South Carolina scrapped its proof-of-needs program on Tuesday after state senators voted overwhelmingly to remove the requirement.

A 35-6 vote sends the bill to the House.

The issue went unnoticed by many observers when the session began, but the Senate moved quickly to block any attempts by supporters, such as the South Carolina Hospital Association, to keep parts of the program, which they say protect health care in rural areas, and can Prevent hospitals from overspending due to competition.

The most ardent supporters of the repeal come from fast-growing areas such as Horry County and suburbs south of Charlotte, North Carolina. Groups there have been unable to convince state regulators and courts that hospitals are needed to serve the region.

“Eighteen years, no hospitals. Eighteen years, no medical care. Broken bones, ruptured spleens, heart attacks, childbirths — all of these have come and gone,” said Senator Michael Johnson, a Republican from Fort Mill.

Legal proof is required to obtain a permit from the state Department of Health and Environmental Control to build or expand a hospital or to purchase expensive equipment such as an MRI machine. Supporters, including the statewide hospital system, say the rules save money by avoiding costly duplication of services, encourage health care to locate or stay in rural areas, and ensure that care is provided of the highest quality. Fifteen states have repealed programs mandated by the federal government in the 1970s.

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The six senators who voted against repeal said they feared that already bleak health care options in rural areas would get worse.

“I hope I’m wrong about the impact of this repeal,” said Sen. Kevin Johnson, D-Manning, who said he was asked to vote no by his local McLeod Health Clarendon Hospital, which worries about excess competition Hospitals would fail, and these competitors would then move themselves out of rural areas.

But the bill did have some Democratic support. “It couldn’t have gotten worse without the hospital,” said Sen. Mike Fanning, who represents rural areas in Fairfield and Chester counties.

The bill’s lead sponsor, Sen. Wes Cramer (R-Rock Hill), said the merger of South Carolina’s hospital system and the COVID-19 pandemic reversed the trend of repealing the law.

Previously, any medical business had to hire a consultant to help with the certification process, plus a lawyer to read the documents, and – if they were certified – even more lawyers to fight the inevitability of the decision appeal, Climer said.

“All you have to do now is raise capital and start building,” he said.

If repeal becomes law, 28 projects worth more than $1 billion currently bundled after initial approval will be free to build. They range from a 98-bed hospital in fast-growing Lancaster County to nine new cradles in the neonatal intensive care unit in Charleston, according to information provided to senators by Cramer.

It is no longer needed for 34 programs awaiting approval, including 10 different businesses that want to spend $70,000 each to provide intravenous drugs to people in most rural counties in the state.

“There is a general desire to compete in medicine,” Cramer said.

In 2013, when the then-governor, the need for a certificate was all but dead. Nikki Haley vetoed officials in the state budget of $2 million to run the program. The hospital sued, saying lawmakers never voted to end the program, and the state Supreme Court ruled in 2014 that the program should continue.

The House has previously passed bills that limited the program, but never ended it entirely.

Democrat Kevin Johnson said he hoped some Republicans who had proved so enthusiastic about the need to end would join their different health care proposals.