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Eye on the Election
THEME
Caution, Risks Ahead for Healthcare
■
In March, Credit Suisse launched a series of reports that examine the
potential impact of candidates’ proposed policy changes. (See Eye on the
Election: A First Look at Implications across Sectors, March 27, 2008.) This
update focuses on the healthcare sector.
■
The market’s current focus is on macro trends. Following second quarter
results, we expect attention to shift toward the potential implications of the
upcoming elections. We see this as a risk for the healthcare sector, as we
believe the subindustries are not uniformly pricing in the political risks.
■
Our Washington consultants and voter polls indicate Barack Obama as the
likely president, with a Democratic-controlled Congress, which could be::
! Negative for managed care, as Democrats favor reducing MA payments
and supporting guaranteed issue requirements, and broadly encourage
greater federal regulation of the health insurance industry. On a positive
note, Democrats support an expansion of SCHIP.
! Negative for major pharma, as we expect greater pricing pressures, but
a positive twist could be the FDA climate.
! Negative for medical devices, as we expect Medicare reform along with
more price and mix pressures and tighter regulation.
! Slightly negative for biotech due to pricing pressure and generics.
! Neutral for medical supplies due to their product and geographic mix.
! Initially positive for providers given efforts to expand coverage, but
longer term it is a negative, as Medicare reform seems inevitable.
! Slightly positive for labs and diagnostics, as lab testing is viewed to be
cost-effective and able to offer early detection/prevention.
! Positive for generics given the Democrats’ support of generic drugs,
which in turn is slightly positive for the PBMs and drug distributors.
Table of Contents
Politics Matter 3
What Voters Think about Healthcare 4
Both Parties Support Healthcare Reform 6
Where the Race Stands Today 7
Healthcare Sector Performance 8
What’s Price In? 10
Democrats and Healthcare 11
But What If McCain Wins? 15
Election Implications beyond Healthcare Reform 16
Credit Suisse Stock Selections 17
The U.S. Healthcare System 21
An Overview of the Healthcare System 22
National Health Expenditures 23
Healthcare Payors 24
Private Health Insurance 24
Medicaid and SCHIP 26
SCHIP Reauthorization 26
Medicare 28
Defining the Healthcare Problem: The Basis of the Candidates’ Platform 29
The Number of Uninsured Continues to Rise 29
Health Insurance Premiums Outstrip Wage Growth 29
National Health Expenditure Continue To Rise 31
What’s Driving the Growth in Healthcare? 32
The Medicare System: The 800-Pound Gorilla 33
The CBOs’ View on Healthcare Reform 35
MedPAC’s Medicare Reform Recommendations 36
How Does the U.S. Compare with Other Nations? 38
Major Reform Topics by Healthcare Industries 40
Medical Supplies and Devices 41
Medicare Part A Reform Seems Inevitable 42
CMS Exploring Gainsharing and Bundling Payments 44
Pricing Transparency 45
Sales & Marketing Practices Under The Microscope 45
Comparative Effectiveness 46
Labs, Home Healthcare, and Oxygen Providers 49
Medicare Part B Reform: Competitive Bidding 49
Managed Care 51
Medicare Part C Reform: Medicare Advantage 52
The Wyden-Bennett Healthy Americans Act 53
Winners and Losers under the Wyden-Bennett Healthy Americans Act 55
Pharmaceuticals 60
Medicare Part D Reform: Drug Price Negotiation and Reimportation 62
Generics and Biotech 63
Generic Biologics 64
Pricing Scrutiny On Biotech Drugs 66
PBMs, Drug Distributors, Healthcare IT 67
PBMs, Drug Distributors 67
Healthcare IT 68
Glossary 69
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