evidence: New York City, November 12, 2003—Nearly two of five (38%) Americans under age 65, and more than two-thirds (68%) of those with low incomes, had no health insurance at some point during 1996-1999, according to a new analysis for The Commonwealth Fund of a survey that tracks coverage over time. The number of people with a time uninsured during these four years—85 million—is more than double the number who were uninsured at any one point in time or any one year during 1996 to 1999. The longer view provided by the four-year time period reveals that unstable insurance put millions more at risk than the numbers estimated from annual "snapshots" by year. These higher rates are due to millions of people cycling on and off coverage, or "churning." [...] "These high rates uninsured indicate that far greater numbers of Americans are at risk of going without needed health care, having difficulties paying medical bills, and experiencing financial stress than we see in any annual survey," said Cathy Schoen, vice president at The Commonwealth Fund. "Insurance churning disrupts and undermines efforts to provide timely medical care and likely raises public and private health insurance costs due to frequent cycling on and off coverage." [...] Churning on and off coverage was a frequent problem. One third of all those with a time uninsured—28 million people—had multiple spells without insurance as they gained and lost coverage over time. Nearly two of five (38%) of those living on low incomes had more than one time when they were uninsured.