Tennessee has one of the least healthy populations in the country, a problem its Republican governor tried to address by expanding Medicaid. It was rejected, and insurers have raised their rates.

ROBERT SIEGEL, HOST:

Republican voters have been vocal. They want to see the Affordable Care Act repealed. Well, now that it appears to be happening, some of those voters have a different message to Congress – delay. Chas Sisk of member station WPLN in Nashville explains why many people in Tennessee want to go slow.

CHAS SISK, BYLINE: It seemed like a risk worth taking. Cindi Malone, a real estate agent just outside Nashville, has diabetes. And before the Affordable Care Act, she spent $1,700 a month on health care coverage for her family.

CINDI MALONE: That’s a lot of money, a lot of money for anybody.

SISK: Malone had doubts Obamacare would work, but moving to an ACA plan cut their premiums by a thousand bucks a month, so they made the leap three years ago. Those savings didn’t last, and this year she faced premiums higher than before the ACA because her income was too much to qualify for a subsidy.

Malone dropped out and bought a plan that wasn’t part of the exchange. It’s what she could afford even though the plan falls short of ACA standards and comes with a tax penalty up to $3,000. That’s what galls her the most.

MALONE: Just because I have insurance and you don’t like it, how can you penalize me? That makes no sense to me.

SISK: But the email Malone wrote to her congressman might be the most surprising part. It said if you’re going to repeal Obamacare, don’t go too fast. Wait. Get it right.

MALONE: And I am for repealing, but it’s not as easy as waking up this morning and wiping it out because there are people like me.

SISK: Tennesseans are among the least healthy people in the country with high rates of smoking, obesity and diabetes. That’s part of why the state’s insurance regulators last year approved the dramatically higher premiums people like Malone face. Regulators let the rates get so high because they were worried providers would pull out of Tennessee altogether.

And Republican Governor Bill Haslam’s plan to expand Medicaid, which might have taken pressure off insurers, was voted down by the state legislature. So now it’s on Tennessee’s members of Congress to find an answer, and at least some of those Republican lawmakers seem to be listening. Tennessee Senator Lamar Alexander gave a speech to urge caution.

(SOUNDBITE OF ARCHIVED RECORDING)

LAMAR ALEXANDER: Obamacare should be repealed, finally, only when there are concrete, practical reforms in place that give every American access to truly affordable healthcare.

SISK: Alexander’s views are important. He’s the chairman of the Senate’s health committee. That puts him in a position to steer the debate over repeal and replacement. Moving slowly sounds like a good approach to Sherry Cothran. She’s a Methodist minister in Nashville.

SHERRY COTHRAN: I just see a lot of at-risk people who feel very abandoned by the system.

SISK: Cothran is part of a group of ministers urging Republicans in Congress to have a plan in place before they repeal the law. She knows other forces are at work. Groups that have tried for years to reverse the Affordable Care Act can now sense victory. But she says a path can be found that preserves coverage for vulnerable Tennesseans.

COTHRAN: We want to see all of our political representatives on both sides of the aisle look at human dignity and look at our moral responsibility to people in general and put that before politics.

SISK: Cothran believes congressional Republicans are saying the right things about replacing Obamacare. The question on many Tennesseans’ minds is whether those words will translate into policies that protect them as the ACA is repealed. For NPR News, I’m Chas Sisk in Nashville.

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