The Results Are In: Health Care Consolidation Works

Nearly two years ago, South Carolina lawmakers debated merging the state’s fragmented health care agencies. The proposal was controversial; members of the South Carolina House Freedom Caucus warned the merger would concentrate too much power in a single person, creating a “health czar”. 

Today, the consolidation is showing results. In 2024, Palmetto Promise Institute produced a legislative analysis arguing that South Carolina’s health structure was unnecessarily fragmented and that merging the agencies would save taxpayer dollars and serve citizens more effectively.   

While it did not fully adopt the original reform, the legislature reached a compromise on a more limited version with the same basic idea. In 2025, South Carolina created the Department of Behavioral Health and Development Disabilities (BHDD), bringing three different agencies together under one department. 

Now, a year later, there is clear evidence that the efficiencies Palmetto Promise Institute predicted were possible after all. As part of the new agency, BHDD eliminated 275 positions, most of which were vacant. Of those positions, 47 were filled and resulted in layoffs, while the rest were positions the agency had already left vacant. None of the eliminated positions directly served people with mental health needs, developmental disabilities, or substance use disorders. The consolidation was never about firing government employees; it was about eliminating unnecessary duplication while protecting the services provided. Before the merger, each agency had its own HR, accounting, and other support functions. Often the positions overlapped and reorganizing them eliminated unnecessary jobs.  

At the time of debate, critics warned of an unchecked health czar. But there is a difference between unchecked and consolidated power. Now the offices operate within the larger department rather than as independent agencies. Each still has the same responsibilities, but they all report to one director. This creates a clearer chain of leadership and makes it easier to hold the agency accountable. 

Eliminating unnecessary positions also eliminates unnecessary taxpayer expenses. Fewer administrative positions mean fewer costs while maintaining the services South Carolinians rely on.  

The consolidation validates Palmetto Promise Institute’s analysis and demonstrates what effective reform can look like. It proves that streamlining government does not mean cutting services; it means cutting duplication, prioritizing accountability and taxpayer value without sacrificing services.