The first (and last) thing you notice about Amy Dowd is her smile. Tasked with one of the hardest jobs in Idaho, the executive director of Your Health Idaho--the Gem State's health care exchange--Dowd, more often than not, is usually smiling.
"Anyone involved in a change of this magnitude is doing very important work," she said. "When the Affordable Care Act came out, I always thought that the exchanges could change the landscape. It's very energizing to be a part of a change of this nature."
Dowd and her Your Health Idaho team's long days and nights have been made that much longer by the federal-based exchange, the plagued website shackled to Idaho's Web portal for at least another year.
"Our goal, right now, is to open the doors of our own marketplace to Idahoans starting in January 2015, and we expect that it will happen by the end of next year," said Dowd. "It's an aggressive timeline."
Boise Weekly had a rare opportunity to sit down with Dowd to have a wide-ranging dialogue about her team, focus and what it's like to be the most prominent face of the Affordable Care Act in Idaho.
How ready was the Your Health Idaho team to throw the switch on Oct. 1?
We actually opened the doors to our call center a week early. We had hoped that federal technology would have worked better than it has.
For the record, how much does Idaho lean on the federal system?
For the first year, Idaho is completely reliant on the federal technology for the application and enrollment process. We have our own website that provides a lot of resources and tools, but ultimately, our website is a portal link into the federal system.
Did you always expect to depend on the federal website in year one?
When you look at the timeframe of when the exchange-enabling legislation was passed by the  Idaho Legislature, there really wasn't sufficient time to form a board, hire a team and do a full-fledged technology procurement.
But can you appreciate that an Idaho user doesn't really differentiate what the state does on its website from the federal website?
Our hope was that it would have been a streamlined process. The challenge is that the federal platform hasn't been working.
And how much flak have you taken because of that?
We're the face of the exchange in Idaho; that's a fair assumption. What we've done is create tools and resources to help people with as much of the process as possible so that once the federal site is working, Idahoans are more ready to make a selection and enroll.
But the burden still remains on Idahoans to continually check back until the federal site is running 24/7.
Yes; right now the enrollment process end-to-end is hit or miss. But we know that Idahoans are enrolling. [YourHealthIdaho.org tracked 70,000 unique visitors since Oct. 1; 4,753 applications were completed in the first month of operation and 338 Idahoans selected a plan from an Idaho carrier].
What do these numbers tell you?
That people are very interested in the marketplace. When you consider that there are just over 200,000 uninsured Idahoans, there's a very big appetite to learn more.
If the federal exchange is not running full-tilt by Christmas, are you prepared for your job to get more difficult?
This is a marathon, not a sprint. Unfortunately, we're heavily reliant on the federal system. Yes, we believe that the federal platform will improve over time, but our focus is to get the Idaho technology up and running. And that's a big enough task.
Are you able to brush away the politics from all of this?
Politics play an important role in what we're doing so, no, we certainly can't ignore it. But we have to stay focused on what the Idaho legislation is guiding us to do.
I'm presuming that there's a fair amount of thanklessness in your job.
The stories I hear from our front line--our call center--really hit home. We're hearing from people who had previously been denied coverage, or they thought they could never afford insurance in the first place. We have a lot of change ahead.