The Affordable Care Act, like the state’s 2006 health law, is designed in large part to relieve American families of burdensome medical bills. In Massachusetts, however, the latest data show there has not been much of a change in the number of people with medical debt or the amount of debt they are carrying.

One in five people reported having medical debt in fall 2010, according to a Blue Cross Blue Shield of Massachusetts Foundation report. More than half of those surveyed said they owed money to a hospital.

For a story in today’s Globe, I talked with attorneys from Health Law Advocates, who have worked with hundreds of people in recent years who have debt troubles. Executive Director Matt Selig said assistance programs available through the state safety net or from hospitals directly are “underused.”

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Tim Gens, executive vice president of the Massachusetts Hospital Association, in an interview, said that his group is willing to talk with advocates about problem cases, but the state has “a very strong, well-tested system.”

“What we want to do is make sure we maintain the integrity,” Gens said.

The two groups may not have a lot of common ground on the issue, but they met monthly for the first half of this year. They issued this joint statement late last week:

Health Law Advocates (HLA) and the Massachusetts Hospital Association (MHA) agree that despite a broad array of patient protections, there are patients in Massachusetts who still need assistance with large medical debt that they may be unable to pay. It is in these cases that groups like the MHA and HLA have been working closely to try and identify the reasons why medical debt occurs so that current systems can be reformed. Reforms that MHA and HLA are exploring include creating better educational resources for patients and providers, and identifying and correcting gaps in the current system of enrolling patients in public assistance programs.

Changes in the health care system such as higher co-insurance and deductibles and limits on enrollment periods for the Health Safety Net program have contributed to the problem of medical debt. And, medical debt is not limited to patients in hospitals. However, there is a unique opportunity to address hospital medical debt because there are state programs designed to pay for a portion of hospital services, including co-insurance and deductibles, for many but not all low-income patients who fall through the cracks. In fact, hospitals help fund the health care safety net with more than 285 million annually. The process of implementing the Affordable Care Act in Massachusetts presents an excellent chance to adopt reforms that will reduce the impact of medical debt on patients and the financial strain on hospitals.