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SC health agency merger bill can't afford to wait, leaders say, but what's in the proposal

State - 6/3/2024

Legislation to merge six state health care agencies hit a roadblock on the last day of the General Assembly's 2024 session over objections from hard-line conservative lawmakers that their concerns weren't being considered.

However, it's a bill Gov. Henry McMaster wants sent to his desk and a piece of legislation overwhelmingly supported by both chambers.

But what does the proposal do?

The legislation follows up the split of the Department of Health and Environmental Control into the Department of Public Health and the Department of Environmental Services that is scheduled to take place July 1.

Under the merger, the departments of Public Health, Alcohol and Other Drug Abuse Services, Disabilities and Special Needs, Health and Human Services, Mental Health, and Aging, would be combined to create the Executive Office of Health and Policy.

The departments of Public Health, Mental Health, Department of Disabilities and Special Needs and DAODAS already are slated to move to a health care campus in Cayce away from the Bull Street corridor in Columbia.

Health and Human Services, DAODAS and Aging are in the governor's cabinet. The DHEC, DMH and DDSN have their own boards, which hire the agencies' directors.

Those opposed to the legislation say it creates a "health czar" because it consolidates all of the health agencies under one director. Opponents have even likened the creation to a "Fauci-esque" position, referring to Anthony Fauci who served as the most prominent health advisor during the COVID pandemic to both former President Donald Trump and President Joe Biden.

The bill creates a secretary of health and policy who reports to the governor as part of the cabinet. The executive office of health and policy would have divisions and each director appointed by the director and confirmed by the senate.

The merger will allow for better coordination between the now separate agencies, which is helpful when a person or family needs services from multiple agencies. The bill does not add any new powers in state government, said Brandon Charochak, spokesman for the governor's office.

Opponents of the bill complained that the new secretary could order the national guard and law enforcement to enforce public health emergencies.

The legislation clarifies that only the governor can mobilize sheriffs and constables to assist with public health emergencies. The bill also clarifies that the Department of Public Health, with approval from the governor, may enforce preventive measures to limit or prevent the spread of communicable or epidemic diseases, according to an analysis by the Revenue and Fiscal Affairs Office.

Local law enforcement already can ask for assistance from the national guard to enforce restrictions during a public health emergency, but that's only after the governor has declared a public health emergency. And only the governor can authorize the use of the national guard.

The legislation also includes some cleanup language that needed to be implemented as part of the DHEC split. As the agencies are merged, no job cutbacks are expected.

Breakdown of agency responsibilities

The merged agencies would each have their own division within the new health and policy office.

The Department of Health Financing would run tasks covered by the current Department of Health and Human Services, which runs the state's Medicaid program;

The Department of Public Health would take over tasks of the health side of DHEC;

The Department on Aging to handle senior care issues;

The Department of Intellectual and Related Disabilities to cover tasks performed by the department of disabilities and special needs; and

The Department of Behavioral Health, which would cover tasks performed by the Department of Mental Health and the alcohol and drugs abuse services department.

Why was the bill blocked?

The legislation was passed out of the Senate in February. The House didn't take it up until the last week of the legislative session, making changes that required by approval by the Senate.

Before the bill was sent back to the upper chamber, House members held a long debate on the second to last day of session, which included a request to read the bill in its entirety in order to stall its passage and an order to bring back absent lawmakers to the State House. Those requests were later rescinded and the bill was allowed to return to the Senate.

The following day the Senate agreed on amendments from state Sen. Shane Martin, R-Spartanburg, that could have assuaged concerns from the hard-line conservative Freedom Caucus. But when the bill returned to the House with less than an hour before mandated end of session, Freedom Caucus member state Rep. Josiah Magnuson, R-Spartanburg, objected to the bill being brought up, killing the bill for the session.

"The most important piece was that they said it was going to streamline government but they said it was not going to actually result in anybody being dismissed or streamlining from their jobs. So that was a problem," Magnuson told reporters the afternoon of May 9. "We didn't have any assurance that there was going to be any funding cuts. That's what we're trying to do is cut government spending to do more for the taxpayer. And so when you streamline government you want for it actually just seemed like government. So that's not what this bill was doing."

The amendments offered by the Senate on the last day could have forced the bill into a conference committee and kept the legislation alive for the year as differences were worked out. But House Freedom Caucus member had doubts their concerns would have been considered.

"Clearly, they're not going to listen to me in conference committee," Magnuson said. "We have a record over the last two years, really four years, where they have been against every single thing that the Freedom Caucus has tried to do. For them it's about power, not about reasonability or actual results for the taxpayers."

Proponents of the legislation were vocally frustrated, saying the Freedom Caucus move hurt real people.

"That is probably one of the most monumental restructuring bills in the history of the state of South Carolina. And it's not about us. It's not about personalities, it's not about your bills," House Speaker Murrell Smith said. "It's about the citizens of South Carolina, and that bill right there, took one of the most fractured health care systems in the country and consolidated them and also would have driven down costs. So holding hostage bills like that only harms South Carolinians. It doesn't harm the members that they feel did not work nice to them. It doesn't doesn't harm the institution. It harms real South Carolinians."

If a person goes to DAODAS for help with a potential alcohol abuse problem, he could be told that it's really a mental health issue and told to seek assistance from the Department of Mental Health. DMH might disagree and send the person back to DAODAS, leading to a ping-pong effect between the agencies that might not be communicating and collaborating with one another, proponents of the merger legislation say.

Will lawmakers take it up in June?

Lawmakers return to the State House this month to hold a state Supreme Court election, finish the budget and take up any reports from established conference committees.

As of now, however, work cannot include the health agency bill after the end of the formal session because it's not part of an agreement lawmakers have in place limiting what they can debate.

In order to bring up the health agency merger bill, it would require a two-thirds vote for each chamber to change the General Assembly's sine die agreement.

House Majority Leader Davey Hiott said he has heard no discussion of changing the sine die agreement.

Senate Majority Leader Shane Massey said that move could be a "big lift" in the Senate as different groups within the senate may want other topics included in a changed sine die agreement.

Democrats want to include the hate crimes bill as part of an amended sine die agreement as any change to that agreement would require help from the minority party in the Senate.

But that move could lead to losing Republican support. Others could want a vote on other conservative lawmaker priorities.

Language between the two chambers on the health care bill also still needs to be worked out.

"At this point, it's still a long shot," Massey said. "But there are a number of us who realize this is important and we need to try to take an effort to get it done if we can."

The sine die agreement has been changed just twice in recent history. Once for a Boeing economic development deal, the other time to take down the confederate flag.

Changing the sine die "doesn't happen all that often and the times when it has has happened have been very significant events for the state as a whole," Massey said.

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