About a year ago, six months after her mother was laid off from her job, Kate Simpson's health insurance coverage expired.
A month later, the University of Texas student went to university health services for a sinus infection and found out her heart was beating three times faster than the normal rate, which soon led to a diagnosis of severe hyperthyroid disorder.
It became a pre-existing condition that prevented her from getting new coverage, even through her father's employer. She eventually decided to take off the next semester from school after her symptoms worsened.
As more and more college students become uninsured or underinsured because of a parent's job loss or strict insurance policies, an increasing number of colleges and universities are choosing to mandate health insurance coverage for students. The reasons they cite are many: retention rates, student safety and cost burdens to local hospitals.
A 2008 survey by the American College Health Association (ACHA), a group that sets standards for higher education insurance coverage, estimated that 38 percent of public four-year colleges require coverage, up from less than 25 percent in 2006.
Simpson said a mandate would have helped her because she didn't think she was vulnerable to serious health issues as a young person and thus didn't make coverage a priority.
"When you have it, you take it for granted," Simpson, 22, said of insurance coverage. "I never realized what a doctor bill cost or what medicine cost. I had amazing insurance where I paid $15 for a prescription, and I never thought twice about it. And then, when I didn't have it, I didn't think it would be a problem. I was going to get around to getting it but neither of my parents or I did anything about it."
The University of North Carolina system will require insurance coverage for students at all of its 16 institutions starting in fall 2010. Only five schools in the system, including the flagship campus at Chapel Hill, did not have an insurance requirement already, but the 11 that did had different providers.
Bruce Mallette, senior associate vice president of academic and student affairs for UNC general administration, said the system did a study that showed it could provide cheaper comparable coverage with lower premiums if it sought a vendor to cover the entire system.
That means the students at schools that once relied on voluntary insurance plans will pay $650 instead of more than $1,000 for their insurance coverage, Mallette said.
At many state schools in the U.S., $1,100 is 15 percent or more of total tuition for a year.
"They look at $1,100 or $1,600 a year and it scares them away from even considering it," said Mallette, describing students at UNC schools with voluntary insurance.
Stephen Beckley, a health insurance consultant who has helped more than 170 colleges and universities design health insurance plans and policies, said 22 states, including Utah and Florida, currently are researching or discussing student health insurance mandates.
As more universities choose mandates, Beckley said, more and more will likely catch on as they realize the benefits of knowing students are covered in case of an accident or illness.
"We expect more states to do mandates given that college students often bubble up as one of the largest groups of uninsured persons nationally," said Beckley.