDs caused by excessive lifting, bending, and repetitive motion are among the most common workplace injuries. Accounting for about three-quarters of injuries in the retail industry, they can lead to chronic pain and long-term debilitation.

Parker’s experience trying to apply for paid leave coincided with a rollback in worker protections at the federal level. This year, Senator Elizabeth Warren and five colleagues announced an investigation into the Trump Labor Department, reporting a sharp drop in inspections by the Occupational Safey and Health Administration (OSHA) and 42 percent fewer fines in 2025 than in the prior year. They accused the administration of using the language of “workers first” to pursue a deregulatory agenda and pressed the Labor Department for information about the declines.

I spoke to Debbie Berkowitz, a worker safety and policy expert and former senior OSHA adviser about the current state of workplace safety regulation. She told me that OSHA has never been fully funded and is under constant attack by business interests because “companies don’t want to be regulated.” The agency has had “no power to do things quickly” and has “fewer inspectors now than under Ronald Reagan.” It is also hampered by a lengthy rulemaking process that means it could take 10 years to write a regulation.

Berkowitz stated that OSHA has long known about the dangers of MSDs in industries such as retail and meatpacking. “It was clear that repetitive motion causes disorders,” she said. During the Clinton administration, officials tried to “address the rising tide” of injuries by issuing a rule, or “ergonomic standard,” that would require employers to identify MSDs in injury reports. “It’s just record keeping,” she said. “It wouldn’t have cost [employers] anything.” The agency “finally issued a rule right before George W. Bush became president.”

But employers lobbied Congress to eliminate the ergonomic standard. The effort was spearheaded by Eugene Scalia, an attorney and the son of former Supreme Court Justice Antonin Scalia. In 2001, Congress overturned the rule using the Congressional Review Act, a 1996 law signed by Bill Clinton that gave lawmakers the authority to repeal federal regulations.

OSHA tried to reinstate the rule during the Obama administration. This time, officials received pushback from the Office of Management and Budget. “They were all for just burying it, for not focusing attention on MSDs,” said Berkowitz. The result is an understaffed, patchwork system. “It would take the agency 160 years to inspect every workplace.” Jordan Barab told me that right-wing attacks have also weakened OSHA’s ability to protect workers. As deputy assistant secretary of labor at OSHA from 2009 to 2017, Barab worked on employee safety policies, including the ergonomic standard. “Republicans don’t like anything having to do with OSHA or ergonomics,” he told me. “It’s part of Republican ideology.”

But Barab notes that Democrats are also at fault. Obama’s election was a missed opportunity to put the ergonomic standard back on the national agenda. “We could not get it through the Obama White House,” he said. “It was also ignored and forgotten about during the Biden administration.” When I asked Barab why the agency was stymied by the party that claims to care about workers, he told me that Democrats were “reluctant to reignite any partisan fires.”

More recently, Trump’s administration has targeted OSHA. In 2025, the Department of Government Efficiency (DOGE) eliminated the National Institute of Occupational Health and Safety, the OSHA research institute that had spearheaded the agency’s attempt to regulate MSDs. (The attack came in the wake of a series of safety violations by OSHA at the Boring Company and Space X, entities owned by former DOGE chief Elon Musk.)

And last year, the Trump administration removed from the federal register the proposed rule to require employers to track and record MSD injuries. Trump’s people are “trying to clear the shelves of any regulations or standards that they don’t intend to push forward,” Barab said. The move effectively eliminated MSDs from the regulatory agenda.

This was the regulatory environment in which Parker picked up that box of cauliflower. At urgent care, he received an X-ray and pain medication and was advised not to lift heavy objects. Since lifting was part of his job, he asked if urgent care could help him file paperwork for a workers’ compensation claim. He was told that only primary care doctors could do that. Instead, providers gave him a note recommending four days off. But his store manager would not accept the note, telling him that it “didn’t mean anything.”

his was the regulatory environment in which Parker picked up that box of cauliflower. At urgent care, he received an X-ray and pain medication and was advised not to lift heavy objects. Since lifting was part of his job, he asked if urgent care could help him file paperwork for a workers’ compensation claim. He was told that only primary care doctors could do that. Instead, providers gave him a note recommending four days off. But his store manager would not accept the note, telling him that it “didn’t mean anything.”