医疗保健投资者找到了他们最喜欢的选举赌注：医院运营商。但他们最好记住上一次反对党赢得众议院并誓言推翻总统医疗保健议程时发生了什么。
Investors are betting a blue wave will help hospitals. Don’t count on it. Healthcare investors have found their favorite election wager: hospital operators.
预测市场显示，民主党人在周二夺回众议院的概率极高，而参议院的归属则悬而未决。这一赌注的基础是，民主党获胜将为遭受华盛顿医疗补助计划（Medicaid）削减和强化版奥巴马医改（Obamacare）补贴失效打击的医院带来喘息之机。
But they would do well to remember what happened the last time an opposition party won the House vowing to roll back a president’s healthcare agenda. Prediction markets give Democrats heavy odds of recapturing the House on Tuesday, with the Senate hanging in the balance. The bet is that a Democratic win will bring relief to hospitals battered by Washington’s Medicaid cuts and the lapse of enhanced Obamacare subsidies.
医院类股票经历了大幅上涨。自6月1日以来，Tenet Healthcare上涨了61%，HCA Healthcare上涨了28%，Universal Health Services上涨了22%，而标普500指数几乎原地不动。
Hospital stocks have had a big run. Since June 1, Tenet Healthcare is up 61%, HCA Healthcare has advanced 28% and Universal Health Services gained 22%, while the S&P 500 has barely budged.
Tenet的涨幅很大程度上依赖于其手术中心业务强劲的盈利。另外两家公司则在不利消息下依然攀升。上周，HCA预计明年的盈利将持平，而UHS公布的季度利润有所下降。然而，投资者并未退缩：根据FactSet的数据，HCA目前的预期市盈率约为15倍，Tenet为13倍，两者均高于其五年平均水平。（最近的一些涨幅也受到向防御性股票轮动的推动。）医院确实需要帮助。
Tenet’s gains rest in large part on strong earnings from its surgery-center business. The other two have climbed despite bad news. Last week HCA guided for flat earnings next year, while UHS delivered lower quarterly profits. Yet investors haven’t shied away: HCA now trades at about 15 times forward earnings and Tenet at 13 times, both above their five-year averages, according to FactSet data. (Some of the more recent gains are also being driven by a rotation into defensive stocks.) Hospitals could use the help.
特朗普的“宏伟美丽法案”将很快开始实施医疗补助工作要求和更频繁的资格审查。到2028年，该法案将开始逐步削减许多州输送给医院的额外医疗补助拨款。另外，国会在去年年底让强化版的奥巴马医改补贴失效，将数百万人挤出了他们的计划。许多人仍然生病并出现在急诊室却无力支付费用。HCA上周表示，失去平价医疗法案（Affordable Care Act）交易所的承保使其在第三季度损失了约4亿美元的税前收入。
Trump’s “big, beautiful bill” will soon begin imposing Medicaid work requirements and more frequent eligibility checks. In 2028 it will begin phasing down extra Medicaid payments many states funnel to hospitals. Separately, Congress let enhanced Obamacare subsidies lapse at the end of last year, pushing millions of people out of their plans. Many still get sick and show up at emergency rooms unable to pay. HCA said last week that lost Affordable Care Act exchange coverage cost it about $400 million in pretax income in the third quarter.
但这就是医院交易中的漏洞所在。翻转众议院、甚至翻转参众两院，都不会让特朗普总统签署。雷蒙詹姆斯公司（Raymond James）的华盛顿政策分析师克里斯·米金斯（Chris Meekins）提到了2010年的中期选举，当时共和党人赢得众议院时承诺废除平价医疗法案。他们曾数十次投票废除该法案。当废除法案最终于2016年呈交给贝拉克·奥巴马总统的办公桌时，他予以否决。
But here is the flaw in the hospital trade. Flipping the House, or even both chambers, won’t deliver President Trump’s signature. Chris Meekins, a Washington policy analyst at Raymond James, points to the 2010 midterms, when Republicans won the House promising to repeal the Affordable Care Act. They voted dozens of times to repeal it. When a repeal bill finally reached President Barack Obama’s desk in 2016, he vetoed it.
“民主党人废除某些条款的唯一途径是，如果特朗普觉得他不得不向他们妥协，而他又何时那样做过？”米金斯说。他说，医疗保健方面的大妥协是“电视剧《白宫风云》（West Wing）编剧的想法，而不是华盛顿现实世界的想法”。
“The only way Democrats repeal some of the provisions is if Trump feels like he has to cave to them, and when has he ever done that?”Meekins said. A healthcare grand bargain, he said, is “TV show ‘West Wing’ writer thinking, not actual real-world D.C. thinking.”
周二民主党获胜将赋予该党筹码。政府资金将于12月11日耗尽，但该截止日期落在了当前的共和党国会上。米金斯预计议员们将通过一项权宜之计的延期法案直至2月份左右，从而将威胁政府关门的难题留给新国会。民主党人去年秋天试图延长强化版奥巴马医改补贴，引发了美国历史上持续时间最长的政府关门，而这些补贴最终还是过期了。
A Democratic victory on Tuesday would give the party leverage. Government funding runs out Dec. 11, but that deadline falls to the current Republican Congress. Meekins expects lawmakers to pass a stopgap extension through around February, leaving the new Congress to threaten a shutdown. Democrats tried last fall to extend the enhanced Obamacare subsidies, triggering the longest shutdown in U.S. history, and the subsidies expired anyway.
即便达成协议，对医院的任何救助也可能会非常有限。米金斯将推迟医疗补助工作要求或资格审查的概率定在15%以下。他说，最好的机会是将医院补充支付费用的逐步削减推迟一年，他认为这一概率约为40%。
Even if a deal does come, any relief for hospitals would likely be narrow. Meekins puts the odds of delaying Medicaid work requirements or eligibility checks below 15%. The best chance, he says, is a one-year delay in the phase-down of supplemental hospital payments, which he puts at about 40%.
这并不意味着这项交易在短期内不能继续发挥作用。周二民主党的大获全胜可能会给接触奥巴马医改和医疗补助的医院和保险公司带来又一波上涨。但在当前的估值下，医院股票几乎没有留下让人失望的空间。对妥协更为乐观的伯恩斯坦公司（Bernstein）分析师兰斯·威尔克斯（Lance Wilkes）写道，医院的潜在救助似乎已经反映在其当前的市盈率中。
That doesn’t mean the trade can’t keep working in the short term. A Democratic sweep on Tuesday could give one more bump to hospitals and insurers exposed to ACA and Medicaid. But at current valuations, hospital stocks are leaving little room for disappointment. Bernstein analyst Lance Wilkes, who is more optimistic about a compromise, wrote that the potential relief for hospitals appears to be reflected in their current multiples.
如果国会达成协议，威尔克斯认为森蒂恩（Centene）和莫利纳（Molina）等医疗补助保险公司可能会受益更多。它们的收入直接取决于保持参保的人数，而随着工作要求生效，投资者预计医疗补助参保人数会缩减。延期将使这些保险公司拥有比华尔街预期更多的会员以及更健康的结构，因为最有可能失去医保的人往往是那些使用医疗服务最少的人。
Should Congress strike a deal, Wilkes thinks Medicaid insurers such as Centene and Molina could benefit more. Their revenue depends directly on how many people remain enrolled, and investors expect Medicaid rolls to shrink as work requirements take effect. A delay would leave the insurers with more members than Wall Street expects and a healthier mix, since those most likely to lose coverage tend to be the people who use the least care.
购买医院股票的投资者是在押注华盛顿的妥协。如今，这是一个勇敢的赌注。
Investors buying hospitals are betting on compromise in Washington. These days, that is a brave bet.