COLUMBIA, S.C. (WCSC) - A push to majorly restructure how health services are delivered to millions of South Carolinians cleared a big hurdle Wednesday at the State House.

After a five-plus-hour debate, the House of Representatives approved a bill, H.4927, to merge several state agencies into one, a week after the Senate passed similar legislation.

The bill is the second step in a massive reorganization that started last year, when the legislature passed a new law to split the Department of Health and Environmental Control, DHEC, into two new state agencies.

As part of that legislation, the state’s Department of Administration contracted with Boston Consulting Group last year to study whether more changes to agency structure would benefit South Carolinians.

Boston Consulting Group’s study of South Carolina’s healthcare delivery system found it is the most fragmented model in the country.

Lawmakers said that leads to people falling through the gaps when these agencies fail to coordinate as well as they could.

“They’ll come in with a mental health issue and a drug problem, and … it’s one of these where they’re sent somewhere else. So there’s no economy of scales right there, but also two, it’s the worst thing we can do for our constituents if we’re putting money in this to get them well,” Rep. Bill Herbkersman (R-Beaufort) and the sponsor of the House bill, said during Wednesday’s debate.

This bill is intended to streamline that by combining six separate state agencies into one, a new “Executive Office of Health and Policy.”

This office would merge the existing Departments of Alcohol and Other Drug Abuse Services, Disabilities and Special Needs, Health and Human Services, Mental Health, and Aging, plus the new Department of Public Health that will be created this summer when DHEC splits.

Under the bill, a new Secretary of Health and Policy would lead the new agency. That person would be a member of the governor’s cabinet and appointed by the governor, with senators’ approval.

“So that we can streamline the state agencies’ structure and roles,” Rep. Jay Jordan (R-Florence, said.) “This will hopefully allow to build a strategic plan and an operating approach so these healthcare services can be delivered in a more efficient manner.”

But members of the ultraconservative Freedom Caucus opposed the consolidation, saying it would give one person, the new agency’s secretary, too much power.

“What it’s going to end up being is centralization of power. It’s putting all the medical bureaucrats under one chief bureaucrat,” Rep. Josiah Magnuson, R – Spartanburg, said.

Many of their concerns focused on giving this new secretary the authority to command sheriffs and local law enforcement to enforce mandates during times of public health emergencies, an authority the director of DHEC has under the current structure.

Magnuson proposed an amendment that would allow the secretary to request law enforcement’s assistance but not compel it. That change was not adopted.

Rep. Micah Caskey, R – Lexington, noted law enforcement is not trained to determine what does and does not qualify as a public health emergency.

Caskey pointed to previous pandemics, epidemics, and outbreaks, when such enforcement has been needed to address these emergencies, including the 2013 tuberculosis outbreak in Greenwood County. During that period, DHEC issued a public health order that mandated people who tested positive for the disease comply with certain directives or else face arrest.

“Public health authorities need authority to act because they are not law enforcement officers themselves. They cannot take independent action to compel or restrict behaviors, which are subject to the public health directives that they have issued,” Caskey said.

The House ultimately approved the bill in a 100-17 vote, but the legislation must still clear a few more steps to reach the governor’s desk because the House and Senate passed separate bills, though they include similar language.

Gov. Henry McMaster has urged this consolidation, calling it one of the most important bills the legislature can take up this year.

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