Tennessee residents who are struggling to pay their medical bills are not alone. A study that appeared in the American Journal of Public Health found that illnesses and their associated costs contributed to around two-thirds of all bankruptcies.

According to the study’s lead author, more than half a million families face bankruptcy annually because of expenses related to illnesses. The study chose more than 900 people at random who filed for bankruptcy from 2013 to 2016. For more than 58 percent, medical bills were an issue while income loss from an inability to work due to the illness was an issue for more than 44 percent of debtors. For many respondents, both were factors.

The lead author also pointed out that having health insurance was not necessarily a protection against bankruptcy. Because of co-pays, deductibles and loopholes, insurance policies might not provide the necessary coverage. Roughly the same percentage of debtors filed for medical reasons before and after the Affordable Care Act was put in place. The study authors said this reflected the fact that while the ACA helped many poor families, middle class families might be less likely to be helped by it and more likely to file bankruptcy to help protect assets.

While a Chapter 13 bankruptcy may help a person protect assets such as a home, there are a number of reasons a person might want to file bankruptcy even without significant assets to protect. A Chapter 7 bankruptcy is generally for people who have a lower income. A person is still allowed to keep some assets when filing for Chapter 7, and filing will immediately stop creditor harassment. The medical bills can generally be discharged at the completion of the process, giving filers a fresh start.