COLUMBIA, S.C. (AP) — South Carolina hospitals would no longer need state permission to build new facilities, make expansions or buy expensive equipment after senators voted overwhelmingly to get rid of the requirement Tuesday.

The 35-6 vote eliminates the Certificate of Need program, long criticized by free market Republicans, and sends the bill to the House.

The issue wasn't on many observers' radar when the session began, but the Senate acted swiftly for its part, fending off any attempts to keep parts of the program by supporters — such as the South Carolina Hospital Association — who say it protects health care in rural areas and can prevent hospitals from overspending because of competition.

The repeal's most enthusiastic supporters came from rapidly growing areas like Horry County and the suburbs just south of Charlotte, North Carolina. Groups there have been unable to convince state regulators and the

“Eighteen years, no hospital. Eighteen years, no medical care. Broken bones, ruptured spleens, heart attacks, births — all of it came and went," said state Sen. Michael Johnson, a Republican from Fort Mill.

The Certificate of Need law requires permission from the state Department of Health and Environmental Control to build or expand hospitals or to buy expensive equipment like MRI machines. Supporters, including hospital systems across the state, said the rules save money by avoiding costly duplication of services, encourage health care to locate or stay in rural areas and assures care offered is the highest quality. Fifteen states have repealed their programs, which were mandated by the federal government in the 1970s.

The six senators who voted against the repeal said they were worried that already dismal health care options in rural areas would get worse.

“I hope I’m wrong about what this repeal will do," said Sen. Kevin Johnson, D-Manning, who said he was asked to vote no by his local McLeod Health Clarendon hospital, which fears a glut of competition will run the hospital out of business and those competitors would then leave rural areas themselves. 

But the bill did get some Democratic support. “It is impossible for it to get worse when you have no hospitals," said Sen. Mike Fanning, who represents rural Fairfield and Chester counties.

The bill's main sponsor, Sen. Wes Climer, R-Rock Hill, said the mergers of hospital systems across South Carolina and the COVID-19 pandemic turned the tide on repealing the law.

Before, any medical business had to hire a consultant to help go through the Certificate of Need process, plus a lawyer to read over the paperwork, and — if they won a certificate — even more lawyers to fight the inevitable appeal of the decision, Climer said. 

"All you have to do now is raise the money and go build," he said.