Donald Trump's victory over Hillary Clinton for the White House means that some big changes are coming for the healthcare industry. Trump plans to repeal the Affordable Care Act as quickly as he can, which will have positive and negative implications for many healthcare stocks.
In this episode of The Motley Fool's
A full transcript follows the video.
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This podcast was recorded on Nov. 9, 2016.
Michael Douglass: Welcome to Industry Focus, the podcast that dives into a different sector of the stock market every day. It's Nov. 9. I'm Michael Douglas, filling in for Kristine Harjes. I've got Todd Campbell, our regular contributor, on the line. Todd, how are you doing?
Todd Campbell: I'm doing great. This is going to be a fascinating show, and hopefully we're going to deliver a lot of value to people. As you led with, it's Nov. 9, and that means yesterday was a pretty important day.
Douglass: Yes. In case anyone who's listening is not aware, yesterday was an election day. Hopefully we're all aware, and hopefully we all got the chance to vote and exercise your civic duties. So, let's hop right in. Donald Trump is the president-elect. And the market responded. It was really interesting, because at first, there was a significant move down in the market. At one point, I saw the Dow down more than 700 points. At this point -- and it's roughly early afternoon -- the S&P 500 is actually up a little bit. This is all more or less normal. Historically, the markets moved around 1% a day over the last four elections. This is not totally abnormal in terms of market movement. There's always a little bit of response when somebody gets elected. Interestingly as well, healthcare is generally moving very positively. The IBB, the biotech index, has been up as much as 8% today. So, certainly, those with a lot of healthcare in their portfolios are probably seeing some green.
Campbell: Especially if they happen to be focused on the biotech area of healthcare, which is just absolutely taking off today. There are a number of reasons, which you and I will chat about with our listeners in a second. I just want to go backwards in time for one minute. You mentioned, last night, the futures had indicated of massive potential drop in the S&P. I think it's good to remind investors not to pay too much attention to those very illiquid overnight markets. They can make huge swings up or down. I know it can be frightening at times -- on balance, ignore them, because the result can be very different the next day once those markets open.
Douglass: Yes. That is important. If there's one takeaway from everything -- I'll just go ahead and give it away -- it's that we should always treat intraday, day-of, week-of moves with a lot of skepticism. The number of times that somebody has had a quote, or a tweet, or there was a rumor of a thing and stocks moved a bunch, and it ended up really not meaning much in the long term. That's definitely the Foolish way to think about it. Thank you for that, Todd.
Campbell: Absolutely. I guess that's segues pretty nicely into what we're going to be talking about today, especially, I would like to focus a little bit of attention on this biotech situation, because that's the basket within healthcare that's performing so much more strongly than these other baskets. We'll talk about some of the losers today as we go forward. As many of you know, if you've been listening to the show and following the biotech sector, it suffered a lot of selling in the past year. There were revelations of incredibly high price increases last fall that led presidential hopeful Hillary Clinton to come out with a number of different strategies or policy plans that she hoped would cap pricing or limit the cost of drugs to payers and patients. As a result, the election of Donald Trump last night changes the dynamic a lot for what kind of regulatory environment we could be in for this industry over the course of the next four years.
Douglass: Yeah. Or, at least in terms of the rhetoric. I think one of the really important things that we all have to accept and acknowledge in elections is that there's a lot of discussion about what could be done and what would like to get done, and then whoever you have elected, as president, then ends up having to work with Congress and the federal bureaucracy. So it's never quite as simple as people present it. But, certainly the tenor of that conversation has changed a lot now. A Donald Trump presidency, at least from the rhetoric so far, we would think would be less hostile to drug company price increases, in general.
Campbell: Sure. On the campaign trail, the two candidates presented very different approaches on their view for healthcare moving forward. On the one side, you had Hillary Clinton advocating for changes on the margin to Obamacare, that would improve it and potentially expand it. And then, on the other side, you had Donald Trump advocating for the removal and replacement of Obamacare entirely. So you've got some significant potential shifts. And with Congress also going red, I think while some of the smaller policy differences between the two still could get debated fairly handily -- again, we don't know how this whole Obamacare they will shake out once everybody starts negotiating -- but it would seem like we're going to have a big change to how insurance is provided, in Washington, at least.
Douglass: Yes. Certainly, the Republican Party has largely run on an anti-Obamacare platform. We can't predict the future, but it seems like that is something that could happen. If so, what's interesting about that is, that it actually potentially a bit of a con for these biotech companies where the stock prices are doing very well today, because it means you have a lesser patient pool. Fewer insured patients tends to mean less healthcare.
Campbell: There's like 12 million people enrolled in insurance plans through Obamacare on the exchanges earlier this year. I think the effective, or the ones who paid, gets you down to a little bit less than 11 million. You get a lot of Medicaid expansion states, 30-plus of them, where a number of millions of people got enrolled there as well. Theoretically, depending on what replaces Obamacare, we don't know whether or not the overall pool of people that could get reimbursed for medication is going to shrink. If it shrinks, then that could be a drag on the top line. However, you could also argue on the other side that there are other components of the ACA, or Obamacare, that if removed, would actually offset that headwind, and could actually provide some tailwinds.
Douglass: Right. One of my favorite things to say about healthcare is that we call it one industry, but it's really seven or eight, at least. You have biotech, and of course that gets a lot of the attention, a lot of the oxygen on this program. But there are other parts of healthcare, and in some of those, the stock price response to Donald Trump's election has been very different. Most notably, the hospital stocks are not having a good day, let's put it that way.
Campbell: Yeah. You look at large companies -- again. going back to some of the positives if Obamacare is rolled back -- and then you look at the tax plan that Trump has proposed from business taxes, you could get a significant drop in the tax rate for all of these companies, the ones that are profitable, down to 15%, which conceivably would be a positive. There's also the potential to repatriate cash -- that could be big for some of the large-cap biotech companies that operate overseas. That's a potential benefit there, not only for biotech but also for the big drugmakers like Pfizer, which has something absurd like $100 billion in cash overseas. So, there's a lot of different nuances you have to take into consideration here as you're evaluating the different industries within the healthcare sector, biotech just being one segment of that. There's less of a risk of price controls now. That would be good for specialty drugmakers, and makers of expensive cancer drugs, life-saving treatments, that type of thing. You mentioned hospitals as being a loser today. Absolutely. If Obamacare is repealed, that could push more people into uninsured care, or increase the bad debt expense at hospitals. Billions of dollars came off of bad debt expenses over the last few years after the passage of Obamacare. That's why you're seeing a number of these hospital stocks fall 20% today, or more. Then, of course, you also have the insurers that you have to take into consideration on this too, Michael, right?
Douglass: Right. It's kind of an interesting nuance because some of them have really struggled with the exchanges, but others have really benefited from Medicaid expansion. What it really comes down to is, if you're trying to pick long-term winners or losers today from this election, that's going to be a very difficult thing to do, because there's been a lot of rhetoric, there's been a lot of broad-based conversations about these things, but the devil is in the details. It's going to be really difficult to know, really, who's going to benefit, and what nuanced change will make a big difference to any one group. My general thoughts for our listeners are: Watch, keep an eye out, but don't necessarily make decisions about your portfolio based on what's going on in the market today, or on what you think might end up coming out of a unified Republican government and national legislature. Wait until you see the policy proposals and better understand exactly what the winners and losers could be.
Campbell: Right. In the past, Kristine and I often talked about this. You have to look at the longer-term picture as being the driving force behind healthcare. That includes a larger, older, longer-living population.
Douglass: Yeah. So, long term, the demographic tailwinds for healthcare still make it a very attractive sector. Let's wrap that there.
Let's head into our second segment. That's talking about individual state ballot questions. And my oh my, there was quite a bit about healthcare. Do you want to start with California Prop 61, Todd?
Campbell: Yeah, we'll take this one because it's easy and it segues nicely into what we were just talking about as far as drug pricing and the future of drug pricing. California had something on the docket. It was the California Drug Price Relief Act, also known as Proposition 61. Proposition 61 sought to tie California's healthcare spending, the state's spending on drugs, to the prices that are paid by the Veteran's Affairs Department. The concept there was the Veterans Affairs Department can typically pay 40% to 50% of whatever the list price happens to be for an individual medicine. Therefore, by passing this, they're basically saying, "We're going to get whatever the lowest price is that the VA is passing on these drugs." Theoretically, that could save California as a state a lot of money.
Douglass: Right. And it didn't pass.
Campbell: Didn't pass.
Douglass: The drug industry spent over $100 million lobbying against it. It's believed to be the most ever spent on a California ballot measure.
Campbell: Yeah, $106 million or $109 million, depending on who you listen to, was spent defeating this proposition. There were a lot of different things that could have happened, even if it had passed, they may have escaped some of the meat of the proposition. But, regardless, it's a nonevent because it was defeated. Proponents battled that $106 million or $109 million with $17 million. That tells you a little something. It suggests, we're still hunting for ways to control the cost of increasing drug prices. But, at least as far as California voters are concerned, tying it to the price that's paid by other government organizations or government payers such as a VA is not the way to go.
Douglass: Yeah. There is a large conversation going on about drug pricing in the United States, and that the drug industry is engaged in as well, with other stakeholders, including payers and patients and patient advocacy groups and hospitals, etc. So, this is definitely a conversation that's going to continue, just not in this particular way. I do not think that the drug pricing conversation is over, by any means, and I don't think anyone really thinks it is, either. It's definitely going to be something that continues, and continues to be an issue that people are talking about and voting on.
Let's also turn to marijuana initiatives. There were a number of them that passed, and a few that failed, as well. Florida had a medical marijuana ...
Campbell: Yeah. Nine states in total had marijuana on the ballot. Not all of them were recreational. To give a little refresher: There's four states right now that have passed recreational marijuana legislation. There are about 25 states that have passed medical marijuana legislation. On yesterday's ballots, you had California, Nevada, Maine, Massachusetts, and Arizona that had recreational on the ballot. Then, you had a host of other states -- Arkansas, Florida, North Dakota, Montana -- that were taking up the medical marijuana side. Broadly speaking, Michael, pro-marijuana advocates won the day yesterday.
Douglass: Yeah. You had medical marijuana pass in North Dakota, expanded use of medical in Montana, recreational in Massachusetts ...
Campbell: Yeah! Recreational passed in every state except for Arizona. California passed it, Nevada passed it. Maine was a really close call, I'm not sure if they've finished calculating all the votes. But early results show it passed there. Massachusetts passed as well.
Douglass: Yeah. So, certainly a big one for marijuana advocates. Of course, here's the thing with medical and recreational marijuana -- there are no good publicly traded business models right now that really rely on the sorts of things these ballot measures are talking about. You have your cannabidiol biotechs, but they're really not that related to medical or recreational use of marijuana. So, while their stock prices may or may not move based on a poll or the outcome of these initiatives, it really doesn't indicate anything about the underlying business model of a publicly traded marijuana company. There just simply aren't any good ones right now.
Campbell: Yeah, most of them trade on the pink sheets. They're not suitable for the majority of our listeners to even consider. It's not like you're talking about Reynolds or Philip Morris -- established companies. These are very fledgling companies that oftentimes have nothing more than addresses. Do not invest in these stocks until they get to the big time. I think the reason we talk about marijuana a lot on this show is simply because it's potentially expanding its use for different medical indications. There has been a lot of success using it in epilepsy, for example. And there are a lot of forecasts out there that shows rising use of marijuana through legalization and through the expansion of medical marijuana laws could have this industry growing 30% annually for the next five to 10 years. So, there's definitely a big shift, and potentially a market opportunity here. However, it's still in the very early innings. In fact, I would say this is spring training. We haven't even started the game yet when it comes to marijuana.
Douglass: (laughs) Oh boy, another sports metaphor that goes right over my head -- no, I'm just kidding, I got that one. Thank you, Todd. I think that's exactly right. When you think about a lot of these political issues, government issues, you really need to think very carefully before you start picking winners and losers, because all too often, it's really just too soon to know.
In response to market volatility today, Andy Cross, our chief investment officer, wrote a note that was sent to all Motley Fool members. It's currently top of site on fool.com, so check it out there and you can see it. If anyone, for whatever reason, isn't able to get it and wants to, email and ask for it. I can certainly shoot you the link. That's
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