Opponents of the Patient Protection and Affordable Care Act arehoping the third time is the charm. Although the Supreme Court hastwice upheld central features of President Obama'ssignature health law in landmark decisions, conservative activistsare still hopeful that another one of their legal challenges willget a day in front of the high court.

The lawsuit, Sissel v. U.S. Department of Health and HumanServices, was filed by the Pacific Legal Foundation, aconservative advocacy group, and claims the PPACA isunconstitutional because it was passed incorrectly. Specifically,it claims the legislation is in violation of the Origination Clausein the Constitution, which specifies that all bills that raiserevenue must originate in the House of Representatives, rather thanthe Senate. Although the PPACA was never marketed as a tax bill,the Supreme Court essentially ruled that the legislation ––specifically the individual mandate to buy insurance –– was a formof taxation in its firstdecision upholding the law in 2012.

The Sissel challenge seeks to invoke the Court's firstdecision in favor of the PPACA to argue that the law isunconstitutional.

Writing in Newsweek, James Dorn, a legal fellow at theconservative Heritage Foundation, argued that the PPACA originatedin the House "in only a very formalistic sense" under the title,"Service Members Home Ownership Tax Act of 2009." Dorn writes thatthat bill, which did not deal with health care, was passed by theHouse and later dramatically altered by the Senate to incorporatethe central features of what became the PPACA. He and theplaintiffs in the legal challenge thus argue that the bill's mostimportant revenue-raising aspects originated in the Senate, not theHouse.

So far, the judiciary has not been receptive to the lawsuit,which was first launched three years ago. The U.S District Courtfor the District of Columbia dismissed the suit in June 2013, adecision that was affirmed in July 2014 by the U.S. District Courtof Appeals in Washington D.C. Just last week, the Court of Appealsdenied a request by the plaintiffs to have the case heard "enbanc," a situation in which all of the judges in the circuit wouldhear the case. Typically, most cases are heard by arandomly-selected three-judge panel.

The only place for the case to go now is the Supreme Court.Whether the court will take up the case is anyone's guess, althoughthere appears to be very little expectation that a court that hasalready twice upheld the landmark legislation would rule toundermine it. Dorn points out that even Justice Antonin Scalia, themost vigorous dissenter in the previous two cases, has not beenreceptive to legal challenges based on the OriginationClause.