A legal challenge concerning whether Washington’s main health insurance plan discriminates against disabled workers has been sent back to Thurston County following a state appellate ruling.
Division I of the Washington State Court of Appeals issued a unanimous decision last Monday, overturning a prior dismissal by a Thurston County Superior Court judge. The case centers on the Washington State Health Care Authority’s Uniform Medical Plan and its treatment of prescription drugs used to manage obesity.
The dispute involves a policy that systematically withholds coverage for medications specifically prescribed to treat obesity, even when medical professionals deem them necessary. State employees Jeannette Simonton and Ryan Kelso, both enrolled in the plan, received denials for such medications, prompting their class-action lawsuit.
Their complaint, initially filed in Thurston County, highlighted that the Uniform Medical Plan excludes obesity-related drugs outright, unlike other obesity interventions such as surgical procedures and dietary services, which remain covered.
Plaintiffs contended that because obesity qualifies as a disability under the Washington Law Against Discrimination, the blanket exclusion contravenes state law—specifically RCW 48.43.0128—which bars insurers from shaping benefits in ways that disadvantage individuals based on actual or anticipated disability.
A prior ruling from Superior Court Judge Allyson Zipp had sided with the state, citing a regulatory provision that permits—but does not require—health plans to include weight-loss medications among essential benefits. The judge concluded that the legislature’s explicit authorization of the exclusion shielded the plan from discrimination claims and warned that accepting the plaintiffs’ position could obligate plans to fund treatments for any condition meeting WLAD’s expansive disability definition.
The appellate court, however, rejected that narrow reading. Judge Ian Birk, authoring the opinion for the panel, clarified that the referenced regulation sets only a baseline for benefits required under federal law and does not override standalone anti-discrimination obligations.
“The nondiscrimination requirement operates separately from essential health benefits standards,” the opinion stated. While insurers may lawfully omit treatments supported by sound evidence—such as when a therapy is experimental or lacks demonstrated effectiveness—the court emphasized that excluding care *solely* because it addresses a disability constitutes discrimination “because of” that disability.
Simonton and Kelso maintained that the Health Care Authority had not performed a formal assessment of the medical or financial impact of obesity medications before instituting the exclusion, relying instead on longstanding precedent.
The state agency further argued that legislative intent constrained its discretion, suggesting lawmakers had signaled approval for the exclusion through budgetary and regulatory frameworks.
The agency cited language within the state's 2025 operating budget, which explicitly instructed the Health Care Authority to withhold coverage for weight-loss medications due to the strain such coverage would impose on insurance premiums.
Although the appellate court recognized the state's budgetary concerns, it determined that a spending measure cannot supersede substantive anti-discrimination statutes.
What Comes Next
The Court of Appeals decision does not require the state to begin covering obesity treatments immediately. Rather, the ruling revives the lawsuit, permitting the plaintiffs to proceed with the discovery phase.
Proceedings in Thurston County will resume, allowing Simonton and Kelso to present evidence arguing that the Health Care Authority’s exclusion of coverage stemmed from discrimination rather than legitimate medical or financial management.