A Realigned Health Agency is Coming: Here’s What You Need to Know

March 4, 2024

Palmetto Promise Team

The last two weeks have seen both the SC Senate and the SC House pass legislation to create a robust new cabinet-level agency dedicated to Health Policy.

As our LegislationVisualized graphics below reveal, the new agency would be composed of parts of numerous existing state agencies. This reorganization is a follow-up to the 2023 statute that split the Department of Health and Environmental Control (DHEC) into a health agency and an environmental agency. (Palmetto Promise called for the splitting of DHEC (S.399) in our 2023 Freedom Agenda. Government efficiency is a top priority of ours, and splitting DHEC does exactly that.)

The House passed the Health Policy consolidation bill (H. 4927) on February 29 by a vote of 91-18 following a surprisingly heated debate on the House floor. Critics of the bill claim that H.4927 would create a South Carolina “health czar,” (think Dr. Anthony Fauci) and expand state power over individuals and local governments. In the wake of COVID-19 madness, those concerns are certainly legitimate, but they are not what this bill does.

To understand the nearly 100,000-word bill and its many parts, we must examine the historical context. Since 1973, South Carolina has housed all health policy and environmental management under one behemoth state agency with a portfolio including federal food programs, septic tank permits, birth/marriage/divorce certificates, and health care regulations, to name only a few. As the state has grown, problems with this agency’s structure have become even more apparent.

Under the requirements of the original bill splitting the agency into two (S.399), the Department of Administration commissioned an efficiency study to recommend how state agency structure could continue to be improved for the benefit of taxpayers, citizens, and patients. In January, the study’s initial findings reported that “South Carolina has the most fragmented agency structure across the United States,” with six independent health and human services agencies.

This is where H.4927 (and its Senate companion bill S.915) come in. These bills create one Executive Office of Health and Policy within the executive branch of the state government, consolidating numerous cabinet agencies who currently have overlapping responsibilities operating within their silos—their own buildings, budgets, staff, and expenses.

Details of the New Agency

  • Department of Health Financing – to deal with functions like Medicaid and insurance. What used to be the Department of Health and Human Services.
  • Department of Public Health – to handle hospital and health facility licensing, track infectious diseases, and oversee local health boards. All that the health component of DHEC currently does.
  • Department on Aging – to administer senior care facilities and various programs/benefits for the elderly. All that the current Department on Aging does.
  • Department of Intellectual and Related Disabilities – to oversee special needs facilities, care, and licensing. What used to be the Department of Disability and Special Needs.
  • Department of Behavioral Health – to absorb the duties of the current Departments of Mental Health and Alcohol & Drug Abuse.


About The Secretary

The Executive Office of Health and Policy would be overseen by the Secretary of Health and Policy, a cabinet position appointed by the Governor and confirmed by the Senate. He would be a cabinet member like any other, with a direct line of report to the Governor. He could be removed by the Governor or impeached like any other cabinet secretary. But, the buck would stop with one Secretary responsible for all things health, rather than having citizens being tossed back and forth between a confusing web of independent agencies with unaccountable and inaccessible directors.

Much of the controversy in the House floor debate centered on a section under the Department of Public Health regarding the Department’s powers under a healthcare emergency. As the state’s current law is written, in a state of public health emergency, DHEC’s Department of Public Health can enlist the help of local law enforcement to enforce health directives. The new agency restructuring would continue this existing power, again only in instances of “a public health emergency.” The Secretary of Health and Policy could not unilaterally declare a public health emergency with no accountability. The Secretary would serve at the will of the Governor, who could remove the Secretary at any time, and he could be impeached by the House and Senate if the General Assembly feels he is acting outside the scope of his powers.

In response to concerns about this emergency power, the House passed an amendment early in the debate that clarified that emergency power to rally law enforcement does not extend to the National Guard. This amendment assuaged concerns and persuaded many Representatives to support the final bill.


The Bottom Line

House and Senate bills passed last week facilitate the necessary next step in restructuring South Carolina’s health agencies, consolidating state bureaucracy, and creating clear lines of accountability. Silos will disappear and health agency functions will be coordinated for the first time ever. The result should be a more efficient use of taxpayer dollars, better coordination and delivery of health services, and a central entity charged with working together to deliver better results for citizens.

Note: Much of this legislative review has focused on the text of the House bill, but the Senate bill is very much in play as well. The Senate bill’s text further accounted for some of the “Health Czar” concerns. The roll call in the Senate was a lopsided 44-1.

As a Conference Committee looks inevitable, we urge the General Assembly to move forward on consolidation of Health agencies in 2024 like it did on splitting health and environment in 2023, being careful to protect the constitutional medical freedom rights of all South Carolinians.