Millions of hard-working Americans leave the labor force every year, at least temporarily, because of injury or illness. Without steady earnings, these workers and their families often end up in public programs such as Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid. The public sector could help reduce the steep costs to state and federal governments by adopting strategies to help people stay at or return to work, rather than fall through the cracks of a fragmented system.