Summary: Childhood immunization is one of the most effective ways to prevent disease, saving as much as $14 for every $1 dollar invested. Yet the United States has one of the lowest rates in the Western Hemisphere for childhood immunizations against diseases like measles, mumps, and polio. The average preschool full immunization rate among the states was only 59 percent in 1990, and the Centers for Disease Control estimate that only about one-third of all urban preschool children are immunized. In 1990--less than a decade after the United States had supposedly eradicated measles within its borders--more than 27,000 measles cases and 89 deaths were reported. GAO testified that although funding was a barrier to better vaccination programs, states could lower their Medicaid vaccination costs by adopting more cost-effective vaccine payment policies. Savings on vaccine costs could allow states to use their limited financial resources to strengthen their immunization programs, including developing or enhancing a tracking, outreach, and education system.