Religiously affiliated institutions, including schools, say the mandate under President Barack Obama's signature health care reform violates a federal law protecting religious freedom.
The court heard about 90 minutes of oral arguments over seven combined lawsuits, marking the fourth time in as many years that the highest court in the land has taken up a challenge to the law popularly known as Obamacare.
With late conservative justice Antonin Scalia's death, and Senate Republicans' refusal to vote on a replacement until Obama leaves office next year, the court is now evenly split along ideological lines.
Federal appeals courts handed down inconsistent rulings when they heard the cases -- all but one ruled for the Obama administration -- so a tie would leave an unseemly patchwork of regulations across the country.
The four liberal justices were vocal in their criticism of Christian groups' challenge to the health care reform, formally known as the Affordable Care Act.
Organizations can opt out of the mandate by providing written notification of their opposition on religious grounds.
The court's liberal wing -- incidentally all three women on the court plus Justice Stephen Breyer -- voiced support for this alternative.
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