Hans Scheltema spent three days in line outside the supreme court proving that big money buys access in Washington.

When court officials finally began ushering spectators into the court early Monday for the beginning of politically-charged hearings challenging the legality of President Barack Obama's healthcare reforms, Scheltema and a group of other men in line stepped aside. Into their places slipped several lobbyists and health industry businessmen who paid thousands of dollars to the less fortunate to secure public seats at the hearing.

By dawn on Monday, more than 100 people were in the queue on the street outside the court, including a nurse who described herself as a strong supporter of the health reforms after years of watching those without medical insurance walk into hospital emergency rooms as a last resort, and Tea Party movement supporters who say the law will mean government-run "death panels" rationing healthcare, and bureaucrats, not doctors, deciding treatment.

Scheltema, who makes his living securing places in line, usually outside congressional hearings, was among the first in the queue after pitching up on Friday.

Wrapped in blankets against the cold of the night, he said he mostly likes Obama's health insurance reforms, although he has a problem with the issue that's centre stage at the supreme court – the requirement for almost all Americans to buy health insurance, known as the "individual mandate".

"I'm in a spot where I don't have health insurance because I make too much money, but if I did go and buy it it would probably be more expensive than my rent. I choose to go without it because I'm pretty healthy," he said.

That, the Obama administration intends to tell the court, is precisely why the reforms are needed. Many healthy people don't buy insurance until they fall ill which contributes to premiums that are unaffordable for large numbers of Americans. Requiring everyone to have insurance is supposed to spread the risk and bring down the cost.

Opponents say the requirement is unconstitutional because Congress has exceeded its power by, for the first time in history, requiring Americans to buy a product from the private sector.

While the longest supreme court hearing in nearly half a century – lasting about six hours over three days – will largely be a dry contest of legal precedent, outside, the case has generated furious passions.

"Who are they to tell me?" said David Clift, a store owner from Virginia. "If I don't have health insurance and I get hit by a car or have a heart attack, that's my responsibility. That's what freedom is about.

"Obamacare is about the government taking control of our lives. If they can do this, there's no limit to what they can do. Americans are very angry and very scared."

But what would he do about a man how has a heart attack in the street and who has no insurance? It's a question asked at one of the recent Republican presidential candidates' debates. Someone in the audience shouted: "Let him die".

That's Clift's view.

"The government can't protect you from everything. Why am I responsible for what happens to someone else," he said.

Marching nearby was a man from the Alexandra Tea Party who declines to talk but thrusts out a printed statement.

"The individual mandate, if allowed to stand, would completely subvert our founding principles. Upholding the mandate would result in a government with no limits on its power that, far from protecting freedom, will extinguish it," it said.

Laura Brennaman, a nurse who secured a place further down the line outside the supreme court on Saturday evening, is scornful.

"People are not in favour of the government telling them what to do. We're a country that thinks people should pull themselves up by their own bootstraps. Unfortunately not everybody has boots," she said.

Scheltema may not like the individual mandate but there are parts of the law he does support, such as efforts to increase access to primary healthcare in order to encourage people not to put off medical problems until they get much worse. He says lack of universal free primary care is "a flawed system" because it means that people are in worse shape than they need to be by the time they qualify for free healthcare as a pensioner.

"Your whole life, when you're smoking two packs of cigarettes and drinking a pint of vodka a day – then you turn your body, which you've trashed, into the government and say 'here, take care of me'," he said.

That's exactly the problem Brennaman sees in her job as a hospital emergency room nurse.

"I'm passionate about access of healthcare for everyone. I've worked in emergency rooms for nearly 30 years and in this country emergency rooms are the safety net for the poor and folks that don't have access, especially primary care," she said. "I've watched thousands of people come in to emergency rooms with problems that should have been prevented had they only had the ability to access primary health services and they've not been able to. They come in much sicker, with long term problems that having access to primary care would have prevented."

Brennaman is uncertain how the justices will rule, but believes the issue has been driven to the court by industry interests with plenty of money to spend and political allies in the Republican party, although she says she doesn't think Obama has promoted the reforms very well.

"It's probably somewhat of a poor sell job on the part of the administration but there's just been many more dollars put out by the opposition to the bill, so it's been a tough sell," she said.

Conventional legal punditry has it that the four most liberal justices will uphold the law leaving the issue to be decided by the court's five conservatives.

Brennaman says that if the law survives the constitutional test, it will grow in popularity as its provisions kick in.

"People don't understand what's in the bill. People are afraid of this individual mandate but if you ask them if they are in favour of individual provisions like kids up to 26 being on their parents insurance or insurance companies not being able to put lifetime caps on your coverage, absolutely they support it," she said.

In the chair next to Scheltema is Kevin, who's also being paid to wait in line and doesn't want to give his last name. But he does say he's against a system where people can't afford health insurance.

"What kind of system is that? Not very good, right?" he said.

Kevin had an accident on a visit to London once and got patched up for nothing under Britain's socialised National Health Service.

"You can have our healthcare, I'll take yours," he said. "I think they should have a single payer health system here but they couldn't get it through so we got this hodgepodge."