Bill that merges 6 of SC’s public health agencies touted as improving services

COLUMBIA — A bill touted as reducing bureaucratic inefficiencies in South Carolina’s fragmented public health system received overwhelming support in the House, despite objections from a faction of the chamber’s dominating Republicans.

The 100-17 vote Wednesday on legislation that would merge six public health agencies followed five hours of GOP infighting over costs associated with the mega-merger and powers transferred to the would-be new agency head. All “no” votes came from Republicans, mostly from the chamber’s uber-conservative Freedom Caucus.

A perfunctory vote Thursday will send the bill to the Senate, which passed similar legislation 44-1 last week.

Advocates call the proposal the necessary next step in reorganization following a law passed last May that will split the state Department of Health and Environmental Control into separate agencies for public health and environmental regulations. That division of roughly 3,000 employees will take place this summer.

The bill would create a new Executive Office of Health and Policy, which would become South Carolina’s largest state agency with more than 6,300 employees. It would combine separate agencies overseeing services for the elderly, mental health issues, disabilities, patients covered by Medicaid, and those addicted to drugs and alcohol, plus an unknown number of workers brought over after the health and environmental agency breakup.

The tally could be less if the mergers lead to layoffs.

House GOP leaders contend putting public health agencies under one umbrella would reduce duplicative, confusing services that impede delivery.

By consolidating, “we’re not only streamlining operations but also significantly improving the quality of care for every South Carolinian,” House Majority Leader Davey Hiott, R-Pickens, said after the vote.

The massive new agency would be led by a Cabinet-level secretary, who will report to the governor.

Rep. Joe White questioned why legislators want to combine agencies after arguing the Department of Health and Environmental Control needed to be split because it was too big.

“Now we’re saying six different groups need to be brought into one to make it better,” the Newberry Republican said. “I just don’t understand the logic sometimes.”

Making the case

The changes come at the recommendation of a private consultant, hired by the state last year, who told lawmakers, “South Carolina is the most fragmented structure for health and human services delivery in the country.”

To make the case for the bill, Rep. Jay Jordan, R-Florence, shared the story of man he called “Ethan.”

In crisis and seeking treatment for drug abuse and mental health issues, Jordan said Ethan ping-ponged between emergency rooms, jail, detox facilities, rehab and even prison due to a lack of coordination by the state agencies that oversee these services. In all, Jordan said Ethan was treated by 11 different doctors over a three-year period struggling to get the care he needed.

Much of the debate Wednesday centered around a lack of information about how much the agency changes would cost.

The bill’s sponsors said they expect spending to decrease with the consolidation, but they could offer no hard numbers.

They also did not know how many workers the new agency would ultimately employ once fully reorganized, saying it was likely certain positions would be eliminated. But they also highlighted vacancies elsewhere in state government available to employees laid off by the mergers.

Freedom Caucus opposition

“I think that most people in here would agree that restructuring is important, but what about responsible restructuring? Does that mean being able to put a price tag on it?” asked Rep. April Cromer, R-Anderson, among the Freedom Caucus members who voted “no.”

Most proposed changes came from that uber-conservative group.

They tried to remove the secretary’s authority to have police enforce mandates issued during public health emergencies. The authority has rested with DHEC since 2002 as part of the post-9/11 Emergency Health Powers Act, but the agency declined to exercise that power during the COVID pandemic despite a senator’s urging.

Freedom Caucus members also sought extra legislative power to fire the secretary if lawmakers are not happy with the person.

Rep. Josiah Magnuson of Spartanburg County said he didn’t think one person should have that much power. He referenced fights over mask mandates that spurred lawsuits and protests across the state during the height of the coronavirus pandemic.

“You’re gaslighting people of South Carolina,” the Fingerville Republican said. “We know what happened during COVID. We know it was overblown … the mandates, the lockdowns, people were told to stay home.”

In response, Rep. Micah Caskey, referenced other past disease outbreaks — SARS in 2003, swine flu in 2009, even a tuberculosis outbreak at a Greenwood County school that infected more than 50 children and led to the death of a 79-year-old man. The government needed the power to act in those instances, he said.

“There are public health emergencies that have stricken us in the past that require power to exist within the government’s hands,” the West Columbia Republican said.

Others argued having a public health agency head under the command of the governor, rather than a board of directors who are appointed by the governor, would actually make that person more accountable.

Since both chambers have now passed similar bills, it’s clear the idea has overwhelming support. But the separate legislation complicates the next steps. Unknown is which bill, if either, will make it to Gov. Henry McMaster’s desk before the regular session ends in May.