Louisville Magazine

AUG 2017

Louisville Magazine is Louisville's city magazine, covering Louisville people, lifestyles, politics, sports, restaurants, entertainment and homes. Includes a monthly calendar of events.

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72 LOUISVILLE MAGAZINE 8.17 Equity Report," which he says "changed his life." It showed that life expectancy in many west Louisville neighborhoods was just 68 years old, 15 years fewer than the life expectancy in east Louisville. Upon studying page 21 of the report, Imburgia grew even more unsettled. In the California/Parkland neighbor- hoods, there were 341 deaths related to heart disease per 100,000 people between 2006 and 2010. Port- land tallied 327 per 100,000 people. e numbers were lower in the more affluent, eastern part of the map. St. Matthews, for example, showed 120 heart disease deaths per 100,000 people for that same time frame. Imburgia decided he had to move his free services into a space downtown. A bus ride to his St. Mat- thews clinic took at least one hour from south and west Louisville. (Most of Imburgia's 140 patients in 2016 came from south Louisville.) He determined many people who needed his help probably wouldn't or couldn't make that trek. So in early 2017, Have a Heart moved to a rented space, a former dermatology office on East Broadway. Since the move, Imburgia says, patient volume has swelled by 75 percent. Imburgia is a calm presence, friendly and person- able. Get him talking about the health-equity report and those qualities dim slightly, a visible, earnest irritation scratching at the surface, eyebrows furrow- ing and exasperated sighs escaping between thoughts. "e disparity, it should be an embarrassment for this country," Imburgia says. "It's not OK to have people in our country live 15 years less purely because of the situation they are born in. It's OK to have a nice car, a nicer house. But is it really ethically OK to have people die sooner?" As the clock nears 9 in the morning, the Have a Heart Clinic bustles. Nurses and front-office staff busy themselves with paperwork. Large take- out cups of soda collect on a counter. "What's my password again?" the clinic's other volunteer cardiol- ogist hollers as he logs into his computer. e clinic is professional, familiar, a standard medical landscape — six exams rooms, pleasant artwork in the hallway of Louisville neighborhoods, a lobby with cushioned chairs, magazines and a kids' corner. Imburgia calls to the volunteer translator — "Ma- ria, can you help?" — as he heads to one of his first patients of the day. ey greet a Hispanic man in his 30s dressed in a ball cap and jeans. e man sits with his legs crossed at the ankles, nervously shaking one foot. "I like your work boots," Imburgia says after greeting him. "Gracias," replies the man, who was referred to Imburgia from a free healthcare clinic run out of the basement of a Catholic church. Imburgia jots notes as his patient relays symptoms — pain that bursts into one arm, then spills across his chest into his other arm. "When's the last time he had it?" Imburgia asks the translator. "It started three days ago and (he) still has it now," she responds. Like nearly all of Have a Heart's patients, the man lacks insurance. e Affordable Care Act, better known as Obamacare, helped fill gaps in insurance coverage. In 2013, the year before the ACA went into effect, 43 million Americans lacked coverage. By 2015, that number was down to 28 million. As of 2016 more than 30 states, including Kentucky, expanded their Medicaid coverage to include adults with an income at or below 138 percent of the federal poverty line. (at comes out to about $16,000 for an individual, $33,500 for a family of four.) With the expansion, Kentucky's uninsured rate plummeted — from nearly 19 percent to 7 percent. Still, low-income individuals and minorities con- tinue to lack insurance at high rates. Imburgia says many immigrants don't qualify for Obamacare because they have not been in the United States long enough. Also, some of his patients fall just above the income guidelines. "We see a lot of people at 200 percent of the poverty level," Imburgia says. For that group, em- ployers often don't offer insurance and patients simply can't afford the premiums offered through the ACA Marketplace, even with the tax credits that Obamacare has made available to cushion the cost. (According to the Kaiser Family Foundation, in 2016 40 percent of people with ACA Marketplace coverage said they were dissatisfied with their monthly premium and 46 percent were dissatisfied with their deductible.) Imburgia listens to the man's heart with a stetho- scope. "Has he ever been told he had a heart murmur?" he says to the translator. "No," the man replies quietly. He's lucky to have found medical care. More than half of uninsured Americans skip preventative services because they don't have someplace to go. Medicaid re- cipients face a different challenge, Imburgia says. ey may have access to a primary-care doctor, but special- ists, like cardiologists, often deny Medicaid. "Medicaid is the worst-paying insurer out there," says Imburgia, adding that providers may also have another motive for avoiding this population. "ese people have a lot of issues. Not that they asked for them. But I think a lot of providers don't want to deal with those compli- cated patients." In about an hour, Imburgia will see a middle-aged woman battling addiction, depression and homelessness. With tears in her eyes, she'll report that she's often so exhausted it's a struggle to breathe. Her arms ache. Her legs throb. Imburgia will run some tests. Her heart function will look normal. So he will "It's not OK to have people in our country live 15 years less purely because of the situation they are born in. It's OK to have a nice car, a nicer house. But is it really ethically OK to have people die sooner?"

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