The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

Washington has laws that protect many residents’ ability to get insurance coverage for mental health care.

But as the Trump administration considers rescinding federal rules that strengthen those protections, thousands of Washingtonians — about 25% of the state’s insurance customers — may still see protections for mental health coverage lessened.

The administration is reviewing federal laws that require health insurance companies to cover mental health treatment at the same rate it covers physical health care — a practice known as mental health parity. For example, if a plan covers unlimited visits to the doctor for a physical ailment such as diabetes or cancer, it must also cover unlimited visits for a chronic mental health condition such as schizophrenia.

The original federal laws requiring mental health parity were passed in 2008. But enforcement has been a struggle and studies show that insurers were frequently disregarding the law. For example, one 2024 report found that patients were 10.6 times more likely to go out-of-network for psychological care compared to specialty medical care, indicating the mental health care the patient needed wasn’t available in network.

To try to spur more insurers toward parity and strengthen protections for patients, Congress passed legislation to require more reporting about which companies were following parity laws. Those rules, which also require insurers to make changes if they identify parity gaps, were finalized last year.

Advertising

However, the Trump administration said in a May 12 court filing that it plans to review the Biden-era rules and potentially suspend them. The filing also said the administration does not plan to enforce the rules while they’re reviewing them.

The court filings were part of a lawsuit by a group of large employers who have objected to the updated parity rules because they say the rules limit their ability to provide affordable health benefits to their employees.

Washington has laws that mirror the federal ones, meaning that many residents will not be affected by any changes. But if the Trump administration decides to rescind those rules, it could still potentially leave a large group of Washingtonians with less protection for access to mental health treatment.

Patty Kuderer, the Washington Insurance commissioner, said Washington has robust protections for mental health parity, both thanks to existing laws and a new one that was passed this session — House Bill 1432. That law, which will go into effect in 2027, requires insurers to use a uniform set of standards, approved by doctors, when deciding whether to approve or deny mental health coverage.

“The state Legislature appropriated funding to our agency to support our enforcement work, and my office is committed to continuing to enforce Washington’s mental health parity laws regardless of what happens at the federal level,” Kuderer said in an email.

But those strengthened state laws only apply to “fully insured health plans,” those that employers purchase directly from an insurance company.

Advertising

Those under “self-funded plans” — where employers provide health benefits directly to their employees — fall under the federal rules.

Many of Seattle’s largest employers, including Amazon and Microsoft, have self-funded plans, meaning changes to parity laws could still affect a lot of people. According to data from the Office of the Insurance Commissioner, in 2022, about 25% of the state’s residents were under self-funded plans, which means they wouldn’t be covered by the state laws. Only about 15% were under fully insured plans, which the insurance commissioner’s office regulates. About half of the state’s residents are under Medicare or Medicaid, which fall under different guidelines and wouldn’t see a change.

David Lloyd, the chief policy officer of Inseparable, a lobbying group that has pushed for more mental health legislation, said withdrawing parity rules would have a negative effect across the country.

“It’s important that Washington (state) took this step, making sure insurers are accountable for what they’re promising to cover,” he said, referring to the most recent bill passed to require insurers to follow more specific standards when deciding whether to offer mental health coverage.

Lloyd said recent federal mental health parity regulations put in place more concrete standards that insurers would have to meet, to prove their coverage was leading to equal access for physical and mental health treatment.

Advertising

“Having them potentially withdrawn would be very damaging,” he said. “We don’t know exactly what the Trump administration will do. We hope they maintain key pieces of the rule, but we don’t have a sense yet of where they’re going to land.”

Lloyd said parity is just one important tool of many to increase access to mental health and substance use disorder treatment.

“If its power is essentially rolled back, we need to look at other mechanisms, look at state laws,” he said. “States can always go beyond the parity act.”

He said increasing access to mental health and substance use care is important not just to those needs, but to overall health and health care costs — and not providing adequate behavioral health care can lead to an increased strain on public programs such as Medicaid.

“When people are relapsing and have untreated mental health conditions or substance use disorder, physical health care costs are actually much higher,” Lloyd said.

“So holding insurers to their responsibilities, frankly, what they’re promising, is critical to not allowing them to essentially shift costs onto taxpayers,” he said. “(Improving coverage for mental health treatment) is a critical part of the equation.”