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Democratic state Rep. Mike Villarreal of San Antonio sees the potential for a public health disaster in a document that lays out options for cutting the state health department's budget by 10 percent, according to a news release from his office. Perry administration proposes ending immunizations for 113,000 kids, says the subject line of Villarreal's Sept. 7 statement. We want Texas kids in school learning, rather than sitting at home or the doctor's office suffering from preventable diseases. ... If we don't prevent the spread of diseases among these children, we put at risk all Texas kids who are too young to receive their immunizations yet. An end to immunizations for thousands of youngsters? We wondered if Villarreal's shot hit the spot. First, some background on the federal Vaccines for Children program, which Texas has participated in since 1994. According to the website of the Texas Department of State Health Services, the program provides vaccines to health care providers for eligible children, including those who lack health insurance and those enrolled in the Children's Health Insurance Program and Medicaid. In 2010, the federal government spent more than $380 million on immunizations for children in Texas, according to the Centers for Disease Control and Prevention. Carrie Williams, a spokeswoman for the state health services department, said 4.2 million Texas children qualified for the vaccinations under the federal program that year. To expand eligibility beyond the federal requirements, Texas pitches in some dollars so that any child who comes to a public health clinic can be immunized. The department is spending $7.1 million on the program in 2010-11 and expects to need $9.5 million for full funding in 2012-13. In May, Gov. Rick Perry and other state leaders, mindful of a looming revenue shortfall (lately pegged at $24 billion), asked state agencies to spell out possible 10 percent cuts in their budgets for 2012 and 2013. In August, the health services department laid out $238 million in possible reductions, with $7.7 million of that coming out of the state's spending on childhood immunizations. That proposal represents an 81 percent cut from what the agency expected to spend on the vaccination effort during 2012-13. The agency document, which Villarreal cites in his press release, describes the impact of the $7.7 million cut: At this level of reduction, the overall safety-net program will need to reduce the number of children being vaccinated with GR funds (estimated 112,661 children). A significant portion of these children could be affected. GR refers to general revenue funds. The document further says: This could end the public health clinic policy of turning no child away and instead will result in public clinics making referrals for those individuals that have health insurance to their medical homes for vaccines. If families are unable to go to their referral sites/medical homes, then the children may not be able to obtain vaccination services and could fall behind in the immunization schedule, ultimately lowering vaccine coverage levels and making our communities vulnerable to outbreaks of vaccine preventable diseases. A medical home is one's usual health-care provider. While Villarreal's press release also says the Department of State Health Services estimates that half of the children could be immunized through other programs, he concludes that the end result of the budget cut would be to eliminate immunizations for 113,000 children. At the agency, Williams disputed Villarreal's interpretation. She said 112,661 is the number of kids the agency estimated would receive vaccines purchased with general revenue in 2012-13. If the Legislature reduces the state contribution to the vaccine program by $7.7 million, she said, the agency estimates that half of the 112,661 children — about 56,000 — would not be able to receive immunizations at public health clinics. However, Williams said, that doesn't mean those kids would necessarily go without. They may have to seek their immunizations elsewhere, such as through their regular doctor, Williams said. And what would happen to the other 56,000 children? Williams said the agency expects that they would still be able to receive immunizations at public health clinics, but she did not specify how that would be accomplished. We likely will have to fill in the gap with vaccine from other resources, possibly federal sources, she said, because state dollars alone may not be able to cover all of them. Upshot: There's a 56,000 difference between the number of children Villarreal said would no longer get immunized and the number of children the agency says could no longer be served at public health clinics if the proposed budget cut happens. Asked to explain the discrepancy, Villarreal told us by e-mail that he issued his September statement after his office discussed the August budget cut proposal with agency officials. At that time, they communicated to us that the proposal would end funding for 113,000 children and about half of them could be expected to find services elsewhere, Villarreal said. That's what I said in the first two sentences of my press release. The agency now says that we misunderstood. The point is the same either way: A very large number of our children would be left without immunizations. We asked Williams about that early September conversation between a Villarreal staffer and Nick Dauster, director of the agency's Government Affairs Unit. She said: There must have been a misunderstanding between what was said and what was heard in a phone call a couple months ago. Admittedly, it’s a complex topic that involves estimates and unknowns, and our early information could have been clearer, which is why we provided clarification. The clarification was an e-mail sent from Dauster to Peter Clark, Villarreal's legislative director, on Sept. 1 — before Villarreal issued his press release — saying that an estimated 56,000 children could be affected by the cut in immunization funding. This represents children who receive immunization services normally paid for by general revenue, Dauster wrote. Finally, we explored whether it makes sense to ascribe the agency-level proposal to the Perry administration, as Villarreal's statement does. By law, the governor appoints the chief executives as well as the governing boards of some major agencies, including the Texas Health and Human Services Commission, whose Perry-appointed executive commissioner chooses the commissioner of the health services department in consultation with the governor. Also, Williams told us that the health services staff put together its budget reduction proposals with input from commission overseers. We asked Stephanie Goodman, a commission spokeswoman, if it was accurate to characterize the health services department ideas as Perry administration proposals. Her response: No. Our staff developed the options. She said the governor's office wasn't involved in deciding what cuts to propose. And how does Villarreal's statement that the Perry administration proposes ending immunizations for 113,000 kids shape up? We'll take his reference to the Perry administration as a defensible poke. And a state agency has proposed ending most of the general revenue funding for immunizations for that many kids. However, the suggestion that none of those 113,000 children would get vaccinated misstates the estimated impact of the proposed $7.7 million budget cut. While the state acknowledges that half the children would no longer be served under the immunization program — and some of those may have insurance coverage — it expects the rest would still get their shots at public health clinics. However, it says it doesn't yet know exactly how those immunizations would be paid for. We rate Villarreal's statement Barely True. Editor's note: This statement was rated Barely True when it was published. On July 27, 2011, we changed the name for the rating to Mostly False.
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