SC public health overhaul could be resurrected, senator says: ‘It’s not trivial.’

Sen. Tom Davis, R-Beaufort, talks to House Speaker Murrell Smith, R-Sumter, shortly before the end of session Thursday, May 9, 2024. Davis came into the House chamber to plead his case about a bill combining six state health agencies into one, which House Freedom Caucus members stalled on a procedural vote. (Screenshot of SCETV legislative livestream)

COLUMBIA — One of the architects of legislation restructuring South Carolina’s public health system still hopes to resurrect the issue this year.

Lawmakers could amend this year’s so-called sine die resolution — the temporary law that allows chamber leaders to bring legislators back after Thursday and limits what they can do — to allow discussion of the health care merger bill to resume. And Sen. Tom Davis is urging for that to happen.

The Beaufort Republican said he continues to work with House leadership on a compromise proposal that could be brought up in June, when the Legislature is expected to return to vote on the next Supreme Court justice and finish work on the state budget.

The move comes after an ultra-conservative faction of the House used a procedural maneuver to kill the bill in the last five minutes of the regular legislative session Thursday.

The idea of merging South Carolina’s health care agencies has been studied for more than two years by a private consultant hired by the state, who concluded in a report that “South Carolina is the most fragmented structure for health and human services delivery in the country.”

“Too much time has gone into this, too much effort,” Davis told the SC Daily Gazette on Friday. “That’s why it’s important to not give up on this. We’d be letting the people of South Carolina down not to get this across the finish line.”

Ordinarily, lawmakers frown on amending the law governing what’s supposed to be the off-session for part-time legislators. Altering it is intended to be difficult: A two-thirds majority of both the House and Senate must agree to any changes.

But Davis said if there’s any bill legislators should support adding to the agenda to get over the finish line, restructuring public health should be it.

“It’s not trivial,” Davis said. “South Carolinians are not getting their money’s worth when it comes to public health care delivery.”

Merging agencies

The following agencies would be combined into the SC Executive Office of Health and Policy:

• Department on Aging

• Department of Alcohol and Other Drug Abuse Services

• Department of Disabilities and Special Needs

• Department of Health and Human Services

• Department of Mental Health

• Department of Public Health*

*The Department of Health and Environmental Services is set to split into two this summer under a law passed last year.

If recent House and Senate votes on the legislation are any indication, an effort to resurrect the bill from the dead could succeed.

Before a series of last-minute amendments, the bill had passed in the Senate by a vote of 44-1, with only Sen. Tom Corbin, R-Greenville, voting no.

The last vote in the House was 98-15, with all of the opposition coming from the hardline House Freedom Caucus.

Davis said the House and Senate versions only differ on a few major points.

Those include whether the House gets a role in who leads the new Cabinet agency — rather than confirmation of the governor’s pick only going through the Senate, as usual for agency heads — and whether the secretary should be able to have police enforce mandates issued during public health emergencies. (That authority has rested with the Department of Health and Environmental Control since 2002 as part of the post-9/11 Emergency Health Powers Act.)

Other differences added Thursday are what allowed the Freedom Caucus to run out the clock.

‘Play stupid games, win stupid prizes’

The antics that killed the bill started late Wednesday.

Rep. April Cromer invoked a rarely used rule forcing House staff to read every word of the roughly 220-page restructuring bill to the chamber. After nearly an hour, the Anderson Republican backed down.

The House returned the bill to the Senate with amendments, but its troubles were not over.

With just an hour left in the session Thursday, Sen. Shane Martin, R-Pauline, proposed half a dozen of his own changes to the bill which would need agreement from the House.

Facing warnings from his colleagues, he sped through proposals such as requiring informed consent for administering vaccines. He eventually withdrew his final amendment.

“There are a lot of dangerous moves going on,” Sen. Nikki Setzler, R-West Columbia, said at one point. “Don’t take it too far, now.”

“I’m not trying to,” Martin replied.

The Senate got the bill back to the House with about half an hour left in the day. (By law, business must stop at 5 p.m. the second Thursday of May.)

But when asked for unanimous consent to bring it up, Rep. Josiah Magnuson, objected, effectively blocking the House from considering it.

Davis came to the House floor to plead with the Campobello Republican to let the bill go to a vote. He went to the dais to ask House Speaker Murrell Smith to keep trying to push it through. But it died as the clock struck 5 p.m.

“A handful of Freedom Caucus members objected and burned it down and the people of South Carolina lost here,” Davis told reporters immediately after.

The Freedom Caucus called the bill’s death Thursday a win for South Carolina.

Freedom Caucus members tried to amend the bill to their liking, but other members shot them down or ruled them irrelevant, said Rep. Adam Morgan, R-Taylors.

“Play stupid games, win stupid prizes,” Morgan told reporters after session ended.

What happens next?

The Freedom Caucus has opposed the bill from the get-go, saying it would create a “health czar” to enforce public health emergencies.

But Davis said combining the agencies under a single Cabinet-level director who answers to the governor would actually eliminate that concern, as a number of the agency directors currently only report to governing boards.

“That’s what we’re trying to cure,” he said.

Smith, a Republican from Sumter, said the bill would have consolidated services, making it easier to get resources to people who need them, such as people with drug addictions and mental health issues.

“Holding hostage bills like that only harms South Carolinians,” Smith said.

Still, while the agencies will not be combined in state law, they can start combining services in the interim, including relocating to one central campus, Smith said.

“I don’t see any reason that the merging of these agencies should not start being deployed,” Smith said.

If lawmakers don’t succeed in amending the sine die resolution in June, the bill would have to be introduced for the new session that starts in January. And the whole process, to include subcommittee hearings, would start over.

“Maybe we can restart this process and actually listen to all voices and not play petty political games, which is exactly what this leadership does every single day,” Morgan told reporters Thursday.

Smith said he hoped to get it through as quickly as possible.

Reporter Abraham Kenmore contributed to this report.

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