The healthcare security system is a major institutional arrangement to reduce the burden of medical treatment, enhance people's well-being, and maintain social harmony and stability. College students participating in basic medical insurance for urban and rural residents is an important component of national medical insurance coverage. This article takes seven colleges as examples to analyze the current situation of college students' participation in medical insurance from the perspective of students, colleges, and medical insurance, deeply analyze the factors that affect the enthusiasm and expansion efficiency of college students' participation in basic medical insurance, summarize the problems and reasons, and propose suggestions for expanding and increasing the efficiency of college students' participation in basic medical insurance.