At issue is whether married same-sex couples who work for the federal government are entitled to enroll their spouses onto their healthcare plan.
Ninth Circuit of Appeals worker, Karen Golinski of San Francisco, has been trying for two years get her wife, Amy Cunninghis, onto her medical insurance. They were married in 2008 when same-sex marriages were briefly legal in California.
"We have a son who is 7, and I paid my premiums and I only get to put one member of my family on," she said.
Despite having won four rounds in court already, the couple's case is now before the U.S. District Court in San Francisco. The federal government keeps refusing to sign up Cunninghis even though it has been ordered to do.
The lawyer for the federal government wasn't authorized to talk to media, but he centered his arguments around the Defense of Marriage Act, a 1996 law that prohibits the federal government from recognizing same-sex marriage.
The federal government has typically deferred to states when it comes to allowing same sex marriages. The case puts increasing pressure on President Obama to fulfill his repeated promises to support gay rights.
Obama has called for the repeal of the Defense of Marriage Act, calling it discriminatory. In fact, the federal judge began Friday's hearing by quoting Obama who said the law was "abhorrent," yet his administration sent an attorney from Washington to California to defend it.
"Here, it's very difficult for the government to justify providing unequal health insurance to employees doing equal work," Jennifer Pizer from Lambda Legal said.
For now, Cunninghis has private insurance, which she calls inferior to the federal plan. The 48-year-old puts off doctor visits, especially preventative care.
"There are certain things we have to weigh financially, whether it would make sense for us to do," she said.
There's no timeline as to when the judge would rule, but he did acknowledge Cunninghis has been waiting a long time for health insurance.