HIALEAH, Fla. — The unlikely epicenter of Obamacare lies in a solidly Republican working-class town just 10 miles outside the Miami stomping grounds of Jeb Bush and Marco Rubio.

The city of Hialeah — a Cuban-American neighborhood of Spanish speakers that is blanketed with Obamacare advertisements — enrolled more people under the Affordable Care Act than anywhere else in the country.


That coverage is now at risk. The Supreme Court this month will decide whether Obamacare’s tax subsidies can go to people in 34 states, such as Florida, that did not set up their own health insurance exchanges. Hialeah brings to the fore the political consequences for the GOP if some 6.4 million people — including the reliably Republican voters here — suddenly lose their health insurance subsidies this summer.

“There’s a lot of folks who took advantage of the marketplace and are now potentially going to be impacted tremendously by the case if it goes the other way,” said Nicholas Duran, the Florida state director for Enroll America, a White House-aligned nonprofit that helped create the sign-up momentum in this state.

Neither the Republican lawmakers who represent this community in Congress nor the national GOP have decided whether or how to respond if the court cuts off the subsidies and voters blame them for millions becoming uninsured. Some Republicans favor restoring the subsidies — if they can repeal big parts of the health care law. Other conservatives want to ride out the political consequences by promising to build a new and better health care law on the wreckage of Obamacare.

Florida was a top target for Obamacare advocates, who ran an exceptionally strong outreach and enrollment campaign here. About 1.4 million people now have coverage in Florida — more than in any other state. And 93 percent of them got subsidies, higher than the national average. South Florida was particularly fertile ground; the top 15 ZIP codes for enrollment all run from Miami to Fort Lauderdale.

Hialeah beat them all. More than 52,000 people signed up in the five ZIP codes that make up most of Hialeah — 15,000 in one ZIP code alone, the top enrollment ZIP code in the country.

“Everywhere you went, it was, ‘Obamacare! Sign up for Obamacare, get a free beach ball!’” said Rep. Ileana Ros-Lehtinen, a Republican who represents part of Hialeah, and who, like all congressional Republicans, has voted repeatedly to repeal part or all of Obamacare.

The promotion, she said, was “really intense.”

Ariel Quintana, a 22-year-old Cuban-American, is one of the Hialeah residents who was happy to sign up. He likes the financial and health security. Plus the price was right — $83 for him, with an approximately $150 subsidy, per month.

But Quintana, who said he didn’t know anything about the Supreme Court case that could end his subsidy as soon as this summer, said he would likely drop his coverage if he had to pay for it all himself.

“To be honest, at my age, being a healthy person, I wouldn’t do it,” he said in Spanish, adding that most of his friends and family who have bought Obamacare plans like them.

Quintana and his neighbors in Hialeah are an unlikely juggernaut of Obamacare. The town of 233,000 people voted for Mitt Romney in 2012 and Marco Rubio in 2010. It’s a Republican stronghold in the more Democratic Miami-Dade County.

“Historically, Hialeah has tended to be very Republican and very anti-government programs, so with Obamacare, you can imagine those kind of messages would be received negatively,” said Duran. “But when folks begin to get the facts of what is Obamacare, focusing in on the messages about [coverage for people with pre-existing conditions and financial security], it helped Obamacare bubble to the top.”

Drive down any street in Hialeah today, and it’s hard to not run into a sign advertising “Obamacare” and displaying the Obama campaign’s signature “O” with a sunrise — even though the regular 2015 enrollment season is over and the next one won’t start until November. Health centers have hung banners. Insurance brokers — tucked in strip malls between Cuban restaurants and check cashing centers — hawk Obamacare in their storefronts. Signs tout “Obamacare aqui” and “Obamacare enroll here.”

The need here was great. As of 2013, about 37 percent of Hialeah residents were uninsured, according to census figures. Just as many were on public insurance, either through Medicare or Medicaid. Only about one quarter of Hialeah residents reported having insurance coverage through a job.

Maria Azqueta, a 52-year-old Miami resident who works at Citrus Health Network in Hialeah, said most people have separated the politics of the law from the insurance it provides.

“I hope, I think, that outside of the political side of things, this idea of health care for everyone is a good idea,” Azqueta, who signed up for a plan under Obamacare, said in Spanish in her small office at Citrus, where she promotes cancer screenings among the uninsured and underinsured. “It seems to me like a good idea for people who work as well as people who don’t work, because we all have the right in a country this free with rights [that] everyone has a right to access to health care.”

All that could change soon.

If the Supreme Court rules against the White House, about two-thirds of people who are receiving subsidies would drop their health care coverage, according to an estimate by the Urban Institute. The people most at risk of losing subsidies are predominantly Southern, white, employed and make modest incomes, according to the study. Those are the demographics of Southern Republican voters.

Pre-empting the political battle to come if the challengers win, Democrats have already said Republicans are to blame for backing the lawsuit and failing, so far, to put forth a workable plan to restore the subsidies.

Rep. Mario Diaz-Balart, a Republican who has represented part of Hialeah since 2003, is expecting Democrats to quickly introduce a bill to restore the subsidies.

“Here’s what Obama would do: The Democrats are going to say it just takes a one-page bill,” he said. “And that’s going to be the pressure” on Republicans.

He doesn’t want to see his constituents lose their health insurance, but he’s not ready to support a Democratic fix that he says would permanently entrench a “disastrous” law. Like most House Republicans, Diaz-Balart wants his party to have a “doctor-patient-centered” health plan ready to go in case the court upends the law.

Ros-Lehtinen wouldn’t say whether she would want to restore the subsidies if the court strikes them.

“We’ll have to see,” she said. “It’s always doomsday, but we’ll wait to see what the decision says and how they rule.”