A three-judge panel at the D.C. U.S. Circuit Court of Appeals says a coalition that opposes the Patient Protection and Affordable Care Act raised a question about constitutionality too late to pursue the challenge at the appeals court level.

But Stephen Williams, a member of the panel, observed in an opinion explaining the ruling that another party is still moving ahead with an appeals court case that raises a similar question.

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The panel was ruling on Association of American Physicians and Surgeons and Alliance for Natural Health USA vs. Kathleen Sebelius et al. (No. 13-5003).

AAPS – a group of physicians skeptical about Medicare and commercial managed care companies as well as PPACA – and the natural health group argued in a case filed in the U.S. District of Court for the District of Columbia that the minimum coverage provision is an unconstitutional undertaking, and that federal officials have violated fiduciary duties to the American people with poor management of Medicare and Social Security.

A district court judge filed a judgment for the government in 2012.

The D.C. appeals court panel looked only at the constitutional claims in the appeal, noting that consideration of the statutory claims would depend on the success of the constitutionality claims.

The appeals court panel noted that the Supreme Court already has sustained the PPACA individual health mandate as a valid exercise of congressional taxing power in 2012, in NFIB vs. Sebelius.

The appellants raised another question – that all taxes must start in the House, and that the PPACA provision that created the individual mandate tax started in the Senate – too late for the appeals court to consider that issue, Williams writes.

"We note, though we do not rely on, the presence of an origination clause challenge … in Sissel vs. U.S. Department of Health & Human Services," Williams writes.

An appeal in the Sissel case – brought by an artist who also alleges the PPACA tax provision originated in the Senate – is still pending at the D.C. Circuit Court of Appeals, Williams writes.

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Allison Bell

Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.