With prayers, slogans and American flags, hundreds turned out Monday to protest noisily for and against President Barack Obama's health care law as the nation's top justices weighed the reforms.
"Protect our health care, protect the law," shouted some of the crowd, as inside the majestic marble-columned Supreme Court the most closely-watched legal case of the year got underway.
"We love Obamacare, that's why we here," chanted some, at the start of three days of deliberations which could see Obama's signature legislation either enshrined in America's legal code or ripped apart.
"I see children with asthma, adults with diabetes, adults that can't afford their medication or cutting their pills in half to try to make them extend longer," said Angela Golden, president of the American Academy of Nurse Practitioners.
"We in America have to find a solution to this crisis."
But the reforms, signed into law two years ago and which mandate that all Americans must have health insurance, are hugely divisive, and the top US bench must rule whether they are constitutional.
A long-held cherished goal of Obama and his Democratic allies, for Republicans the law strikes at the very heart of civil liberties and individual freedoms. Republican hopefuls for the 2012 elections have vowed to repeal it.
"This is the most important issue in this election. It's one that encapsulates all the issues that are at stake in this very critical election in our country's history," he told the crowd.
The law would provide health insurance to some 32 million Americans lacking coverage, but also would force people to buy insurance -- an unwelcome intrusion by "big government" for others.
"I do not support the law. Giving the government the power to force citizens to buy something is a very dangerous precedent," said Chris Crawford, a 20-year-old political sciences student.
He had come equipped with a case stuffed with blankets and supplies saying he was very excited about the "opportunity to witness history."
"It gives control of our lives to the federal government," agreed Ron Kirby, 66, from Virginia, proudly waving a large Stars and Stripes.
Such is the interest in the case that queues began forming on Friday as spectators jostled for the few public seats inside the courtroom.
In an unusual step, the judges have agreed to release an audio-tape of each day's hearings as soon as possible. But no cameras, recording equipment, telephones or laptops were allowed inside to hear the arguments as the government took on its opponents.
Outside the imposing Supreme Court building, a stage had been set up with microphones to allow participants to wade into the issue.
People from all walks of life, including doctors and nurses, but also ordinary citizens were eager to have their say in the debate, likely to shape the nation's political landscape with Obama seeking a second White House term.
"If this law is overturned or repealed, my son will face a lifetime not being able to afford health care," she pleaded.
Along one of the steps, sat a line of people with a red cloth plastered on their mouths bearing the word "life."
"We are here doing what we always do, praying for an end to abortion," explained Amy Hoffer, from the Bound For Life group. She said the group did not support the reforms as they provide funds for abortions.
Another group was waving a yellow flag dotted with hundreds of black squares, signed with "God bless America," or "America is back."
"I'm a Tea Party patriot," said Kelly Carender, 32, from the West Coast city of Seattle, as she protected the flag aloft in the wind, and referring to the conservative rightwing movement. "We're going to put people back in charge."
But for others, including health care professionals, the reforms have been an instant success, even though the mandatory health insurance provision does not come into effect until 2014.
"I've seen specific instances of patients which have been helped by... the law. I want to be sure the law stays in effect because I have seen it helps people," said Cameron Page, a physician in training at the Beth Israel hospital in New York.
Source: AFP American Edition