Last month, Chappell Roan’s femininomenal year was capped with a Grammy win for Best New Artist in an especially strong field. As she’s done before with issues like transphobia and violence against Palestinians, Roan used the stage to speak passionately to a pressing problem:

“Record labels need to treat their artists as valuable employees with a livable wage and health insurance and protection,” she said. “Labels, we got you, but do you got us?”

Roan’s call was met with both enthusiasm and skepticism, and it begs the question: Could the change she called for actually happen?

A widely criticized op-ed piece in The Hollywood Reporter by successful music executive Jeff Rabhan called the 27-year-old “too green and too uninformed to be the agent of change,” and while offering a handful of concrete ideas, essentially stated that unless she was willing to invest her own money in the cause she was accomplishing little. (There’s something bleakly apropos about an insider with a history at major labels essentially saying, “You pay for it.”)

“Her statement brings the crises in the music industry into the context of the broader crises in the economy,” said Glennon Curran, co-owner of the Chicago indie label Sooper Records. “You only get a few minutes to talk on stage right at the Grammys, so Chappell didn’t have the time to deliver a sweeping analysis of the historical dynamics of capital and labor in the contemporary music economy. I think ‘labels’ was a shorthand way of pointing to this larger system.”

These calls for big industry shifts are not new. When superstar rapper Juice WRLD died from a fatal overdose in December 2019, some voices pushed for labels to provide addiction support and mental health counseling for their artists. Juice himself had raised similar concerns during his life: “I feel like some of these labels, they be pushing these artists damn near to the point of death,” he said in an interview. “[They’re] over-pushing them, overbooking them, [having them] walking around taking Adderall and all that other shit.”

Mental and physical healthcare in the music world has largely fallen to outside entities like MusiCares and Backline, non-profit organizations that support artists navigating issues like depression, addiction, and financial assistance caused by work-related injuries. Backline helps people receive care quickly, and teaches mental health professionals about the unique challenges of working with music industry professionals.

Theresa Wolters, Vice President Of Health & Human Services at MusiCares, explained that through their Wellness In Music survey, Musicares has determined that the rate of musicians with health insurance is close to the broader US population, “but so many people who work in music are undercovered in terms of their health insurance. They often have health insurance if they need catastrophic care, but not dental cleanings, vision [checkups], all of that preventive care that we want people to have access to.”

In his Hollywood Reporter essay, Rabhan wrote that the “whiny expectation that labels and/or publishers should be responsible for making sure artists function as fully formed adults is absurd and reeks of entitlement.” The problem there is that being an artist is not a normal job and asks more of you than most industries. You’re often encouraged to mine your most personal struggles and insecurities and perform them in front of progressively larger audiences. Everyone in the industry works non-traditional hours and deals with significant stress that differs from the usual 9-to-5. And whether you’re a singer with vocal damage or a venue employee with a pinched nerve from moving equipment, a physical toll is likely.

Recently, pro sports leagues in the US have invested in dedicated psychologists to help their athletes and staff deal with the tremendous stress of the profession in part because major stars have spoken frankly about their struggles with depression. Hollywood sets sometimes employ on-set therapists, and the newfound ubiquity of intimacy coordinators also speaks to creating a healthier industry with stronger safety nets.

There are obviously many major differences between the music industry and film or professional sports, but what might be the most relevant here is the disparity between union involvement, awareness, and influence. Organizations like the International Alliance of Theatrical Stage Employees (IATSE), the Writers Guild of America (WGA), and the players’ associations in the NFL, NBA, and MLB have robust membership, are well-funded, and receive widespread media coverage when they push for change. (In his essay critiquing Chappell Roan, Rabhan said that improving healthcare options for musicians “sounds like a union thing to me.”)

The Hollywood unions like the Screen Actors Guild–American Federation of Television and Radio Artists (SAG-AFTRA) are open to musicians who meet their membership criteria. Responding to Stereogum’s coverage of the Chappell Roan-Jeff Rabhan debate, Nirvana’s Krist Novoselic tweeted that he and his bandmates joined SAG at the suggestion of their accountant once they’d signed to Universal Music Group subsidiary DGC. As a result, “I have had great health insurance for 35 years,” Novoselic wrote.

When Nirvana signed with a major label, our accountant suggested we join @sagaftra. We did and I have had great health insurance for 35 years. — Krist https://t.co/IsBAO4onWk

— Nirvana (@Nirvana) February 7, 2025

SAG-AFTRA membership is not available to just any musician, though. “Last year, I was having this conversation with my manager and he was like, ‘A couple of the bands I’ve worked with have played on late night [TV] and if you play on late night, you can get a SAG card and get health insurance through SAG,'” said Jilian Medford of the acclaimed indie project Ian Sweet. “You can get it through SAG as a musician, but not through your own avenue. It’s this very backwards system.”

Music-specific unions do exist — the American Federation of Musicians has been around for more than 100 years, and new ones like United Musicians and Allied Workers are being created — but there’s a lack of awareness and, with that, reduced power. Unlike SAG-AFTRA or the Director’s Guild, which feature A-listers, the music organizations are more filled with working-class performers and behind-the-scenes folks who don’t have that PR power. Most importantly, Hollywood workers are able to organize collective action around key industry issues, recently the SAG-AFTRA and WGA strike in 2023 that focused on streaming royalties and the encroachment of AI in their fields. These strikes had headline-generating figures like Jack Black, Colin Farrell, and Octavia Spencer out on the picket line demanding change.

To Curran, grappling with issues on this scale necessitates “a more revolutionary approach, not a reformist approach.” As he put it, “Traditionally, the only thing that you really have at that scale is withholding labor.”

We’re in a bleak but necessary moment for collective action, even if it will likely be met with resistance by the current administration. Legislation like the Protect Working Musicians Act and antitrust efforts against companies like Live Nation are unlikely to develop major congressional backing during a second Trump term. (The new administration is expected to roll back legislation that aided independent contractors, which musicians and industry professionals tend to be.)

According to the Kaiser Family Foundation, which specializes in public research around health information, as of 2023 the average business was paying a little over $7,000 annually for individual employee insurance, and more than $17,000 for families, with a projected 6% increase in costs for 2025. It’s easy to see why record labels, which in many ways operate like venture capital firms, would balk at this. To put it simply, when a label signs an artist, they offer an advance and their services in exchange for a significant cut of the musician’s royalties and frequently their masters. With indie labels, the exact terms of the deals can be more artist-friendly, but that doesn’t mean they’re offering health coverage. Data illustrates that small businesses in general are offering insurance at lower rates than they were in previous decades.

They’re never guaranteed a certain return on a signee, a point that Rabhan emphasized in his piece, though that’s not egregiously different from the risk in hiring a new employee who may not be a proper fit for a role. Many companies have a buffer period between 30 and 90 days (the Affordable Care Act’s PHS Act forbids businesses from extending the wait past three months). Perhaps there’s a way to incorporate that idea into music – using releases would be too volatile, but a number of submitted songs moving you from independent contractor to full employee status.

There’s no denying that Chappell Roan has changed the momentum around the conversation on healthcare in the music industry. Backline Co-Founder and Executive Director Hilary Gleason called the ensuing stretch the “craziest week of my life,” as the nonprofit’s “We Got You” campaign received $25,000 donations from Roan, Sabrina Carpenter, Charli XCX, Noah Kahan, and other music entities like AEG, Live Nation, and Sumerian Records.

“I think what is happening right now is the flowers [blooming] from the seeds we’ve been planting over the past five and a half years,” Gleason said.

But unsurprisingly, some musicians are skeptical about the industry’s desire to really make these seismic changes despite the rhetoric of the moment. Lillie West of the band Lala Lala has a great relationship with her label Hardly Art, but said she long ago accepted that a label would not provide her with insurance, and that most musicians in her orbit think similarly. She encourages this conversation and “would like to believe that anything can happen,” but is careful about believing in a sea change.

“When Chappell Roan said that I thought, ‘That would be great,'” West explained. “And then I see – I’m not going to name names – but a label tweeting, ‘It’s not a radical idea. Labels should be giving all their health insurance,’ and I know that label doesn’t do it.”

Ian Sweet’s Medford has been signed to prominent indie labels since 2016, but because of the present financial climate, currently works full-time as a music teacher for kids. (Six years ago, Vulture asked 17 successful indie artists about the side gigs they did to make ends meet, including everything from truck driving to barista work to digital marketing for a major airline.) Like West, Medford said she has a positive relationship with her label, Polyvinyl, but also acknowledged, “I’ve never had any sort of health insurance or mental health services recommended or provided or even helped with my entire 10 to 12 years of doing this.”

Medford stressed another crucial point in these debates: Artists are sort of their own cottage industries and hold up a musical ecosystem around them including touring musicians, producers, managers, and others. “Even if you’re a small artist, you’re still the backbone of this industry in some way. And this industry runs on that, especially because so many small artists do so many things for much less money,” she said.

That colossal pressure makes it hard for performers to cancel shows when they’re ill, or take extended time to deal with a mental or physical health issue. In 2019, Medford entered inpatient mental health treatment but was also midway through completing an album. Suddenly, every moment outside of the demanding therapy schedule was devoted to finishing that album.

“It wasn’t like anyone was banging the hammer, [saying] ‘Get this done,’ but time is money in this industry,” she said. “If you don’t put out constant content, are people going to forget you exist?”

Despite justifiable skepticism from different corners of the music world, now does seem like a smart moment to call for changes. The industry just saw its ninth consecutive year of revenue growth in 2023, per Billboard, up to $28.6 billion. Breaking that revenue down further, the majority of it comes from streaming and largely goes to the label entity itself, with smaller artists often receiving far more meager percentages than established stars on their second or third deals. (This is a situation where theoretically artists like Roan could do the kinds of things Rabhan suggests and use their money and leverage to create funds assisting smaller musicians, although that again takes the onus off of the labels and puts it on the creatives.)

“There already is a major difference between the indie label system and the major label system. Deals are structured differently,” Curran said. “Indies usually have a 50-50 net profit split as opposed to a more traditional major label royalty points system. So there’s already, at least in theory, a more equitable sort of structure.”

Wolters says that MusiCares, which has been part of the Recording Academy since 1993, conducts regular informational sessions with labels and other music businesses to educate them about the resources that exist for industry professionals. The music healthcare experts we spoke to were hesitant to state that Chappell Roan’s vision for the industry is realistically attainable, but as people who care about the welfare of creatives, they all see this moment as a watershed one.

“How I interpret her comments is more that the ideas aren’t new, but what was new and courageous about it was where she said it,” Curran explained. “She said it in their house while they were all there.”