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State House

South Carolina ‘Certificate Of Need’ Program On Its Way Out

Palmetto State health care marketplace about to change for the better …

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In a legislative session dominated by ‘Republican’ infighting, elevated crony capitalism, expanded bureaucratic bloat and a lack of meaningful progress on core free market priorities, GOP supermajorities in South Carolina did manage to take a modest step toward addressing anti-competitive health care restrictions.

The Palmetto State’s unduly burdensome “Certificate of Need” (CON) program – which this news outlet has railed against for years – will be largely phased out over the next three-and-a-half years thanks to legislation pushed by state senator Wes Climer of Rock Hill, S.C.

Climer has been a leading advocate for CON repeal for several years. His latest bill – S. 164 – is on its way to the governor’s desk after clearing both chambers of the state legislature.

“This is a long overdue win for patients,” Climer told me on Friday. “More competition and choice means higher quality and lower costs.”

(Click to View)

Sen. Wes Climer talks with colleagues during a Senate Judiciary Committee meeting in Columbia, S.C. (Travis Bell/STATEHOUSE CAROLINA)

Administered by the S.C. Department of Health and Environmental Control (SCDHEC), this restrictive “regulatory regime” forces hospitals to seek state approval if they wish to build new facilities, open new practices or purchase certain types of new equipment. Competitors use this superfluous layer of bureaucratic red tape to stifle competition within the marketplace – resulting in fewer options and higher costs for patients and consumers.

“Large existing providers like it this way — CON laws let them veto any competition they don’t like,” noted Wilson Freeman of the Pacific Legal Foundation (PLF) in a recent guest column for this news outlet.

According to Climer, the looming repeal of the measure – or at least its most onerous provisions – has already sparked interest from investors within the health care marketplace.

“It’s been a day and half since the bill cleared the Senate, and I’ve gotten three calls from health care providers about investing in York County,” he said.

Climer said other parts of the state were “undoubtedly” experiencing similar elevated levels of interest in new health care investments as a result of the legislation being signed into law.




Conservative groups – led by Americans for Prosperity (AFP) – have been pushing for the repeal of this mandate for several years. AFP’s South Carolina leader, Candace Carroll, hailed the passage of Climer’s bill as “a watershed moment for South Carolina.”

“With the repeal of certificate of need laws passing both chambers, affordable health care closer to home will be within reach for more patients,” Carroll said in a statement. “This will mean more maternity and neonatal care for moms and babies, more beds for mental health care, more MRI machines, and new hospitals in rural counties.”

Grassroots GOP leaders like Jennifer Black – who has spent the past six years on this issue – also hailed the passage of the legislation.

“Since I learned about CON in 2018, this legislation has been my primary focus,” Black told me. ” At the time, we had a monopoly in South Carolina with one of the hospital systems that was created, ultimately, as a result of the Certificate of Need program.  This program prevented new healthcare systems from coming into South Carolina without facing costly and exhausting court battles that lasted years. This atmosphere not only hurts patients’ access but it also hurts health care employees due to limited options to work their skillset.”

According to Black, getting rid of CON is “a very important step in removing barriers to entry in a free market society.”



“South Carolinians will soon enjoy the fruits of such a market, because better choices do lead to better health outcomes,” she said.

My news outlet has consistently argued in support of a full, immediate CON repeal – allowing the free market to dictate coverage.

Last year, the S.C. Senate passed a bill doing away with CON during the first month of the legislative session – but it stalled in the S.C. House of Representatives when powerful “Republican” leaders refused to allow it to the floor for a vote. One of those leaders – former S.C. speaker of the House Jay Lucas – received a high-paying executive position within the health care industry shortly after the bill was blocked.

Lucas is no longer in the House, and new speaker Murrell Smith was clearly more amendable to seeing CON reform advance through his chamber.

Governor Henry McMaster made it clear this week he was pleased to see the legislation heading to his desk.

“Thank goodness,” McMaster told reporters at a press conference on Thursday afternoon. “It’s time for that – that time has come.”

Actually, South Carolina should have done away with this onerous diktat a long time ago – and the fact we have to wait another three-and-a-half years to see it gutted is unfortunate. And that reminds me: Advocates must remain vigilant over the next three-and-a-half years to ensure legislators do not renege on their commitment.



Will Folks on phone
Will Folks (Brett Flashnick)

Will Folks is the founding editor of the news outlet you are currently reading. Prior to founding FITSNews, he served as press secretary to the governor of South Carolina. He lives in the Midlands region of the state with his wife and seven children.



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