Total shoulder arthroplasty (TSA) is an effective procedure to improve symptoms, function, and quality of life for patients with different clinical conditions that affect the shoulder. TSA use has been increasing in the United States, but whether the short-term and longterm beneficial effects extend to all recipients is less clear. In this issue of The Journal, research by Singh and Cleveland adds to the growing body of literature evaluating the link between socioeconomic status (including insurance and income status) and postsurgical outcomes in patients with TSA. In this study, the authors conclude that public insurance, such as Medicaid and Medicare, were independently associated with more healthcare use (e.g., length of hospitalization and discharge to rehabilitation facilities) and suboptimal clinical outcomes, whereas lower income status was associated with less healthcare use and fewer postsurgical complications after TSA. The findings run counter to their hypothesis.