TOPEKA — About 60 movers and shakers from the health-care and insurance industries met today and agreed to go forward with their planning for a Kansas health insurance exchange.

Made clear before the meeting ended was their general disappointment in Gov. Sam Brownback's recent decision to reject a $31.5 million federal grant to help develop the exchange. But whether that frustration kindles enough political heat to warm the cold feet of the governor and many conservative state legislators remains to be seen.

Dangling question

When one member of the group - attorney Jeff Ellis - asked the others point blank if they would be willing to join in lobbying lawmakers to pass the legislation needed to advance a state-run exchange, the twice-posed question was left dangling.

Ellis after the meeting said he thought the group members might come around to the idea once they've got something closer to a fully-fleshed exchange plan to take to the Legislature.

"I think there's potential for that," he said. "Selling a plan they believe in, hopefully stakeholders will do that."

Seated at the large horseshoe of tables in a hotel conference room were representatives of the state's biggest health insurance companies, leading medical providers, heads of most of the state's major health foundations and the chief lobbyist for the Kansas Medical Society. In short, it was a group that in less politically polarized times could be expected to have significant clout on an issue of this nature, or at very least be able to get a solid hearing from legislators in both chambers.

"Very pessimistic"

But some members of the group wondered aloud whether the Legislature, particularly the House of Representatives, would even consider recommendations they might offer.

"I'm very pessimistic," said former Attorney General Bob Stephan. "I'm very doubtful the governor will change his mind about the exchange and I don't believe the House of Representatives is going to be in favor of an exchange."

There were only a few legislators present and none responded or commented to the group.

Rep. Peggy Mast, an Emporia Republican, after the meeting told KHI News Service that there are "huge questions" on the minds of legislators. Among the concerns, she said, were whether the health reform law was constitutional, enforceable or economically sustainable.

"And then there's the changing political environment and the question of what do Kansans really want," she said.

Default to feds?

But Insurance Commissioner Sandy Praeger told the group that the Affordable Care Act, for now at least, remains the law of the land and the real question before members and state policymakers was whether Kansas would run its own exchange or default to the federal government.

Under the reform law, states that don't develop their own exchanges and have them ready to go by January 2014 will have them anyway, but they will be operated by the federal government.

Praeger told the group that five of seven states awarded federal "innovator" grants to develop exchanges that could be possible models for other states were moving forward with them, including Wisconsin where Republican Gov. Scott Walker and the state's Republican insurance commissioner have found a home for the effort in the Office of Free Market Health Care.

At least 15 states, she said, had enacted exchange legislation and were moving forward. And more than a dozen states have received "open-ended" establishment grants from the feds to launch exchange operations.

Too soon to quit

By the end of the meeting the group had agreed to continue its work, which was mostly expected. The same decision was reached last week at a smaller meeting attended by chairmen of the various planning work groups.

The work groups together include more than 120 people and have been meeting since earlier this year after it became known Kansas was in line for the innovator grant subsequently turned back by the governor in a surprise announcement earlier this month. That development threatened to derail the planning effort, but today's meeting demonstrated it remains on track.

Praeger and others said at very least the information developed could be shared with federal officials in the event they operate a Kansas exchange. And some member group members held out hope that the governor and Legislature could be persuaded that a state-run exchange should be developed.

"It think it is too early to throw in the towel," said Linda Brantner, chief executive of Delta Dental of Kansas.

In other action:

Brenda Sharpe, chief executive of the REACH Healthcare Foundation, told fellow group members that state officials shouldn't expect the health foundations to pick up costs of developing an exchange, as some have suggested might happen.

She said her foundation was already throwing support to overly stressed safety-net clinics.

"We are not going to direct our funds to supplant money that was accepted and then rejected," she said. "Kansans pay federal taxes, too, and I want those dollars coming back to my state not going to some other state."

Carolyn Smith, director of public policy for Wichita-based Via Christi Health, the state's largest health care provider, updated the members on plans being developed by her work group to "educate" the public about the exchange and how it would work.

She said the marketing research had shown that about 240,000 currently uninsured Kansans likely would get insurance through the exchange as a result of the health reform's expansion of Medicaid eligibility.

She said the counties where the most people would benefit or gain coverage were Sedgwick, Johnson, Wyandotte, Shawnee, Douglas and Riley.

"I'm not going to predict the future," Smith said. "But I do know that if there is to be an exchange, it needs to be a Kansas exchange and it's our responsibility to educate the public."