Is The CVS Health/Aetna Proposal Really Just About Amazon?

Financial journalists seem to have a pretty simple playbook these days. Most any retail-related corporate development is a direct result of Amazon (AMZN). Plain and simple. No questions asked.

Last night it was reported that CVS Health (CVS) has made a bid for health insurer Aetna (AET). Immediately the media closed the book on the strategic rationale for the deal; Amazon might soon start offering mail-order prescriptions and CVS needed to make a bold move to counter that attack.

If CVS is really most worried about Amazon stealing away its pharmacy customers, would the best counterattack to be buy the country’s third largest health insurance company? Does that make sense?

It seems to me that the best competitive move to help insulate you from losing prescription share to Amazon would be to buy a last mile delivery company and use it to offer same-day or next-day prescription delivery to the home. After all, it is not like Amazon has any scale in the drug wholesale business, considering that they have yet to even enter the business to start with! And even if they do get into the business, are they really going to be able to get better pricing for drugs than CVS can, with its existing network of 10,000 retail pharmacies?

I would suggest that the CVS bid for Aetna is more about extending their corporate strategy of becoming a vertically integrated healthcare services provider. You have to remember that CVS bought Caremark, a pharmacy benefits manager, or PBM, more than a decade ago. They started Minute Clinic, the largest retail walk-in clinic chain in 2000. They acquired Omnicare, a pharmacy specializing in nursing home services, in 2015. Becoming more than just a retail pharmacy chain has long been the entire idea behind the company. It also explains why reports say that CVS and Aetna have been talking for six months (this idea was not just thrown together quickly because Amazon is applying for pharmacy licenses).

Adding a health insurer to the mix was a logical extension of that. Competitor United Health took the opposite route, as an insurance company that added Optum Health, a PBM, later on. That strategy has been wonderfully successful and I suspect that CVS and United will dominate the integrated healthcare services business for years to come.

Of course, the narrative on Wall Street has nothing to do with any of this. CVS stock is getting crushed today and United Health is up three bucks. The one-year charts make it seem like these businesses have nothing to do with each other:

To me it is simply baffling that UNH trades for 21x 2017 earnings estimates and CVS commands just 12x. If CVS really does build out a UNH-like operation, with a small retail pharmacy division, I can’t fathom how that valuation gap won’t narrow over time. But the investor community right now just can’t get that bricks and mortar component (no matter how small it would be post-Aetna) out of their heads.

What is probably most interesting is that Amazon does not have a history of putting companies out of business when it enters new markets. Amazon started selling books online in 1994. It launched the Kindle e-reader in 2007. If any bricks and mortar retailer should have been gone by now, it would have to be Barnes and Noble. And yet they are still alive and kicking:

A lot of people thought that Best Buy was finished once Amazon started selling a huge selection of consumer electronics. After all, with thousands of reviews, great prices, and fast shipping, why bother going to a store to buy a TV or computer? And yet, here is a five-year chart of Best Buy stock:

All Best Buy had to do was offer price-matching and quick delivery to keep a lot of market share from people who like buying online. And then you will always have a subset of folks who like kicking the tires in-person and asking knowledgeable people questions about the products.

While Amazon’s reach and e-commerce infrastructure will seemingly allow it to always take a certain amount of market share, it does not typically spell death for competitors. This is especially true when Amazon can’t offer anything better than anyone else. Plenty of companies can offer good selection and good prices, and they are finally spending the money to handle the quick delivery too. And with physical stores, in some cases they even have a leg up on Amazon.

Jeff Bezos likes to say “your gross margin is our opportunity.” By that he just means that if you mark up your prices too much, for no good reason, Amazon will undercut you and take your market share. For that to work, margins have to be high in the first place. For books and consumer electronics, gross margins aren’t very high. For other areas like auto parts, where product markups are 100%, do-it-yourselfers will probably shift business away from bricks and mortar retailers and to Amazon for certain items.

In the case of pharmacies, we are not talking about huge markups, from which Amazon can really offer a significantly better deal. Sure drug prices are sky-high in many cases, but there are a lot of middlemen that split the profits. Manufacturers ship product to distributors, who stock the shelves at the pharmacies upon receiving orders, who resell to consumers. Amazon is starting from scratch and has none of those capabilities yet. If their plan is simply to buy drugs from wholesalers and ship them via Prime to their customers, there is not going to be a lot of margin to shave off in the process, nor will they be doing anything different than others.

That becomes even more true because they will not have scale at the outset to get better wholesale pricing from the suppliers. And if Amazon goes directly to the drug makers demands better prices, the drug companies will just say, “sorry, get your supply from the same places everybody else does.” They are not going to voluntarily give up margin when they don’t have to.

And then there is the whole issue of whether Amazon can partner up with the employers, PBMs, and insurers to get access to their customer bases. Is Wal-Mart or Target going to add Amazon to their preferred network for employer-sponsored prescriptions? If CVS buys Aetna, will they let Aetna members get their drugs through Amazon at the same prices they could through CVS retail or mail order? And what is stopping CVS from hiring drivers at $15 an hour to drive around their local neighborhood delivering prescriptions to people’s homes? Does Amazon really have any competitive advantages in this space, assuming they enter it in the future?

I guess they could buy Rite Aid and Express Scripts, to add pharmacies and a PBM, but even after they spend all that money and integrate those businesses, aren’t they just in the same boat as CVS and Walgreens? Sure they are players at that point, but how will they crush the competition?

This is why I am skeptical that Amazon will try to do everything, will succeed at everything, and will kill off legacy providers that have been doing this stuff for decades. When I see a powerhouse like CVS, which will only get stronger if it buys Aetna, trading at 12x earnings, with the rest of the market trading at 20x it just doesn’t make a whole lot of sense. As Warren Buffett would say, “in the short term the market is a voting machine, but in the long term it is a weighing machine.”

Full Disclosure: Long shares of Amazon and CVS Health at the time of writing, but positions may change at any time

 

 

 

Gilead Sciences Take First Step Towards Higher Valuation Multiple

It has been a tough couple of years for shareholders of Gilead Sciences (GILD), the leader in treating HIV and Hepatitis C, or HCV. After shocking the biotechnology world by buying little known Pharmasset in 2011 for $11 billion, which gave them what would be become the leading HCV treatment, Gilead’s stock soared as Sovaldi (and later iterations of the drug) set a record for the best drug launch in the history of the industry.

However, as Gilead effectively cured thousands of patients in short order, it became clear that their HCV franchise would peak, and then slowly decline over time. As profits peaked and turned down, so did GILD shares, beginning in 2015:

What happened next was a classic Wall Street (read: short term focused) reaction. The stock went from darling to dud because Gilead had nothing in their drug pipeline that could offset the loss of HCV revenue after those initial patients were cured. At the beginning of 2017, GILD stock fetched $72, or just 6 times trailing 12-month free cash flow. A free cash flow multiple of 15-20 is pretty normal for the pharma and biotech space, so investors were essentially saying that GILD was going to see its profits decline more than 50% permanently.

I started buying the stock in late 2016 because the situation seemed very similar to instances when quality drug companies come to the end of the patent life for one of their best selling medicines. Knowing that generic versions are coming, investors drastically cut the earnings multiple they are willing to pay, in case new drugs never come to pass.

Of course, this ignores the fact that the vast majority of the time those same companies take actions to limit the profit decline and eventually grow again. In my October 2016 quarterly letter to clients I wrote the following:

“The negative case for Gilead ignores the fact that corporations are very much like living creatures; they do not exist in a vacuum but rather can pull other levers and take actions to offset negative events. For instance, what happens if Gilead discovers new medications for other diseases? What if they siphon profits from their HCV drugs to acquire other companies in order to diversify their product pipeline? What if they use profits to repurchase their own stock, making each remaining share more valuable? Better yet, what if they do all three?

For example, Pfizer’s cholesterol drug Lipitor had sales of $9.6 billion in 2011. In 2012 sales fell by 60% after the patent expired and generic versions hit the market. To reflect this known reality, Pfizer stock closed out 2011 trading for $21 per share, or roughly 9x annual earnings. By 2015, Lipitor sales had plunged by nearly 90% but Pfizer’s annual earnings had only fallen by 5% as other products filled the void. Pfizer stock ended 2015 trading at $32, or 14x annual earnings.”

Today we learned that Gilead has agreed to acquire Kite Pharma (KITE) for $12 billion in what will likely be just their first step in a process to build a formidable oncology franchise. I would expect more deals like this, perhaps 1 or 2 over the next 12-24 months, to further diversify the company away from HIV and HCV.

If the transition is successful, investors will likely reward Gilead with a more normal valuation. The stock is only rising by 1% today, but over time there is no reason the valuation gap (compared with peers) will not close more dramatically. It will be a long time before Gilead gets back to peak profitability (2015 produced $13 per share of free cash flow), if they ever do, but let’s assume they can earn $10 per share in five years (versus perhaps $8 this year). Assign a reasonable 15 multiple to those earnings and Gilead shares would double from their current price.

Full Disclosure: Long shares of Gilead at the time of writing, but positions may change at any time.

Healthcare Stocks Look Poised To Rebound In 2017

Please excuse the technical difficulties this site has experienced lately. After some adjustments everything should be back up and running smoothly. As such, I am hopeful that posting frequency will pick up a bit this year.

Perhaps one of the more surprising stock market trends post-election has been the relative inability for the healthcare sector to get back on track after taking a beating during the campaign season. With government deregulation on the way, as well as a bipartisan bill having passed Congress late in 2016 that will serve to loosen the FDA drug approval process, rational minds might have expected healthcare stocks to stage a large rally, much has been the case with banking stocks (same thesis; rolling back the regulations put in place post-recession).

We have seen a bit of a pickup in recent days, but after an initial one-day surge on November 9th, healthcare stocks have been lagging generally. I fully expect that 2017 will be a much better year for the sector. Abusive drug price increases will surely still get the attention on lawmakers, but that practice should come to somewhat of a halt now that the industry has seen what can happen to the likes of Valeant (VRX).

While investors will have to temper their growth rate expectations for pharmaceutical-related companies, the fundamental demand story should remain intact longer term. The strong companies should have no trouble churning out consistent sales and strong cash flow. Doing so will prove to investors just how resilient the industry can be, and should result in more normal valuations for most players in the sector.

To give you an example of how strange some of the price action has been in these names, consider one that I have been accumulating recently, both personally and for clients: CVS Health (CVS). This leading healthcare name has seen its share price take a stunning downward turn, from over $100 to as low as $70 per share. It’s hovering around $80 currently.

CVS is not some small drug company with a few products that has grown by dramatically increasing prices. We are talking about a blue-chip franchise with leading positions in both retail drugstores and pharmacy benefit management. The historical record of shareholder value creation is impressive. From a long-term demographic perspective, CVS stands to benefit greatly from drug innovations and an aging population.

And yet somehow the stock is currently fetching just 14 times annual earnings, a whopping 30% discount to the S&P 500 index. With overall valuations in the market in the upper band of the historically normal range, CVS looks like quite a bargain, even as the sector has been a focal point for criticism. While stocks like this have hurt investor performance lately, myself included, I see little reason to think 2017 cannot be the start of a healing process for an excellent American company like CVS Health.

Election Cycle + Valeant Collapse = Healthcare Opportunities

If you look around the U.S. market these days you are likely to find the most value from a quantitative perspective in the energy and healthcare sectors. The former area is tricky because the underlying commodity price is so crucial to the profitability of many industry participants. Pipeline owners and large integrated energy plays depend less on the actual commodity price, but because of that you will likely find less value in safer subsets of the industry.

Within the healthcare space, we are seeing a familiar pattern come to the forefront again during the current election cycle. During the 2008 campaign the sector was in focus and saw unjustifiable selling. Back then it was largely centered on the private insurance industry, and this time around bad apples like Valeant have shined a light on drug company practices that sometimes tow a shady line.

Despite many that claim the markets are efficient, history shows us that just because markets go through periods where they shun certain companies, assuming the worst by painting every player with the same brush can be shortsighted. I recall back in 2008 when the health insurance stocks were crushed on fears of what government involvement under President Obama might look like. Many simply assumed that for-profit entities would suffer, without even thinking through what the political goals were and how that would play out in Corporate America.

To address whether the market “always gets it right” during the heat of the battle, let’s briefly revisit the 2008 healthcare scare. The thrust of Obamacare was that Americans would be required to purchase insurance and that said insurance would have a federally mandated minimum level of benefit (no lifetime benefit caps, no exclusions for pre-existing conditions, etc).  For a long time investors were so focused on the government getting involved that they missed the big picture. The law required that Americans buy a private health insurance plan. Only on Wall Street would the resulting market reaction be to conclude that this would be a bad development for companies selling those very insurance plans.

Quite logically, the health insurance stocks have been some of the biggest winners during President Obama’s seven-plus years in office. For instance, the iShares U.S. Healthcare Providers (IHF) exchange-traded fund, whose top holdings include all of the largest health insurance companies, has more than doubled in price since January 2008.

Fast forward to current day and we once again have an assault on the healthcare sector, but this time the selling is focused on pharmaceutical companies and their drug pricing, reimbursement, and distribution policies. Unlike the energy sector, there is not a large outside factor beyond the control of company executives that will determine the fate of their financial results. Sure, bone-headed management decisions like those made at Valeant under CEO Michael Pearson will get you in trouble, but that is true for any company in any industry. The idea that every drug company in the country acts just as Valeant has in recent years is ludicrous.

Sure, the ripple effects will be felt across the sector, but the idea that the business model of selling drugs is broken is silly. The U.S. demographic trends only point to more demand in the future. And with more Americans being covered by insurance, there will be plenty of dollars to be spent on treating an aging population.

So where should investors look for bargains? Below are four names that my firm owns in various quantities. If you strip out the noise and focus on underlying cash flow, I think there are plenty of attractively priced drug companies out there. And a year from now when the election cycle is over and the Valeant situation has been rectified one way or the other (bankruptcy or slow recovery back to health), I suspect market participants will get back to basics.

*Allergan (AGN) $225

*Horizon Pharma (HZNP) $16

*Perrigo (PRGO) $100

*Shire (SHPG) $183

All four of these companies look like Valeant in that they have engaged in a lot of M&A activity. In the case of Allergan, they also competed with Valeant for some of those deals. Horizon is smaller company that has grown by acquisition. Two were targeted by larger firms but had deals fall through (Pfizer walked away from a deal to buy Allergan, AbbVie did the same with Shire). Perrigo today announced that its CEO is leaving to replace Pearson at Valeant, after rebuffing a buyout offer from Mylan for $205 per share. Shire quickly pivoted after its failed AbbVie tie-up and agreed to buy Baxalta.

You can see why these stocks are down anywhere from 33% to 60% from their highs. Lots of noisy news flow over the last year. But if you strip all of that out you are left with strong companies with lots of free cash flow generation ability.

Lastly, I think it is important to note that the idea that growing through M&A in the drug sector is a red flag should be reevaluated. Just because Valeant borrowed more than $30 billion and systematically overpaid for acquisitions does not mean that any drug company that acquires other companies is a suspect investment. Consider that the single best launch of a new drug ever was Gilead’s Sovaldi ($10 billion in sales its first year), which was acquired via the acquisition of Pharmasset in 2012. Before that, one of the best-selling drugs of all-time was Pfizer’s Lipitor, which peaked at over $13 billion in annual sales. Lipitor was developed by Warner Lambert, a competitor Pfizer acquired 15 years ago. As with any acquisition, it all comes down to what you get and how much you pay. The idea that investors should shun drug companies that have a history of M&A, without looking any deeper, is strongly misguided.

Full Disclosure: Long shares of Allergan, Horizon, Perrigo, and Shire at the time of writing, but positions may change at any time

Even Great Investors Like Bruce Berkowitz Make Mistakes

I know, I know, the headline above is not earth-shattering news. Every quarter dozens of the world’s best investors disclose their holdings to the world via SEC filings (granted, the data is about 45 days outdated, but it still gets lots of attention). It’s easy for individual investors to follow well-known money managers into certain stocks, figuring that they can piggyback on their best ideas. I can certainly find far worse investment strategies for people to implement, but it is still important to understand that even the best investors make mistakes. And there is nothing stopping the stocks you follow certain people into from being one of the mistakes rather than one of the home runs.

I think this topic fits right in with my previous post on Sears. Not only is Eddie Lampert the company’s CEO and largest shareholder, but he is one of the best hedge fund managers of the last 25 years. It is perfectly reasonable to assume that a billionaire in his position would be primed to create tons of value for investors. And yet, since Lampert orchestrated the merger of Kmart and Sears, which formed Sears Holdings in 2005, the stock price has dropped from $101 the day the deal was announced to $40 a decade later. Adjusted for dividends and spin-offs received over that time, Sears stock has fallen by about 40%, while the S&P 500 index has risen by about 80% during the same period. Eddie Lampert’s ownership and involvement alone has meant little for investors’ portfolios. Simply put, Sears Holdings has been one of his mistakes.

Interestingly, many of the company’s steadfast bulls point to the fact that another very smart and successful investor, Bruce Berkowitz of Fairholme Capital Management, owns 23% of Sears Holdings. That’s right, Lampert and Berkowitz own or control 70% of the company. Berkowitz isn’t new to the Sears investor pool either; he started buying the stock in 2005 just months after Sears Holdings was created. How can both of these guys have been so wrong about Sears for so long? It’s not a tricky question. Neither of them is perfect and they have made (and will continue to make) mistakes. It really is that simple. Since I have written about Eddie Lampert many times since this blog was launched ten years ago, I think it would be interesting to try and figure out why Bruce Berkowitz has been on the losing end of Sears.

Berkowitz’s background is in analyzing financial services companies, which is why you will often find most of his capital allocated to banks and insurance companies. Those industries are his bread and butter. In fact, Berkowitz’s flagship Fairholme Fund had more than 80% of its assets invested in just four companies as of February 28, 2014: AIG, Bank of America, Fannie Mae, and Freddie Mac. If that doesn’t signal his preponderance for financial services companies, I don’t know what would.

Now, Berkowitz has not been shy about why he invested in Sears Holdings; he thinks there is a ton of hidden value in its vast real estate portfolio. Unfortunately, his trading record in Sears (he first bought the stock during the third quarter of 2005 at prices well over $100 per share) shows that real estate might not be one of his areas of expertise. Warren Buffett has popularized the term “circle of competence” and tries very much to only invest in companies he understands very well. That’s why up until recently (his 2011-2013 purchases of IBM shares bucked the trend) Buffett has avoided technology stocks.

I would postulate that real estate investments do not fit squarely into Bruce Berkowitz’s circle of competence. As you will see below, his trading record in Sears underscores this, but we have also seen it with his massive and long-standing investment in St Joe (JOE), a Florida real estate developer.

Below is a quarterly summary of Fairholme Capital Management’s historical trading in Sears stock (I compiled the data via SEC filings). Of the 24.5 million shares Fairholme currently owns, more than 55% (13.6 million) were purchased over a 15-month period between July 2007 and September 2008, at prices averaging about $110 per share. More troubling is that this was when real estate prices in the U.S. were quite bubbly, coming off a string of record increases (most local markets peaked in 2006 and 2007) and Berkowitz was largely investing in the company for the real estate. The timing was quite poor. All in all, if we assume that Fairholme paid the average price each quarter for Sears, the firm’s cost basis is about $85 per share (before accounting for spin-offs).

FAIR-SHLD

St Joe (JOE) has also turned out to be one of his relatively few mistakes. It could certainly be merely coincidence that both the Sears and St Joe investments were made based on perceived (but yet-to-be-realized) real estate value, but I’m not so sure. Like with Sears, Fairholme Capital Management has a very large stake in St Joe. In fact, Fairholme is the largest shareholder (owning about 27% of the company) and Bruce Berkowitz is Chairman of the Board (sound familiar?). Berkowitz started buying St Joe during the fourth quarter of 2007, around the same time he was massively increasing his investment in Sears. His largest quarterly purchase was during the first quarter of 2008 (talk about bad timing), when he purchased more than 9.2 million shares (37% of his current investment).

St Joe’s average trading price during that quarter was about $38 per share, but subsequent purchases have been at lower prices, so the losses here are not as severe as with Sears. By my calculations (see chart below), Fairholme’s average cost is around $28 per share, versus the current price of about $20 each. But again, not only has the investment lost about 30% of its value, but the S&P 500 has soared during that time, so the gap in performance is so wide that it would take a small miracle for either of these investments to outpace the S&P 500 index over the entire holding period, as the returns needed to make up for 7-10 years of severe losses during a rising stock market are significant.

FAIR-JOE

Now, the purpose of these posts is not to point out the few big mistakes two very smart investors have made over the last decade, while failing to mention their big winners. Any of my readers can look at the history of the Fairholme Fund or ESL Partners (Eddie Lampert’s hedge fund) and see that they both have posted fabulous returns over many years. The point is simply to show that sometimes these investors make mistakes, even with companies where they own and/or control a huge amount of the stock. Just because Eddie Lampert and Bruce Berkowitz are involved in a major way (either in ownership, operationally, or both), it does not ensure that the investment will work out great for those who eagerly follow them. Just because they are smart investors does not mean these are “can’t miss” situations. There are plenty of people who are sticking with Sears because of Eddie, or sticking with St Joe because of Bruce. That alone, however, is not necessarily a good reason to invest in something.

I will leave you with one more example of Bruce Berkowitz making a large bet on a stock outside of his core financial services wheelhouse. At the end of the third quarter of 2008 Fairholme Capital Management owned a stunning 93 million shares of pharmaceutical giant Pfizer (PFE). It was an enormous position for him and was featured in many investment magazines. This single $1.73 billion investment represented as much as 24% of end-of-quarter total assets under management for Fairholme, and all of those shares were purchased over a 26-week period in 2008 (more than 3.5 million shares purchased, on average, every week for six months).

FAIR-PFE

Now, given how large of a bet this was, even by Bruce Berkowitz standards, it would have been easy to assume that this investment would be a home run. But as you can see from the trading data above, Fairholme lost money on Pfizer after holding the stock for only about 18 months. During the fourth quarter of 2009 alone, the firm sold more than 73.4 million shares of Pfizer (after having purchased 73.7 million shares during the second quarter of 2008). Perhaps pharmaceuticals aren’t Bruce Berkowitz’s bread and butter either. Fortunately for him and his investors, however, his prowess picking banks and insurance companies has helped him compile an excellent track record since he founded his firm in 1997.

Full Disclosure: No position in St Joe or Pfizer at the time of writing, but positions may change at any time.

Part Time Workers, Consumer Spending, And The Affordable Care Act

Don’t worry, no political arguments will be made here. That is not worth the effort for the author or the readers of this blog. However, since we are focused on stock picking as investors, it is a valuable exercise to dig into the data and determine if there will be a material impact on U.S. corporate profits because of the Affordable Care Act. After all, if consumers’ pockets are squeezed from fewer hours worked each week and/or the need to start buying health insurance for the first time, that would definitely impact the sales and earnings of the companies we are invested in. And that could hurt our portfolios.

Since the September jobs report came out this week I decided to take a look and see if the trend than many people fear as a result of the new healthcare law — employers shifting full-time workers to part-time status in order to be exempt from being required to provide them with health insurance — has actually started to take hold. Many people have already argued one way or the other, but most of them have political motivations and rely on a small subset of anecdotal reporting without actually looking at the numbers and reporting the truth.

The good news for our investment portfolio is that this trend has yet to materialize. It certainly could in the future, so we should continue to monitor the situation, but so far so good. Last month there were 27, 335,000 part-time workers, out of a total employed pool of 144,303,000. That comes out to 18.6% of all employed people working part-time (defined as less than 35 hours per week). That compares with 26,893,000 part-time employees during the same month last year, which equated to 19.1% of the 142,974,000 employed persons. Interestingly, part-time workers are actually going down in both absolute terms and relative to full-time workers. These numbers will fluctuate month-to-month, but it clearly has not happened as of yet.

The other potential problem with the Affordable Care Act, and more specifically the requirement that everyone buy health insurance, is that discretionary consumer spending could fall as more of one’s after-tax income goes towards insurance and is not spent on discretionary items. We should remember of course that consumer spending counts the same in the GDP calculation regardless of whether or not we buy insurance or other things, so there is no overall economic impact. But, we should expect to see consumers allocate their funds differently, which could impact specific areas of the economy (vacationing, for instance).

But just how much of an impact will this have? Will it be large enough to materially hurt the earnings of many public companies? To gauge the overall potential for that we need to dig into more numbers.

About 15% of the U.S. population does not have health insurance. Let’s assume 100% compliance with the Affordable Care Act (either via the purchase of insurance or the payment of the penalty for not doing so). Let’s further assume that the net negative financial impact of such compliance comes to 5% of one’s income (not an unfair assumption based on insurance premiums). That means that approximately 0.75% of consumer spending (5% x 15%) would be reallocated to healthcare and away from other areas. While that is not a big shift, it would be real.

However, the analysis can’t end there. We can’t simply conclude that approximately 1% of non-healthcare consumer spending will be lost due to the new law. Why not? Because that would assume that every American earns the same income. In reality, those impacted by the Affordable Care Act (the uninsured), are skewed towards lower and middle income folks. Most wealthier people get health insurance through their full-time jobs and will continue to do so.

Now, the bottom 50% of Americans only make 15% of the income earned nationwide. If we factor that point into the equation, then the overall impact on consumer spending goes from quite small (0.75% per year) to fairly immaterial. In fact, it comes out to something around 0.2% of overall consumer spending per year if we assume that the average uninsured person falls into the 25th percentile of total income.

So what is my conclusion from all of this? Well, I own a lot of shares in consumer-related companies both personally and for my clients, and I am not concerned about the Affordable Care Act taking a meaningful bite out of the profits that those companies are going to generate in the future.

Investors in Sarepta Therapeutics Should Think About Selling Some

Today’s big stock market winner is Sarepta Therapeutics (SRPT), a small biotech company developing Eteplirsen, a novel therapy for Duchenne Muscular Dystrophy. Shares are rocketing higher by a stunning 175% today, from $15 to $41 each, on news that a phase 2 study showed promising results compared with placebo.

There are some red flags though, that should be pointed out. The study was completed on just 12 patients, normally not a large enough sample to get FDA approval. And 4 of those were the placebo group, so only 8 subjects received the drug for the full 48 week trial period. Second, the particular genetic mutation this drug targets is only present in 13% of cases, so the potential patient pool here is only about 2,000 people in the United States.

At a price of $400,000 per year (a typical level for orphan drugs that treat small patient populations), U.S. sales could reach $800 million if the drug is approved and every patient takes it. There are a lot of “ifs” in this scenario, however, and after today’s huge stock price jump, Sarepta is being valued at nearly $1 billion already. FDA approval, even if it comes, it not right around the corner.

Long investors would be wise to consider taking some of their gains off of the table. Small cap biotech stocks like this are quite risky, especially after having nearly tripled in a single day. Situations like this can easily go either way longer term.

Full Disclosure: No position in SRPT at the time of writing, but positions may change at any time

If Conservatives Succeed in Phasing Out Medicare, HMO Bull Market Will Continue Unabated

Contrary to what opponents of the Obama Administration’s healthcare reform law argued originally (that the “government takeover” of healthcare would drive private insurance companies out of business), HMO stocks have been on fire over the last two years, as this chart of the Morgan Stanley Healthcare Payor index shows:

The reason, of course, is that the new law was about as far from a “government takeover” as one could get. Instead, Americans are being required to buy insurance from the private sector, which not surprisingly, is a huge boon to the HMO companies (hence the stocks are soaring).

With healthcare costs rising far faster than inflation, and the long term costs of Medicare serving as the single biggest problem for our federal government’s long term budget issues, Republicans led by Rep. Paul Ryan are unveiling a new budget proposal. At the heart of the plan is a phase-out of Medicare for Americans who today are under the age of 55. In its place, the government would subsidize the cost of private insurance plans that retirees would purchase on their own. Think of it as the same employer-based system you have now at work, except that the government would pay some of the cost of the plan after you retire, and you would be responsible for the rest.

This concept is sure to face a ton of backlash, as it shifts the burden of surging healthcare costs from the government directly into the pockets of the middle class America. However, imagine how great it would be for the insurance industry and the HMO stocks. Not only would the HMO companies operate in an environment where people were required to buy a plan from them, but all of the country’s retirees would become their customers, whereas today they don’t sell plans to any retirees who qualify for Medicare.

This is surely a development to watch, not only from the standpoint of future retirement planning, but also in terms of how you analyze potential healthcare investments in the future. The U.S. healthcare system is already run based on how much profit can be generated (not how to give the best care for the lowest price) and this new plan would transfer even more wealth from the pockets of Americans to the coffers of the insurance industry. Not good for us, but great for the HMO stocks!

Forbes Investor Team Recommends Genentech Stock, Even Though It Stopped Trading 16 Months Ago

File this away as the most amusing item of the day. I always get a kick out of some of the investment articles I see on various finance-related web sites. Now, I am sure I have made a few mistakes over the years on this blog, but never anything like what the Forbes Investor Team posted on their site today. In a piece written by John Reese of Validea Capital Management, there are four stock recommendations, including Genentech. Here is what John says about the company:

The South San Francisco-based biotech firm ($100 billion market cap) has averaged a 22.1% ROE over the past three years, has increased EPS in six straight years, and has almost three times as much net current assets as long-term debt. It isn’t cheap, selling for almost 30 times trailing 12-month earnings, but my Lynch-based model thinks it’s worth it, given its 41.6% long-term growth rate. (I use an average of the three-, four-, and five-year EPS growth rates to determine a long-term rate.) Another reason the strategy is high on Genentech: the firm’s conservative financing. It has a debt/equity ratio of less than 20%.

Of course, this is amusing because Genentech was acquired by Roche more than a year ago, in March 2009, and the stock has not traded since. I have to question this manager’s “Peter Lynch-based model” given that it flashes buy signals on stocks that do not even exist anymore. Hilarious.

Despite Better Growth Prospects, Investors Are Shunning Biotechnology and Big Pharma Firms Alike

It was not too long ago that leading biotechnology companies fetched premium multiples to their large-cap pharmaceutical competitors. As the large well known pharma companies face many patent expirations in coming years, smaller and more growth-oriented biotech firms commanded both higher valuations and more favorable outlooks among investors. However, for some reason in recent months we have seen biotech stocks give up much of that premium. For the first time I can recall, many biotechs trade for below-market prices, in-line with slower growth pharmaceutical counterparts.

Here is a summary of some leading large cap stocks in both the biotechnology and pharmaceutical areas. You can see that the P/E ratios are very similar but the projected growth rates are meaningfully higher for the biotech sector, by a factor of nearly 5x. The only conclusion I can make from this is that biotech stocks continue to deserve higher relative valuations, but for some reason Wall Street has lost sight of this recently.