The case for insurer UnitedHealth Group (NYSE:UNH) seems almost too easy to make. UNH stock already has been one of the best performers in the market, rising 270% over the past five years. Earnings are expected to grow about 13% in 2019. Yet UnitedHealth stock trades at a seemingly attractive 18x multiple to this year’s EPS guidance.
With a 10% pullback from early December highs, a cheaper price seems to set up an attractive opportunity. UNH’s recent performance and huge earnings growth speak well of management. The company’s Optum unit is cutting-edge, and growing revenue while expanding margins. With $226 billion in revenue, meanwhile, UnitedHealth has the scale to serve customers and the size to pressure suppliers.
All else equal, I’d expect UnitedHealth stock to keep climbing. Indeed, I recommended UNH a year ago, and even ~15% higher, I’m still bullish. But there are risks here, highlighted by near-term trading in UnitedHealth stock. And investors need to understand those risks before proceeding.
The Case for UnitedHealth Stock
This simply seems like a good business. Growth has been phenomenal. The midpoint of 2019 EPS guidance of $14.40-$14.70 suggests a 155% increase from 2014 levels.
Obviously, a lower tax rate and acquisitions have provided some outside help. But this is a company operating well, with revenue and margins both rising.
UNH has a diversified portfolio, too. It has its hands in seemingly every market, with the insurer serving employers, individuals, Medicare, and state and local governments. The Global segment, built through targeted M&A, is now a $10 billion-plus revenue business.
And Optum is at the forefront of changes in the industry. 2018 revenue rose double-digits, and operating margins continued to expand. Other PBMs (pharmacy benefit managers) are struggling. Rite Aid (NYSE:RAD) unit EnvisionRx has disappointed. Express Scripts managed to sell itself to Cigna (NYSE:CI), but at only a modest premium to 2015 highs. In that context, Optum’s performance is even more impressive.
This seems simply like a very attractive business. It’s the largest health insurer in the world. Optum remains a roaring success. And yet UNH stock isn’t that expensive, trading at less than 18x the midpoint of FY19 EPS guidance.
Double-digit annual EPS growth, a 1.4% dividend and potentially a higher multiple over time mean UnitedHealth could return 10%+ annually for years to come.
The Two Key Risks to UNH Stock
There are two key risks, however. The first is that competitors are trying to gain scale themselves and expand their reach. Cigna bought out Express Scripts. CVS (NYSE:CVS) acquired Aetna. Rivals are coming after UnitedHealth’s market lead.
To be fair, larger mergers haven’t played out. Cigna and Anthem (NYSE:ANTM) planned to merge back in 2017, but called it off. Aetna and Humana (NYSE:HUM) did the same. But competitors are trying to copy at least some of UnitedHealth’s strategy, and their success could make them more formidable foes.
The bigger risk is on the political front. UNH stock has struggled in recent sessions after the Trump Administration announced a plan to end drug rebates (which benefit PBMs like Optum). An apparently ham-handed response from Optum, which asked for 21 month’s notice of any changes from drug manufacturers, brought some unwanted publicity, and framed Optum as potentially part of the problem – not the solution.
From a long term standpoint, UnitedHealth almost certainly can adapt to any changes. But with net margins only just above 5%, even modest pressure on pricing, reimbursements, or other areas of the business can have a big impact on overall profits. And in the short-term, noise around regulatory changes could impact UnitedHealth stock, as appears to have been the case of late.
A Matter of Trust
At these levels, at least some of the risks are priced in. And I’d be loath to put too much faith in the federal government, in particular, doing anything to notably change the healthcare model in the U.S.
But that could change. A scenario where a Democratic candidate wins the Presidency in 2020 and is backed by a Democratic Congress is far from impossible. Should such a scenario seem plausible next year, UNH stock could start pricing in that risk.
Right now, 18x earnings might seem cheap but it’s not hard to picture UNH trading at 13-14x (or even worse) if investors believe regulators are coming for the company’s margins.
The changing political landscape and UnitedHealth’s exposure to that landscape, mean this isn’t a set-it-and-forget-it stock. Investors need to understand the risks and be willing to be nimble if political risk, in particular, starts to creep up.
In the meantime, however, the pullback in UNH stock makes an attractive business available at an enviable price. And that’s enough to make UNH a buy – at least for now.
As of this writing, Vince Martin has no positions in any securities mentioned.
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