Health care reform efforts in both the Clinton and Obama administrations have attempted to address college and university health. Yet, although the world of health care delivery has almost universally evolved to managed care, school health programs have not. In general, school-sponsored health plans do little to improve access and have adopted strategies that may in fact breach the school's fiduciary duty to the student. For these health programs to survive, planners must embrace change and integrate their operations with standard health insurance systems. In this way, they can do good both for students and families and for the future of college and university health.