Student Health Coverage Improves, but Disparities and Gaps in Access Remain

The percentage of U.S. college students with health insurance has steadily increased over the past decade, reaching 92% by 2022, but nearly 1.6 million students remain uninsured. Despite overall gains driven by policy changes such as the Affordable Care Act, barriers to coverage persist—especially among disadvantaged student populations, those in non-Medicaid expansion states, and students who are not employed.

Data from the Government Accountability Office (GAO) indicates that coverage gaps disproportionately affect students from historically marginalized racial and ethnic backgrounds and those attending college in states that have not expanded Medicaid eligibility. Nonworking students are also overrepresented among the uninsured. Financial limitations were cited as a key obstacle, particularly in states where Medicaid remains restricted. Additionally, some insurance plans do not provide care across state lines, leaving out-of-state students without adequate access to medical services while on campus.

Colleges have responded to these challenges in varied ways. Among a sample of 12 colleges examined, five required students to carry health insurance and offered campus-based plans. These institutions cited compliance with state mandates and the need to ensure students had access to care. The remaining colleges either did not require insurance or chose not to offer plans due to cost concerns or low student interest. The survey revealed inconsistency in how colleges address student health coverage, contributing to the broader issue of uneven access.

Some institutions provided students with educational resources about their health coverage choices, but these efforts were not universal. According to stakeholders and college administrators, many students still struggle to understand insurance concepts, lack urgency in securing coverage, or face difficulties selecting a plan suited to their needs. The complexity of health insurance continues to be a hurdle, even for students with access to plans.

Federal agencies have taken steps to raise awareness and encourage enrollment. The Department of Health and Human Services maintains a website tailored to help students explore their insurance options. The Department of Education, in 2023, issued guidance and hosted a webinar to prompt colleges to assist students at risk of losing Medicaid coverage following the conclusion of the COVID-19 public health emergency. These initiatives aim to bridge the information gap and help institutions support students’ health coverage decisions.

Article by multiple RFHC contributors, based upon information from the U.S. Government Accountability Office (GAO) press release GAO-25-107024

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