Having insurance is one thing. Being able to pay for a hospitalbill is a whole other thing.

Three years after the implementation of the Patient Protectionand Affordable Care Act (PPACA), the uninsured rate has dropped tojust above 10 percent, but a far greater proportion of Americansstill find basic health care unaffordable.

A recent study published in the National Bureau of EconomicResearch analyzing the credit score ratings of over 1 millionpatients from 2003 to 2007 showcases the dramatic financial effect thata single hospitalization inflicts on the insured and uninsuredalike.

The study focuses on those who were subjected to a somewhatisolated, unanticipated Emergency Roomvisit, so it only included people who had not beenhospitalized in the past three years. It also excludedpregnancies.

Adults aged 50 to 64 with insurance can expect theirout-of-pocket medical expenses to increase by an average of $1,000every year after a trip to the ER. Worse still, their averageannual incomes drop by $7,000 because of missed work or jobloss.

As The Washington Post notes, the loss of income due isone of the most obvious financial consequences of medical problems,but it’s not even addressed by the American system of privateinsurance. In many other Western countries, taxpayers fundstate-run medical leave that takes care of people while they areoff the job recovering from injury or illness.

“Employer provision of sick pay and private disability insuranceis fairly sparse, and public disability insurance is available onlyafter a lengthy application and approval process,” the studyauthors mention.

Of course, those the study examined who lacked insurance hadgreater problems. They incurred an average debt of $6,200 as aresult of the hospitalization.

While increasing insurance access will likely help reduce thenumber of people crushed by unpaid medical bills, health care debtis a big problem that is here to stay for the foreseeable future.Even if the country attained universal insurance coverage, millionsof Americans, including many with Obamacare policies, will remaincovered by policies with high deductibles that they can’t pay whenthe time comes.