Healthy Citizens: 2023-24 Freedom Agenda in Review

Now that the General Assembly has adjourned sine die, we are taking a look back at the 23 policies Palmetto Promise proposed in the 2023-24 Palmetto Freedom Agenda at the beginning of the legislative session. Did our Freedom Agenda policies make it into law? Or, at the very least, did they start a conversation that future General Assemblies can act upon? 

Today, we look at the four policies proposed under our Healthy Citizens category. 

As a reminder, each policy is marked with one of four symbols to match its status ✅ = signed into law, 📝= conference report pending, ⌛ = passed one chamber but fell short, ❌ = no movement. 

Without further ado, let’s dive into these healthcare policies! 

8. Repeal Certificate of Need (CON) ✅

A 1970s-era law known as Certificate of Need led to high prices, long wait times, and low-quality healthcare in South Carolina. In 2016, in only our third year of existence, Palmetto Promise Institute started a new conversation about the need to repeal South Carolina’s Certificate of Need (CON) statute. When the fight began, the tides were strongly against us. An opponent of our efforts even told us, “we will nuke you.” No one gave our little coalition a chance, particularly in “incrementalist” South Carolina, with the added challenge of an army of highly-paid lobbyists patrolling the Statehouse. Yet, through telling the stories of physicians and patients, drawing on a wide breadth of in-house and national policy research, and enjoying grassroots work by allies, we were able to chip away at support for CON each year. In a few years, we went from all the odds stacked against us to finally, in 2023, witnessing the passing the nation’s most significant CON repeal since 2015. Ultimately, the legislation passed the House and Senate with bipartisan and unanimous support. Already, across the state, we are seeing new healthcare facilities pop up, and this year, CON repeal was accelerated for some acute hospital care services with the passage of S.858. Mark your calendars for December 31, 2026. On that date the last vestiges of CON—those required for acute care hospitals—will go away. South Carolinians will only continue to enjoy more access to healthcare facilities and lower prices thanks to free market competition in healthcare. 

9. Expand Telehealth ✅

“The passage of Certificate of Need repeal last year was the springboard for the effort to make healthcare more accessible and more affordable,” tweeted Rep. Sylleste Davis after the passage of the SC Telehealth and Telemedicine Modernization Act in February. This legislation marks a significant win for healthcare freedom in South Carolina and the result of years of work by Palmetto Promise and other telemedicine advocates. Telehealth allows patients to access medical care more efficiently, flexibly, and cost-effectively than going in-person for every appointment, and we fully support the reduction of regulations that allow consumers the ability to choose the best care for them. With this new law, South Carolinians have more options in healthcare. But we are not finished. South Carolina needs an even wider pool of providers, so there is red tape left to cut. 

10. Require Price Transparency ⌛

Patients deserve the right to shop for their healthcare, comparing facilities and services to find the best price and best care for their individual needs. Unfortunately, the healthcare system right now makes that “shopping” and free market competition virtually impossible. Too often, patients undergo medical procedures without ever knowing what they will ultimately cost. Then, they are surprised after the fact when they are mailed a bill for out-of-pocket expenses that can be thousands of dollars. South Carolina needs a strong law on the books to ensure that patients are provided itemized medical bills before they receive medical care. H.4622, a bill requiring healthcare providers to give patients an itemized medical bill for services, passed the House unanimously just before the crossover deadline in early April 2024. Palmetto Promise testified in favor of this legislation. Unfortunately, H.4622 died in the Senate’s Medical Affairs committee after Senators criticized this simple billing disclosure requirement as being too cumbersome for hospitals. Palmetto Promise plans to tackle this issue head on in the 2025 legislative session and advocate for the General Assembly to pass strong billing transparency legislation.  

11. Trust Proven Professionals ✅

Healthcare professionals should be trusted to offer care at the full level (full scope) of their training. This means recognizing scope of practice and making healthcare licensure less burdensome. In the 2023-24 legislative session, several bills were enacted to do just that. We saw scope of practice expanded for certified medical assistants and pharmacy technicians (the latter pending Conference Committee approval). Additionally, South Carolina officially entered an interstate compact to ease state licensing requirements for professional counselors licensed in other states. These are all tremendous victories toward trusting proven healthcare professionals in our state and reducing occupational licensing burdens in this sector. Speaking of freedom, we will fight for the right of medical professionals to practice without the undue burden of noncompete provisions that affect nearly half of physicians in America.