Court of Appeals Revives Thurston County Discrimination Lawsuit Over State Health Plan’s Obesity Drug Ban

A legal battle over whether the state’s primary health insurance plan discriminates against disabled employees is heading back to Thurston County.

In a published opinion released Monday, Division I of the Washington State Court of Appeals unanimously reversed a Thurston County judge’s dismissal of a proposed class-action lawsuit targeting the Washington State Health Care Authority.

At issue is whether the HCA’s Uniform Medical Plan—the insurance provider for state and public employees—violated state anti-discrimination laws by blanketly refusing to cover prescription medications for obesity.

The Origins of the Legal Battle

The dispute began when Jeannette Simonton and Ryan Kelso, both state employees enrolled in the UMP, were denied coverage for medications prescribed by their doctors to treat their diagnosed obesity.

According to their lawsuit, filed in Thurston County Superior Court, the state plan categorically excludes prescription drugs for “obesity (or weight loss).”

The UMP maintains this exclusion “even if the services are medically necessary,” though it does cover other interventions like bariatric surgery and nutritional counseling.

Simonton and Kelso argued that because obesity is a recognized disability under the Washington Law Against Discrimination, a blanket refusal to cover treatments specifically for that condition is illegal.

They claimed the HCA’s policy violated RCW 48.43.0128, a state law that prohibits health carriers from discriminating against individuals in benefit design because of a “present or predicted disability.”

The Trial Court Dismissal

The case initially met a roadblock in Olympia. Thurston County Superior Court Judge Allyson Zipp dismissed the plaintiffs’ claims, pointing to a state insurance regulation that lists weight loss drugs as a service that health plans “may, but [are] not required to, include” in their essential health benefits.

Judge Zipp reasoned that because a state regulation specifically authorized the exclusion, the UMP’s refusal to cover the drugs could not be considered illegal discrimination.

Furthermore, the trial court concluded that if the plaintiffs’ logic were accepted, health plans would be forced “to cover every treatment for every impairment that meets [the] WLAD’s broad definition of disability.”

The Appellate Reversal

The Court of Appeals fundamentally disagreed with the Thurston County court’s interpretation.

Writing for the unanimous appellate panel, Judge Ian Birk explained that the insurance regulation cited by the trial court merely establishes a minimum baseline for essential health benefits—a statutory “floor”—to comply with the Affordable Care Act. It does not give health plans a license to bypass anti-discrimination mandates.

“The nondiscrimination requirement of RCW 48.43.0128 must be met independently of compliance with the essential health benefits mandates,” Judge Birk wrote.

Crucially, the appellate court noted that under the anti-discrimination statute, health insurers are allowed to exclude treatments for valid, evidence-based reasons—such as if a treatment is experimental, ineffective, or lacks medical necessity.

However, Simonton and Kelso alleged the HCA never conducted a cost-benefit analysis for obesity medications.

Instead, they claimed the state categorically excluded the treatments arbitrarily, simply “because it had always done so.”

“The nondiscrimination statute allows excluding coverage for services to treat a disability for an undefined range of valid reasons...but it prohibits excluding coverage for services simply because they are to treat that disability,” the opinion read. “To do so would discriminate ‘because of’ that disability.”

The Budget Factor

The HCA, which is headquartered in Olympia, also argued that the legislature effectively tied its hands.

The agency pointed to the state’s 2025 operating budget, which specifically directed the HCA not to cover weight-loss drugs due to the financial strain it would place on insurance premiums.

While the appellate court acknowledged the state’s financial concerns, it ruled that an appropriations bill cannot abolish or overrule substantive anti-discrimination law.

Next Steps

The Court of Appeals ruling does not mandate that the state immediately begin covering obesity medications. Instead, the decision revives the lawsuit, allowing the plaintiffs to proceed with discovery.

Back in Thurston County, Simonton and Kelso will now have the opportunity to argue, with evidence, that the HCA’s coverage exclusion was rooted in discrimination rather than legitimate medical or financial management.