NEW YORK (Reuters) - US drug distributor Cardinal Health Inc’s deal to buy Medtronic Plc’s medical supplies units days after Abbott Laboratories agreed to a long-awaited purchase of diagnostic testing company Alere Inc has raised the pulse of a sector suppressed by potential healthcare policy upheaval.
Healthcare deal-making among high-quality companies has stalled, with President Trump and the Republican Congress tackling and then unable late last quarter to repeal and replace the Affordable Care Act, known as Obamacare. Highly anticipated tax reforms are being delayed by the ongoing healthcare policy debate.
President Trump has vowed to cut corporate taxes, as well as allow companies to bring cash stockpiles held overseas back to the US at sharply reduced tax rates, which could also stoke merger and acquisition activity.
Investment grade healthcare companies borrowed just US$10bn in the loan market in the first quarter, 57% less than a year earlier, according to Thomson Reuters LPC. Loans to high-quality companies accounted for 60% of the US$178bn in healthcare lending last year. But in the first quarter, the share sank to just 28% of the US$35.5bn volume.
“For healthcare M&A, transformative deals may be more limited in 2017 due to uncertainty related to Obamacare ‘Repeal and Replace’ as well as pending tax reform,” said Allen Fisher, a managing director and global head of healthcare banking at MUFG. “Comprehensive tax reform seems almost as unlikely as healthcare reform.”
The deal logjam budged on Tuesday when Cardinal said it would buy Medtronic for US$6.1bn and agreed to a US$4.5bn bridge loan before locking in longer-term debt.
Earlier in April, diversified healthcare company Abbott said it would buy Alere at a lower price than initially offered in February 2016, with both companies agreeing to drop lawsuits that prolonged the transaction. Last year, Abbot raised a US$9bn bridge for the Alere deal, and has yet to detail further financing needs.
These tie-ups come on the heels of several high-profile health insurer mergers - Aetna with Humana and Cigna with Anthem - scrapped by separate anti-trust rulings earlier this year.
While healthcare mashups are being subdued, domestic M&A broadly is being curbed by the considerable uncertainty surrounding tax and trade policy. Some mergers will push forward, based on an urgency for a takeover target, bankers said.
“On the one hand you have PPG trying to go hostile into the Netherlands - which under the best of circumstances is difficult - as an example of an issuer willing to power through for an asset it wants to buy,” said a senior banker who expects ongoing strategic consolidation.
On Wednesday, Pennsylvania-based PPG Industries dismissed efforts by Dutch paintmaker Akzo Nobel to fend off its takeover bid and won support from an activist hedge fund investor, Reuters reported.
“On the other hand, there may be other Fortune 500 companies that are very much prepared to wait it out and see what the exchange rate environment, regulatory environment and general financing environment are before deciding if it’s still worthwhile,” said the banker.
Amid the unknowns, investors in the healthcare arena are scrutinizing their picks sector by sector.
“We’re trying to assess company performance to see whether there are going to be any liquidity issues, any collection issues, bad debt issues, things that would be indicative of the way payments and coverage may be affected,” said Farboud Tavangar, a founder of LCM Asset Management.
Public and political scrutiny of high-priced medications could pressure pharmaceutical corporations, for example. Hospital companies, on the other hand, could benefit from an aging population and growing medical needs, most investors and strategists agree.
“The essential service component of hospitals has always been a good protector against unreasonable actions in the past,” said Tavangar. “ we’re a little worried about diagnostics and reimbursements for diagnostics, screening and imaging companies, particularly if insurance companies approve fewer medical tests.”
Healthcare loan volume overall could end the year little changed from last year’s total, bankers said, even with current market trepidation.
First-quarter lending was off just 6% from a year earlier, as a surge of refinancing by lower-rated companies to cut borrowing costs tempered the slump in investment grade deals. Refinancing may continue to overshadow borrowing for new transactions.
A tax holiday that brings corporate cash to the US from overseas would “incentivize pharma and med-tech companies to go out and buy assets but not necessarily to make big-bet transformative acquisitions,” Fisher said. “Because the companies would use cash, it won’t necessarily produce a lot more financing activity.”