The fate of President Obama's signature achievement, the Affordable Care Act (ACA), is in the hands of the nine Supreme Court justices.
People began lining up Friday for their chance to be in be inside the courtroom for the opportunity to see history unfold.
Justices kicked off arguments Monday by questioning whether it is too soon to even be hearing the case, as the key part of the law actually under fire--the individual mandate, which requires all Americans purchase insurance or pay a fine--does not take effect until 2014.
A little-known federal law known as the Anti-Injunction Act bars petitioners from asking for a tax refund until the tax has been collected and paid. If the justices agreed that the individual mandate falls under that law's jurisdiction, then the case could be rendered null until the mandate takes effect.
Most of the justices appeared reluctant to go that route, though Justice Samuel Alito and Chief Justice John Roberts agreed that a tax was involved in the case.
Lower courts have had mixed rulings on the individual mandate, with some ruling in favor of the mandate and others striking it down. One lower court rejected the mandate, but ruled that the rest of the law could stand.
The administration says the requirement that all citizens who can afford insurance purchase it is needed in order to implement a critical component of the ACA: that insurers cannot drop people with pre-existing conditions or raise premiums based on medical history.
The reasoning is that uninsured raise health care costs on everybody else, since they typically only seek care in emergencies. If they can't pay the cost of the treatment they receive, hospitals absorb the costs, then raise the costs of their services on those who are insured. This leads insurance companies to raise their premiums to cover their higher health care costs.
If compelled to do so, as they would be if the individual mandate stands, healthy individuals who might otherwise opt to remain uninsured would purchase insurance, allowing insurance companies to keep premiums low for everyone.
The U.S. Department of Health and Human Services say Americans making very low income who cannot afford insurance or those whose religious beliefs conflict with the mandate would not have to comply.
Opponents of the mandate say that if the law stands, Congress would be granted greater authority to dictate what Americans do with their lives.
Colorado Attorney General John Suthers likened the mandate to giving the government the authority to force citizens to buy energy-saving cars.
Suthers is one of the attorneys generals who organized the arguments for the 26 states involved.
“Yes, this [the millions uninsured] is a national problem, but that does not allow you [the federal government] to solve it by doing something unconstitutional. You have to solve problems within the confines of the Constitution, and the Constitution does not permit the government to order individual Americans to buy a specific product or service.”