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

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

“Employer provision of sick pay and private disability insurance is fairly sparse, and public disability insurance is available only after a lengthy application and approval process,” the study authors mention.

Of course, those the study examined who lacked insurance had greater problems. They incurred an average debt of $6,200 as a result of the hospitalization.

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