In Georgia’s Gwinnett County where Republicans rule, few really love Obamacare. Few want to lose it either.

In parts of the county, about 1 in 8 people get insurance from the federal health-care program, making Gwinnett, near Atlanta, one of the biggest per capita users of the Affordable Care Act. The coverage is advertised in road signs along busy Jimmy Carter Boulevard near Lilburn. It’s the reason enrollment has dropped at low-cost clinics in Snellville and Norcross. It’s seeped into the Asian, Latino and African immigrant communities, becoming a mainstay for retail workers, contractors and the downsized.

As the U.S. Supreme Court prepares to rule on a case that could make Obamacare’s private insurance unaffordable in Georgia and at least 33 other states, Gwinnett, where all five of the county commissioners belong to the Republican Party that has been leading the fight against the health care law, illustrates how for many the program has become a fact of life. Obamacare is both groused about and accepted, like taxes and the weather.

“I couldn’t buy insurance for myself after my husband retired, not until Obamacare,” said Ghada Nadhan, 63, an assistant manager of a food store who immigrated from Syria more than two decades ago. “Now I am afraid.”

Now before the Supreme Court, theKing v. Burwell case threatens to make Obamacare unaffordable by ending federal subsidies that hold down premium costs based on income. A suit backed by conservative activists, citing a single phrase in the law, says those subsidies aren’t allowed in states that didn’t create their own health-care exchanges.Undermining Obamacare

Led by the free-market Cato Institute in Washington, those opponents helped persuade Republican governors not to form state-run exchanges, as a tactic for undermining Obamacare.

More than 13 million Americans could lose tax credits that help pay for insurance coverage by next year, according to the Kaiser Family Foundation in Menlo Park, California. Florida, Texas, North Carolina and Georgia, the states with the most to lose, received a combined $19 billion, according to a December report by Democratic staff of the House Energy and Commerce Committee.

All four states declined to create exchanges and could have spiraling premium increases if the court nixes their subsidies. In Georgia, premiums would rise 381 percent without the credits, according to a June 3 analysis by Kaiser.

“It’s not something that should be done based on a twisted interpretation of four words in, as we were reminded repeatedly, a couple-thousand-page piece of legislation,” President Barack Obama said Monday at a news briefing in Germany. “Part of what’s bizarre about this whole thing is we haven’t had a lot of conversation about the horrors of Obamacare because none of them have come to pass.”

In Gwinnett, attitudes about Obamacare depend a lot on subsidies, said Luis De La Rosa, an insurance salesman who advertises in a Hispanic part of Lilburn. He says ending the federal help would be a disaster.