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RGA Investment Advisors 4Q20 Commentary: Naked Wines PLC

RGA Investment Advisors commentary for the fourth quarter ended December 31, 2020, discussing their investment in Naked Wines PLC (LON:WINE). Q4 2020 hedge fund letters, conferences and more Dear Clients, None of us will forget 2020. Collectively, we…

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RGA Investment Advisors commentary for the fourth quarter ended December 31, 2020, discussing their investment in Naked Wines PLC (LON:WINE).

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Q4 2020 hedge fund letters, conferences and more

Dear Clients,

None of us will forget 2020. Collectively, we faced immense challenges brought on by a kind of pandemic that infects humanity once every hundred years. We find ourselves uniquely fortunate, despite the year’s turmoil, as we reflect on how incredibly lucky we are to have a wonderful investor base with the tenacity to weather the storm earlier in the year. Our full year results are a direct result of your trust that the soundness of our process will inevitably result in good outcomes. At the same time, we want to caution that the results of this year are unique and will be incredibly challenging to replicate.

Adapting to the new realities of today poses many challenges. We are privileged to have exceptional partners who believe in us and in our investment process throughout. We continue to learn a tremendous amount from you about both in terms of life and business. Thank you for your patience and your cool headedness during the worst market crash since 1987 and for affording us the opportunity to work without distraction. Thank you for the continued opportunity to manage your hard-earned wealth. Thank you for sharing this journey with us. Some of you joined us more than a decade ago. You took a chance on two young gentlemen in this industry. You gave us the opportunity to try and prove our mettle as investors and we are here today as a direct result of your conviction. In recent weeks we have received an outpouring of thanks the likes of which we have never experienced before. It is imperative to us that we stress that it is we who are the lucky ones.

2020 has become a year of reflection for everyone. People find themselves contemplating their past life choices and present life state. The year has prompted us to think about what is most important in life and what sacrifices have been made in the pursuit of something that previously seemed important but were not actually meaningful in an enduring and spiritual way. We have similarly reflected on all of our past and present portfolio company experiences and in doing so, we spent considerable time reflecting on both our successes and failures (errors of commission and omission). In many respects, it has become clear that we as investors have matured and in doing so, we have identified very clearly our own unique recipe for successful investments. You may find us a little more reflective than usual below, though we think that is inescapable after the kind of year that has transpired.

Learn from Mistakes

The winter in early 2016 was our previous peak in turnover, prior to March of 2020. At that time, in a short span, we purchased meaningful positions in Grubhub, Envestnet and what was then Priceline, soon to be Booking. Each of these positions delivered internal rates of return (IRRs) comfortably above what we had hoped for, and two of these positions remained in our book for roughly our full five-year expected holding period. While we are pleased with the results of these specific purchases, we made a huge mistake of omission at that time. This mistake will likely be one of the biggest we ever make in our careers. Specifically, we did deep work on Shopify and loved everything about the business qualitatively. Unfortunately, we ultimately found ourselves unable to get comfortable with the numbers. We built our model up from the key performance indicators (KPIs) that drive revenues. Our last save of the model dated 8/3/2016 looked as follows:

These numbers seemed right from everything we understood about the company. While we tend not to rely on sell-side consensus estimates before finishing our own workup of the business, we do give them a look once we feel comfortable with how we have approached our analysis as it is often helpful to get a sense of what the average participant in the market expects the business to do. With Shopify, the sell-side consensus was so far from where our numbers were shaking out, it seemed almost impossible that we were basing our analysis on the same underlying information. Our natural next step was thus to take the sell-side consensus data and work backwards to figure out the implied expectations on each of the key revenue drivers. Here is what the sell-side consensus looked like as at the time:

Shopify’s actual revenues for 2016-2018 ended up being $389m, $673m and $1,073m. In other words, not only were we justifiably far more optimistic than the consensus estimate, but we also were far too conservative in terms of how the company actually performed.

The nature of our job as securities analysts is to take calculated risks, in an uncertain world where the “true” answer is inherently unknowable before the fact. We operate in what many call an “efficient market” and subscribe to the belief that for the most part, markets are generally pretty efficient and it requires differentiated analysis to find a return above what the market can offer. So why did we pass on Shopify despite 1) deeply believing in the qualitative elements of the business; and, 2) seeing a meaningful gap between what we expected and the consensus expected? The answer is unfortunate but simple: we lacked confidence in ourselves. It was the first time we truly experienced such a stark divergence between our expectation and the consensus and the result was the inclination was to pound ourselves over the head with how dumb we must be, rather than the other way around. We also learned that the truly great companies use their strong business advantages, smart management and execution to raise the bar every step along the way. Obviously this is a cycle which cannot continue ad infinitum, but especially in instances where our qualitative work identifies the inherent strengths in the business and the numbers shake out to be quite fair, the consistent “raising of the bar” can be a potent driver for the stock.

Please do not judge us too harshly for our mistake on Shopify, for we have from the very beginning made one commitment above all else to both our clients and ourselves: that we will be better today than we were yesterday, and better tomorrow than we are today. While this mistake was quite costly, it ended up being a key confidence and process builder. In fact, we believe that our Shopify “miss” and the learnings derived from it gave us the confidence to underwrite Roku with conviction in 2018.

For two years running, Roku has now been either the largest or second largest driver of performance in portfolios. When we purchased Roku, obviously we never expected such a phenomenal outcome, so quickly—these things can only be chalked up to luck. However, we do think luck is the residue of design and Roku had all the hallmarks ex ante as the kind of position that could do something wildly spectacular. One of the first signs in seeing Roku’s potential was the sharp contrast between our modeled expectations for the top line of the business and where the consensus expectations were. This was the Shopify setup all over again. By this time, we had added an additional tool to our analytical framework, and this helped further enforce our conviction that not only was it we who were right about where things should go, but also that the very existence of this gap could be a potent source of fuel behind the stock as the world came around to our expectation. Specifically, we had become increasingly comfortable building lifetime value analyses of companies, and notably, when we bought Roku, we were quite confident that with only modest annual increases in average revenue per user (ARPU), and a 5-year average customer lifespan, we were buying the company for its existing customer base and nothing more. In other words, the growth at Roku was entirely free at the prevailing prices we bought into.

The World According to GARP

Some have asked us to elaborate on what it means to be a GARP investor. Growth at a Reasonable Price (GARP) is foundational to us as the recipe we follow to guide our decisions. We distill prospective portfolio companies into qualities that are absolute requirements (traits that we are uncompromising in), and niceties which serve as “icing on the top.” While we do not require each and every business to present with all traits within “icing on the top” when making an investment, we do need some presence from this section. Our ideal investment obviously has each and every trait, though to the extent that one of our required elements are exceedingly great (i.e. an extremely low valuation or uniquely impressive growth) we will require less of the “icing.” We have always relied on a checklist geared around identifying these very traits, but we find that formalizing our criterion in this much simplified way helps us be more disciplined about narrowing our universe of companies we will consider before even running them through our process and also provides a valuable framework for communication as a team and with you, our clients:

Required:

Value-using our valuation processes and applying the appropriate technique in a given situation, we require a degree of identifiable cheapness. In particular, we look at the implied expectations and require those be a reasonably achievable hurdle for the business to meet or better yet, exceed.

Growth-while growth need not be swift, we require some kind of structural tailwind underpinning the growth of the business.

Quality-quality to us means the business takes care of and adds value to each of its key stakeholders, has a management team with aligned interests, and has identifiably strong unit economics. We are also looking for a moat that advantages the business against competition.

Some of our “icing” elements:

Change-situations with change are inherently more likely to be mispriced and change can mean either an industry a business is operating in is undergoing change (digitization being a common one these days) or the segment composition within a business is changing to a more advantageous setup that most others do not yet see.

Strategic asset-we like when a business in and of itself is a strategic asset to a larger, well capitalized player in the ecosystem (it need not be a direct competitor). We view this as both a put and a call option, where if something goes wrong with our core thesis, a purchaser will acquire our way out of trouble, and if someone pays up in the earlier end of our timeframe, our IRR can be pulled forward quite dramatically.

Optionality-we like businesses that have the potential with some catalyst to meaningfully exceed the expectations we outline in our base case. COVID-19 was such a stimulant for several of the businesses we invest in.

We have had considerable successes, some modest successes and some failures. Failures when a given business truly has all of these aforementioned traits have been far less bad (and actually by-and-large profitable) compared to errors made across investments in businesses missing these key components. All of the companies in our portfolio today have, at least at the time our purchase, at least the three required traits and some degree of ”icing.”

Let the Winners Ride

Importantly, while we call ourselves uncompromising on value, we are willing to let successful positions extend themselves beyond what we would consider cheap enough to buy. We have some constraints on how large we will let a disproportionately successful position grow, but the absence of value alone is not deterministic in our selling of a position. This is especially true when the optionality of a given thesis is provably being exercised. This brings us back to Roku. While Roku entered 2020 extended on price charts and relative to how much progress the business had made in the prior year, we trimmed down the position to a more comfortable holding size given our expectation that the company needed some time to grow into its valuation. Though we never anticipated it, we stumbled into an opportunity to buy meaningfully more during the late spring and early Summer.

From there, we held on, even as prices soared. Roku uniquely grades out very highly on each one of the elements listed above (leaving valuation aside today).

Growth–A long-term, secular growth tailwind, with consumers rapidly adopting CTV as their core TV watching platform and advertisers swiftly moving budget to catch those eyeballs.

Quality–A high quality business, with already proven, strong unit economics that are improving as viewers shift more time from linear to OTT, as AVOD takes share from SVOD and as advertisers move more budget to the platform. This is all happening amidst the backdrop of widening advantages against competition.

Change–A revenue composition inflection where a hardware company became a platform company and an industry itself was realigning around technological change (the linear to CTV and boring to smart TV transitions).

Strategic asset—Roku has the largest market share in a strategically important area for many larger players (including big cap technology companies, content companies, connectivity companies, etc.).

Optionality–the potential for something way better or faster than in even the bull case in the analyst word to happen for the company. In past terms, it meant there could have been something catalytic that accelerated cord cutting. This happened with COVID. In forward terms, we think about the opportunity to expand internationally and to embed native commerce into the platform as two big ones.

For two years in a row, we find ourselves thinking “never in our wildest dreams did we expect things to play out this well, this quickly;” however, at the same time, Roku continues to exceed our most optimistic expectations within its core business. Truly great companies have a unique way of raising the bar every step along the way.

Naked Wines PLC: Don’t Anchor to Where Price Started

While we say we missed Shopify in early 2016, the fact of the matter is, we missed it repeatedly between 2016 and 2018, when prices were comfortably above our uncompromising value framework. In effect, we missed purchasing shares in this company every single day we woke up for two years running, largely as a consequence to anchoring bias. Anchoring bias as defined in The Decision Lab is “a cognitive bias that causes us to rely too heavily on the first piece of information we are given about a topic.”[1] In investing, this means we think far more about where a stock price has come from than what the business itself is worth today. We often tell ourselves we are immune from this bias and we commence our analysis without thinking about where the stock has come from, while focusing on the qualitatively significant elements of the business and building our reverse DCF to identify the drivers of value and the hurdle rates for achieving our desired returns. The problem is that with Shopify, we anchored to where our own analysis started, and this was a vulnerability we had not considered.

We hope Shopify once again becomes a powerful lesson in what not to do with the company we hinted about in our Q3 commentary - Naked Wines PLC. We started accumulating our shares over the summer and rounded out our position during the fourth quarter of last year. We first encountered Naked Wines PLC (WINE) in December 2019 when Norbert Lou of Punch Card Management (who notably does indeed live up to the punch card mantra) disclosed a substantial position in the company. We started our research immediately. By late February we had read enough to be interested and ordered mixed case starter packs to the office. We shared bottles with everyone on our floor willing to try some wine with the explicit intent of soliciting any and all feedback. Who would have known that a few weeks later would be the last time we set foot in our Connecticut office to work? Who would have known that come March, WINE would go up nearly every single day while the broader market’s collapsed? Who would have known how many other things—from broad to specific—we would focus on in the interim without thinking about Naked Wines for some time.

In June, we received a friendly prompt from Shai Dardashti of the Casulo Group asking if we had done any work on Naked Wines and Elliot’s verbatim response was “I ordered a box, sampled the wines, but then the lockdowns started, and I hadn’t done nearly enough work and the stock went parabolic. I can’t decide if it’s too late…but it certainly is very intriguing!” As we conceptualized the framework we put forward in our Q2 commentary reflecting the belief that there would be a further bifurcation within the COVID “winners” and “losers” brackets, we realized it was imperative we dis-anchor any and all analysis from where stocks have come from and focus purely on the intrinsic setup of the situation.[2] This would be especially important when our belief could be substantiated that a company was a winner, experiencing a “step change in growth.” While we always have aspired to analyze a company first and connect the analysis to price and the path traveled later, we are human, and it is quite challenging to stare at something that has 2x’d in a month and get excited that upside remains.

This chart from that aforementioned Q2 commentary was crucial in getting us there:

The origin story of Naked Wines is in and of itself another reason not to anchor on the stock chart’s path. Naked Wines first launched in 2008 and was bought by Majestic Wine in 2015. Majestic Wine was a publicly-listed, UK wine retailer that bought Naked Wines in order to deploy their lush but stagnant brick and mortar cash flows into a growth asset. [3] In early August of 2019, Majestic Wines arranged to sell itself, but leave behind the growth subsidiary and reorganize its entire corporate imperative around the Naked Wines growth opportunity. This is similar to the setup that brought us into Acxiom/LiveRamp a few years back, though this time the opportunity is even more compelling.[4] The crucial step in realizing the extent of the opportunity for us was setting aside this thought that perhaps “we missed it” and instead recognizing that the company today is not the company whose story the lines on charts actually tells.

An Advantaged Business Model

Naked Wines described itself as “a customer-funded wine business” whereby the customers, affectionately called “angels” “fund talented winemakers and give them the freedom to make wines the way they want to.” “Angels” commit in subscription-like fashion to fund an “angel” account at Naked Wines with a minimum “investment” of $40 per month. This commitment opens up discounted pricing on Naked Wines’ entirely unique inventory. The $40 per month is a powerful force for three reasons:

  • The Cialdini Commitment Concept—”When someone agrees to something small, they are likely to be consistent and go along with a bigger idea later” (an idea we were first introduced to in the book Influence by Robert Cialdini and summed up nicely in the linked article below).[5] Customers who become angels are thus committing in advance to purchase at least a portion of the wine they consume from Naked Wines.
  • The $40 pre-commitment gives Naked Wines very good visibility into what their forward demand will look like and helps efficiently manage the business along the way.
  • The $40 per month comes in before actual expenditures on the platform, thus funding inventory investment for the business enabling Naked Wines to operate with minimal working capital.

These advantages also materialize for winemakers who sell their wine through Naked Wines. Naked can pre-commit to winemakers with a certain level of promised demand, giving winemakers a degree of comfort previously impossible in the industry. Further, winemakers get this without having to convince distributors or retailers (depending on the country) to buy their product, which can be costly and frustrating.

Although Naked Wines started in the UK, its advantages are especially amplified in the US which is encumbered by a three-tier distribution system in alcohol.[6] In the three-tier system, when we purchase a bottle of wine at a local liquor store, that bottle first had to earn margin for the winemaker and then for the distributor. The three-tier system is a consequence of how the US pursued our exit from prohibition and it was recently affirmed as constitutional by the Supreme Court.[7]  Naked Wines is legally structured as a “vineyard” in the US which means they can sell direct to customer and work around the distribution middleman. As a result, a bottle sold through Naked Wines sells for much less than a bottle with equivalent rankings sold through traditional channels:

[8]

The magnitude of the US opportunity and the inflection from small geographic revenue segment within Naked Wines to approaching half of the business was part of the rationale behind selling Majestic and honing in on the opportunity with Naked Wines.

The Wine Sales Channels:

Vineyards can sell direct to customers; however, it is incredibly challenging to build up that business. Most vineyards sell direct in the form of wine clubs, mailing lists and the tasting room, with wholesale making up a large portion of the business:

[9]

The fact that wine is traditionally purchases at retail has made it such that even in the direct sales channels, prices reflect the premium required to fulfill the margin needs of the distributor and end retailer. In some respects, vineyards have actually sold their own wines at a higher price than can be found at retail, because their direct customers are most captive (at the vineyard) or loyal (mail club/wine club members).

Naked Wines was already undergoing dramatic change following the Majestic sale, and with COVID those changes were extremized.

Alcohol had relatively low ecommerce penetration compared to other verticals and that no longer remains the case:

[10]

Clearly the direct channel, between ecommerce and wine clubs have become critically important and we think Naked Wines is fantastically positioned to extend its successes. The market opportunity is large:

[11]

And even with the COVID acceleration, minimally penetrated:

[12]

Delivering Quality

Naked Wines has won meaningful market share in the US DTC market, though that market share is considerably greater in bottles shipped than dollars of revenue (20.5% and 5.8% respectively):

[13]

While Naked Wines has captured a meaningful portion of the volume TAM, the portion of dollar value TAM they have captured is much smaller. The value TAM is much greater as you get into the $20-40 dollar per bottle range.

This will be especially important to our thesis shortly, but for now it is important to understand how the industry is geared:

naked wines plc

[14]

Naked Wines is so dominant in the lower ASPs because it was built to efficiently fulfill a customer’s needs for finding cheap quality. Wine however is in some critical respects a Veblen Good (for those unfamiliar, a Veblen Good is a product whose demand increases as price goes up). In one of our earlier conversations with the company, they explained how a mistake in the US four years ago was “focusing too much on value and low price.” Increasing prices per bottle by $3-4 each immediately led to higher ratings on wines. This is both a challenge and opportunity. It also reflects the fact that early customers were intrigued by the combination of value and quality.

Meanwhile, the entire industry has geared its entire DTC strategy around selling the highest price points. Shipping is incredibly complex in taking a perishable, delicate product, packaged in glass and getting it from vineyards (primarily on the West Coast) to households around the United States. In our conversations with vineyards and surveys of the industry, typical shipping costs range from $60-$120 for a case of 12 bottles, depending on the level of service required. Some elite vineyards simply will not ship product to the NY area between the months of May and October, because warm temperatures imperil the product along the way. In order for a customer to justify paying $60-120 for a case of, it is reasonable to think that no more than a 10% markup per bottle will be acceptable. Consequently, at the low end, that means customers are looking at $50 bottles per wine and up. According to the Sovos DTC Wine Shipping Report, “wines price $100…outperformed the overall DTC channel” each year since 2013.[15]The industry has built its entire shipping edifice around justifying high prices, and above we mentioned how vineyards sometimes price even more aggressive selling direct than at retail, the logistical challenges along the way are but one powerful reason. Most customers of these wines from the industry must wait a week or more to receive the product. This is ok for someone in a “club” where they expect a certain cadence of deliveries, but not ok in the world of one-click checkout convenience.

Since Naked Wines built its entire presence around shipping cheap wines at affordable prices, they had to solve a different problem than the industry at large. Whereas the industry at large was thinking about how to “premiumize” their DTC efforts and drive ASPs upwards, Naked Wines focused on how to ship product more efficiently and cheaper to their customers. In order to ask people to pay approximately $12/bottle, even at the low end of industry shipping costs, you would be asking your customers to pay 40% more for the privilege of getting these wines ($60 shipping cost on $144 of wine). That is not good a great value proposition. As a result, Naked Wines has established four fulfilment centers around the US, the company can not only get product to most major metropolitan areas within 48 hours of the placement of an order, but they can also actually do so far more economically.

Here’s what the average cost structure of a shipment looked like across Naked Wines:

These numbers are assumptions based on iterative calculations we have done to solve for the approximate number of cases shipped based on our assumption around ASP. They are not designed to be perfect, though through our conversations with the company and people in the industry we know they are at least ballpark. The key point is that for $25 all-in (18 GBP converted to USD), or less than half the brunt of what the rest of the wine industry faces, Naked Wines can get wines to your door. Our understanding is that the true price is even better; however, it’s hard to parse out some of the fine-tuned elements of from consolidated financials. Further, this $25 is not comparing apples-to-apples, because the $60-120 range for the industry does not include other costs associated with distribution that Naked Wines embeds in here (like fulfilment centers and staffing around fulfilment).

The ability to fulfill an order for a customer within an extremely reasonable window at a fraction of the cost compared to the industry is a major advantage. It amplifies the relative price advantage on wine itself. Further, in an industry that has an incredibly fragmented supply side (thousands of vineyards, only three scale owners and that scale is modest), with all incentives geared towards moving ASPs upwards, the Naked Wines advantages get larger every single day.

“Cheap quality” à ”Affordable Luxury”

Importantly, the advantages of Naked Wines PLC have given them a wedge into the industry. Using this wedge, Naked Wines has achieved greater than 20% volume share, which has translated some of the initial relative cost advantages into an added layer of scale advantages. They have done this building a customer base around “cheap quality.” There is a certain wheelhouse customer and product assortment that by mandate and corporate imperative while under the Majestic purview that Naked Wines had to fulfill—they had to cater to the 40-60 year old wine drinker who basically was in search of cheap quality. This meant that the company could not truly experiment with a wider assortment of kinds of wine, vintages, and ASPs. In order to invest in some of the more expensive wines, it would take a leap of faith and not a simple a/b test-and-learn kind of setup.

Management recognized early in COVID that the trajectory of the business had meaningfully accelerated and their biggest bottleneck to growth of having the resources to invest in customer acquisition was no longer the threshold factor to grow faster. Naked Wines saw this as an opportunity to help the winemaking community while enhancing the quality and range of wines offered on the platform in offering a “COVID Support Fund” for winemakers impacted by the COVID lockdowns.[16] Jesse Katz was the first winemaker funded in the COVID support effort and he offers an important indication for where Naked Wines can go. Jesse is one of the young, up-and-coming stars in the industry who has produced some of the highest quality, most interesting and notably expensive bottles of wine in the world.[17] His first offering on Naked Wines PLC sold out within 24 hours, at a $42 ASP (compared to a core average of around $12).[18] Jesse is the kind of winemaker with a growing following who can pull in more sophisticated, higher value customers, while lifting upward the range of both quality and price on the Naked Wines PLC platform. He is committed to bringing more wine to the Naked platform and we are confident this will be incredibly successful for both Jesse and Naked Wines.

Early in COVID, in a world where people were specifically seeking out “wine at home” during lockdowns, management also recognized that new channels for customer acquisition could be promising (whereas historically customer acquisition leveraged flyer inserts that looked like gift cards like what you get in a Wayfair or Bed Bath and Beyond). They have committed more budget to Facebook and other high-return online verticals. In fact, customer acquisition was so efficient online in early COVID that the bottleneck was no longer acquiring customers, but rather ensuring there was enough depth and assortment in inventory to maintain a compelling customer value proposition. This is a good problem and important evolution in the business. Importantly, the better the quality on the platform, the broader the assortment, the easier it is to acquire customers and the better the quality of customers that Naked Wines can bring in.

If Naked Wines can gradually shift their customer base upwards and get their ASPs to rise into the low $20s/bottle, the TAM they can address is much larger than the sub-$20 range they dominate today. If they can evolve the narrative from a place to discover “cheap quality” to one that brings customers “affordable luxury” the economics of the entire model improve. With “affordable luxury” Naked Wines will bring on higher value customers and most importantly, with the cost per case essentially fixed, they can 2.5x or more their contribution per case shipped. So not only would this greatly increase the pool of revenue Naked Wines can compete for, it can also expand the low double digit long-term margin target the company has offered.

The Winemaker Value Prop

In order for Naked Wines PLC to be the “vineyard” for regulatory purposes, Naked Wines employs the winemakers as independent contracts and offers everything from issuing purchase orders for grapes to crushing services to bottling in order to get the raw grape to market as wine. There is a fixed salary component based on the expected demand and a variable piece that rewards outperformance. The amount they pay a winemaker depends on their reputation and quality, as one would expect.

We made references along the way, but it deserves its own section. Winemakers are drawn to Naked Wines for several reasons. First and foremost, the economics of being a winemaker in Naked Wines PLC yields a similar gross profit per bottle, with greater visibility into demand, thus requiring less overall working capital in the business. Plus, Naked Wines offers winemakers much higher volumes than they otherwise could garner through other sales channels. Similar gross profit margins and greater volume ends up in much more profitability. Importantly, the visibility into demand, and Naked Wines handling customer acquisition means winemakers themselves can focus more on making the wines they are passionate about rather than spending time hustling and begging distributors to get them a market presence in a given state and then helping retailers drive awareness to their bottle on a wall of dozens of competing offerings. It is incredibly challenging for an independent producer to get distribution. Naked Wines offering is incredibly compelling on this front.

Instead of appealing to distributors, Naked Wines encourages winemakers to respond to the reviews and community feedback on each bottle received on the website or app. This community element is powerful, insofar as each bottle is rated and the data that the company is accruing on this helps steer winemakers to product they know will sell. Some winemakers have told us it can be emotionally challenging at times to encounter negative reviews, especially in instances where customers are critiquing more a misfit with their style than the actual wine itself; however, they have said this is less of a challenge than fighting for distribution.

Customer-level Unit Economics

While we had to do some work, make some assumptions and tap numerous industry sources to triangulate the unit economics of a shipment, the disclosures that Naked Wines provides on customer-level unit economics are some of the most transparent, complete and straightforward in the DTC ecommerce universe.

naked wines plc

[19]

Naked Wines shows us the repeat customer contribution from each cohort, by year in which they started as angels. They also show us cohort CAC:LTV by customer vintage:

[20]

Performance is incredibly consistent across cohorts, though notably during COVID behavior of existing cohorts improved dramatically (churn dropped and orders per customer increased), while new customers were acquired at even higher LTV/CAC rates. This is so partly because of the aforementioned ease with which customers came in and partly because channels like “dining out” which were important sources of demand for the wine industry were replaced with at-home behavior. Most of the increase is the enduring variety (acquiring better customers) rather than the ephemeral (dining out will resume). Moreover, the size of the cohort of new customers, evidenced by the first half of 2021 (they are halfway through the 2021 reporting year as of October) having three times the new angels as all of 2020 brought in (which included a few weeks of COVID benefit during the fiscal year’s last month).

naked wines plc

[21]

We could take the company’s filings and build out our own valuation of an average customer:

naked wines plc

While Naked Wines PLC historically disclosed a 20-year LTV, with their year-end 2020 filing in March of this year, the company made 5 year LTV a new disclosure. While there is some merit (evidenced by churn rates in years 5 and beyond of cohorts below) that twenty years may be appropriate, five years is far more reasonable to consider for a company that is not yet twenty years old. It also helps us investors triangulate value from multiple perspectives. At historical rates of churn and payback the key metrics sum up as follows:

Notably, at our average purchase price, we were buying shares for well less than the 5 year cumulative LTV of their existing customer base. Stated another way, growth was literally free for us in this position, much as it had been in Roku. Meanwhile, in their most recent quarterly report, the company reported an 80% year-over-year increase in sales! The key takeaway on the unit economics is that not only is the company cheap relative to its existing customer base, but also the company is actually profitable and in pursuing that profitability, it may not always report true net income while investing in growth (though things happened so swiftly in the first half of this year, that they are unfortunately…yes unfortunately profitable, because they could not invest the benefits of their growth quickly enough).

With the disclosures on cohort profitability and retention thereof, we were able to build out our bottoms-up expectation for what the business can earn organized by cohort:

naked wines plc

When we trace out the cohorts from here, the bigger picture looks like this:

naked wines plc

naked wines plc

As the time of this writing, we see considerable upside despite the stock having already moved in our favor. We can triangulate this level of upside from our DCF by looking at a broad universe of comparable companies and their respective multiples:

[22]

It is clear to us that Naked Wines PLC is in the lowest end of the multiple range here, with the highest growth and if not the “best” of the pack, at least in contention for being so in quality terms.

The optionality:

Everything we have asserted about this business is based on how things stand today. Importantly, we think there are considerable upside levers that could drive more revenue and add more value for stakeholders over time. First, is the new “Wine Genie” offering geared towards broadening the funnel to younger demographics—the kinds of age groups raised on Netflix and the recommendation engine. Wine Genie uses the considerable data assets Naked Wines has and is building in order to determine your taste profile and offer a periodic assortment geared towards your pallet. We like that this has strong resonance in a demographic range that Naked Wines has yet to truly penetrate.

Second, we think there is a big opportunity for earned media and virality. Naked Wines is starting to get some good press about outstanding winemakers coming onto the platform and sales being incredibly strong for the holiday period.[23] [24] Earned media can meaningfully drive down customer acquisition costs. Relatedly, we think there is a big opportunity to enhance the member-get-member program and leverage angels as a referral source. They are starting to experiment with this more and we expect to see some results. We think there were two missing links that are now resolving themselves: 1) scale in a given region—the more scale, the more natural it is to refer friends; and 2) it is very hard to want to recommend something that is “cheap” even if quality, but it is exciting to recommend affordable luxury. This subtle change makes a huge difference.

Lastly, part of why Naked Wines PLC is so cheap is that company came into existence out of a high cash flowing dividend payer and morphed into a fast grower with little to no reportable profit, while the company is listed in the UK with a far larger opportunity in the US. There is an inherent mismatch in the existing investor base and in the awareness and accessibility of the opportunity. The company suggested on their last call that if the value they deliver “over the course of the next 6-12 months” does not show “value for it, then maybe you look at different things.” We are neither advocates for or against a redomicile to the US, though we do recognize that there could be an opportunity to narrow the valuation gap with a reasonable peer group in doing so. First and foremost though, let Naked Wines PLC keep delivering and in doing so, we are confident good things will happen.

Positioning for 2021

While our portfolios performed exceptionally well in the wake of the COVID crash, we take extra pride knowing our positioning was the result of making challenging choices in a demanding environment. We came into COVID overweight financials, with large positions in a theme park operator, a point-of-sale heavy pseudo merchant acquirer, and a sports betting operator facing no sports at all for some indeterminate amount of time, to name a few. The challenges and questions were many and we acted decisively, especially with respect to our financials positions—we did NOT want to find ourselves fighting against the Federal Reserve Bank’s commitment to maintain rates at zero for an extended period again. This left us with a large cash balance (we did not sell all the aforementioned exposures) that we had the opportunity to slowly and steadily reallocate as we gained conviction in our framework of how to truly break down winners and losers in our new normal.

As we look out to 2021, we think there are pockets of extreme exuberance, bordering on euphoria in financial markets, though this exists against a really strong fundamental backdrop and fairly average (albeit modestly expensive) valuations across the broader S&P 500. Technology as a theme has been on the receiving end of flows and lush valuations for the past few years and the extremes became even more so in the months following the COVID crash. That said, we continue to find outstanding opportunities in our wheelhouse–$500 million to $10 billion dollar market cap companies, with strong structural growth tailwinds and reasonable valuations.

Thank you for your trust and confidence, and for selecting us to be your advisor of choice.  Please call us directly to discuss this commentary in more detail – we are always happy to address any specific questions you may have.  You can reach Jason or Elliot directly at 516-665-1945.  Alternatively, we’ve included our direct dial numbers with our names, below.

Warm personal regards,

Jason Gilbert, CPA/PFS, CFF, CGMA

Managing Partner, President

jason@rgaia.com

Elliot Turner, CFA

Managing Partner, Chief Investment Officer

elliot@rgaia.com

[1] https://thedecisionlab.com/biases/anchoring-bias/#:~:text=Anchoring%20bias%20is%20a%20cognitive,instead%20of%20seeing%20it%20objectively

[2] https://www.rgaia.com/commentary/q22020-investment-commentary-the-tale-of-two-markets/

[3] https://www.thedrinksbusiness.com/2015/04/majestic-buys-naked-wines/

[4] https://www.rgaia.com/commentary/q118-investment-commentary/

[5] https://healthcaresuccess.com/blog/case-studies-best-practices/cialdini-commitment-concept.html#:~:text=It%20goes%20like%20this%3A%20When,Robert%20Cialdini.

[6] https://en.wikipedia.org/wiki/Three-tier_system_(alcohol_distribution)

[7] https://www.scotusblog.com/case-files/cases/tennessee-wine-spirits-retailers-association-v-blair/

[8] Naked Wines plc 2020 Full Year Results Presentation

[9] https://www.svb.com/globalassets/trendsandinsights/reports/wine/sotwi-2021/svb-state-of-the-us-wine-report-2021.pdf

[10] Ibid

[11] Naked Wines plc 2020 Full Year Results Presentation

[12] https://www.sovos.com/shipcompliant/content-library/wine-dtc-report/

[13] Naked Wines plc 2021 Half Year Results Presentation

[14] https://www.sovos.com/shipcompliant/content-library/wine-dtc-report/

[15] https://www.sovos.com/shipcompliant/content-library/wine-dtc-report/

[16] https://news.nakedwines.com/2020/04/24/covid-support-fund/

[17] https://www.decanter.com/wine-news/opinion/news-blogs-anson/jesse-katz-winemaker-setting-382922/

[18] https://www.nakedwinesplc.co.uk/wp-content/uploads/Naked-Wines-H1-FY21-Investor-Presentation_lowres.pdf

[19] Naked Wines plc 2020 Full Year Results Presentation

[20] Naked Wines plc 2021 Half Year Results Presentation

[21] Naked Wines plc 2021 Half Year Results Presentation

[22] Market data: Sentieo January 15, 2021

[23] https://www.forbes.com/sites/cathyhuyghe/2021/01/19/rethinking-online-sales-for-premium-wineries-nakedwinescom-in-the-covid-era/?sh=6ba2f2093c10

[24] https://www.thetimes.co.uk/article/christmas-comes-early-for-naked-wines-2wpz8rmls

Past performance is not necessarily indicative of future results.  The views expressed above are those of RGA Investment Advisors LLC (RGA). These views are subject to change at any time based on market and other conditions, and RGA disclaims any responsibility to update such views. Past performance is no guarantee of future results. No forecasts can be guaranteed. These views may not be relied upon as investment advice.   The investment process may change over time. The characteristics set forth above are intended as a general illustration of some of the criteria the team considers in selecting securities for the portfolio. Not all investments meet such criteria.  In the event that a recommendation for the purchase or sale of any security is presented herein, RGA shall furnish to any person upon request a tabular presentation of:
(i) The total number of shares or other units of the security held by RGA or its investment adviser representatives for its own account or for the account of officers, directors, trustees, partners or affiliates of RGA or for discretionary accounts of RGA or its investment adviser representatives, as maintained for clients. (ii) The price or price range at which the securities listed.

The post RGA Investment Advisors 4Q20 Commentary: Naked Wines PLC appeared first on ValueWalk.

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Copper Soars, Iron Ore Tumbles As Goldman Says “Copper’s Time Is Now”

Copper Soars, Iron Ore Tumbles As Goldman Says "Copper’s Time Is Now"

After languishing for the past two years in a tight range despite recurring…

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Copper Soars, Iron Ore Tumbles As Goldman Says "Copper's Time Is Now"

After languishing for the past two years in a tight range despite recurring speculation about declining global supply, copper has finally broken out, surging to the highest price in the past year, just shy of $9,000 a ton as supply cuts hit the market; At the same time the price of the world's "other" most important mined commodity has diverged, as iron ore has tumbled amid growing demand headwinds out of China's comatose housing sector where not even ghost cities are being built any more.

Copper surged almost 5% this week, ending a months-long spell of inertia, as investors focused on risks to supply at various global mines and smelters. As Bloomberg adds, traders also warmed to the idea that the worst of a global downturn is in the past, particularly for metals like copper that are increasingly used in electric vehicles and renewables.

Yet the commodity crash of recent years is hardly over, as signs of the headwinds in traditional industrial sectors are still all too obvious in the iron ore market, where futures fell below $100 a ton for the first time in seven months on Friday as investors bet that China’s years-long property crisis will run through 2024, keeping a lid on demand.

Indeed, while the mood surrounding copper has turned almost euphoric, sentiment on iron ore has soured since the conclusion of the latest National People’s Congress in Beijing, where the CCP set a 5% goal for economic growth, but offered few new measures that would boost infrastructure or other construction-intensive sectors.

As a result, the main steelmaking ingredient has shed more than 30% since early January as hopes of a meaningful revival in construction activity faded. Loss-making steel mills are buying less ore, and stockpiles are piling up at Chinese ports. The latest drop will embolden those who believe that the effects of President Xi Jinping’s property crackdown still have significant room to run, and that last year’s rally in iron ore may have been a false dawn.

Meanwhile, as Bloomberg notes, on Friday there were fresh signs that weakness in China’s industrial economy is hitting the copper market too, with stockpiles tracked by the Shanghai Futures Exchange surging to the highest level since the early days of the pandemic. The hope is that headwinds in traditional industrial areas will be offset by an ongoing surge in usage in electric vehicles and renewables.

And while industrial conditions in Europe and the US also look soft, there’s growing optimism about copper usage in India, where rising investment has helped fuel blowout growth rates of more than 8% — making it the fastest-growing major economy.

In any case, with the demand side of the equation still questionable, the main catalyst behind copper’s powerful rally is an unexpected tightening in global mine supplies, driven mainly by last year’s closure of a giant mine in Panama (discussed here), but there are also growing worries about output in Zambia, which is facing an El Niño-induced power crisis.

On Wednesday, copper prices jumped on huge volumes after smelters in China held a crisis meeting on how to cope with a sharp drop in processing fees following disruptions to supplies of mined ore. The group stopped short of coordinated production cuts, but pledged to re-arrange maintenance work, reduce runs and delay the startup of new projects. In the coming weeks investors will be watching Shanghai exchange inventories closely to gauge both the strength of demand and the extent of any capacity curtailments.

“The increase in SHFE stockpiles has been bigger than we’d anticipated, but we expect to see them coming down over the next few weeks,” Colin Hamilton, managing director for commodities research at BMO Capital Markets, said by phone. “If the pace of the inventory builds doesn’t start to slow, investors will start to question whether smelters are actually cutting and whether the impact of weak construction activity is starting to weigh more heavily on the market.”

* * *

Few have been as happy with the recent surge in copper prices as Goldman's commodity team, where copper has long been a preferred trade (even if it may have cost the former team head Jeff Currie his job due to his unbridled enthusiasm for copper in the past two years which saw many hedge fund clients suffer major losses).

As Goldman's Nicholas Snowdon writes in a note titled "Copper's time is now" (available to pro subscribers in the usual place)...

... there has been a "turn in the industrial cycle." Specifically according to the Goldman analyst, after a prolonged downturn, "incremental evidence now points to a bottoming out in the industrial cycle, with the global manufacturing PMI in expansion for the first time since September 2022." As a result, Goldman now expects copper to rise to $10,000/t by year-end and then $12,000/t by end of Q1-25.’

Here are the details:

Previous inflexions in global manufacturing cycles have been associated with subsequent sustained industrial metals upside, with copper and aluminium rising on average 25% and 9% over the next 12 months. Whilst seasonal surpluses have so far limited a tightening alignment at a micro level, we expect deficit inflexions to play out from quarter end, particularly for metals with severe supply binds. Supplemented by the influence of anticipated Fed easing ahead in a non-recessionary growth setting, another historically positive performance factor for metals, this should support further upside ahead with copper the headline act in this regard.

Goldman then turns to what it calls China's "green policy put":

Much of the recent focus on the “Two Sessions” event centred on the lack of significant broad stimulus, and in particular the limited property support. In our view it would be wrong – just as in 2022 and 2023 – to assume that this will result in weak onshore metals demand. Beijing’s emphasis on rapid growth in the metals intensive green economy, as an offset to property declines, continues to act as a policy put for green metals demand. After last year’s strong trends, evidence year-to-date is again supportive with aluminium and copper apparent demand rising 17% and 12% y/y respectively. Moreover, the potential for a ‘cash for clunkers’ initiative could provide meaningful right tail risk to that healthy demand base case. Yet there are also clear metal losers in this divergent policy setting, with ongoing pressure on property related steel demand generating recent sharp iron ore downside.

Meanwhile, Snowdon believes that the driver behind Goldman's long-running bullish view on copper - a global supply shock - continues:

Copper’s supply shock progresses. The metal with most significant upside potential is copper, in our view. The supply shock which began with aggressive concentrate destocking and then sharp mine supply downgrades last year, has now advanced to an increasing bind on metal production, as reflected in this week's China smelter supply rationing signal. With continued positive momentum in China's copper demand, a healthy refined import trend should generate a substantial ex-China refined deficit this year. With LME stocks having halved from Q4 peak, China’s imminent seasonal demand inflection should accelerate a path into extreme tightness by H2. Structural supply underinvestment, best reflected in peak mine supply we expect next year, implies that demand destruction will need to be the persistent solver on scarcity, an effect requiring substantially higher pricing than current, in our view. In this context, we maintain our view that the copper price will surge into next year (GSe 2025 $15,000/t average), expecting copper to rise to $10,000/t by year-end and then $12,000/t by end of Q1-25’

Another reason why Goldman is doubling down on its bullish copper outlook: gold.

The sharp rally in gold price since the beginning of March has ended the period of consolidation that had been present since late December. Whilst the initial catalyst for the break higher came from a (gold) supportive turn in US data and real rates, the move has been significantly amplified by short term systematic buying, which suggests less sticky upside. In this context, we expect gold to consolidate for now, with our economists near term view on rates and the dollar suggesting limited near-term catalysts for further upside momentum. Yet, a substantive retracement lower will also likely be limited by resilience in physical buying channels. Nonetheless, in the midterm we continue to hold a constructive view on gold underpinned by persistent strength in EM demand as well as eventual Fed easing, which should crucially reactivate the largely for now dormant ETF buying channel. In this context, we increase our average gold price forecast for 2024 from $2,090/toz to $2,180/toz, targeting a move to $2,300/toz by year-end.

Much more in the full Goldman note available to pro subs.

Tyler Durden Fri, 03/15/2024 - 14:25

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The millions of people not looking for work in the UK may be prioritising education, health and freedom

Economic inactivity is not always the worst option.

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Taking time out. pathdoc/Shutterstock

Around one in five British people of working age (16-64) are now outside the labour market. Neither in work nor looking for work, they are officially labelled as “economically inactive”.

Some of those 9.2 million people are in education, with many students not active in the labour market because they are studying full-time. Others are older workers who have chosen to take early retirement.

But that still leaves a large number who are not part of the labour market because they are unable to work. And one key driver of economic inactivity in recent years has been illness.

This increase in economic inactivity – which has grown since before the pandemic – is not just harming the economy, but also indicative of a deeper health crisis.

For those suffering ill health, there are real constraints on access to work. People with health-limiting conditions cannot just slot into jobs that are available. They need help to address the illnesses they have, and to re-engage with work through organisations offering supportive and healthy work environments.

And for other groups, such as stay-at-home parents, businesses need to offer flexible work arrangements and subsidised childcare to support the transition from economic inactivity into work.

The government has a role to play too. Most obviously, it could increase investment in the NHS. Rising levels of poor health are linked to years of under-investment in the health sector and economic inactivity will not be tackled without more funding.

Carrots and sticks

For the time being though, the UK government appears to prefer an approach which mixes carrots and sticks. In the March 2024 budget, for example, the chancellor cut national insurance by 2p as a way of “making work pay”.

But it is unclear whether small tax changes like this will have any effect on attracting the economically inactive back into work.

Jeremy Hunt also extended free childcare. But again, questions remain over whether this is sufficient to remove barriers to work for those with parental responsibilities. The high cost and lack of availability of childcare remain key weaknesses in the UK economy.

The benefit system meanwhile has been designed to push people into work. Benefits in the UK remain relatively ungenerous and hard to access compared with other rich countries. But labour shortages won’t be solved by simply forcing the economically inactive into work, because not all of them are ready or able to comply.

It is also worth noting that work itself may be a cause of bad health. The notion of “bad work” – work that does not pay enough and is unrewarding in other ways – can lead to economic inactivity.

There is also evidence that as work has become more intensive over recent decades, for some people, work itself has become a health risk.

The pandemic showed us how certain groups of workers (including so-called “essential workers”) suffered more ill health due to their greater exposure to COVID. But there are broader trends towards lower quality work that predate the pandemic, and these trends suggest improving job quality is an important step towards tackling the underlying causes of economic inactivity.

Freedom

Another big section of the economically active population who cannot be ignored are those who have retired early and deliberately left the labour market behind. These are people who want and value – and crucially, can afford – a life without work.

Here, the effects of the pandemic can be seen again. During those years of lockdowns, furlough and remote working, many of us reassessed our relationship with our jobs. Changed attitudes towards work among some (mostly older) workers can explain why they are no longer in the labour market and why they may be unresponsive to job offers of any kind.

Sign on railings supporting NHS staff during pandemic.
COVID made many people reassess their priorities. Alex Yeung/Shutterstock

And maybe it is from this viewpoint that we should ultimately be looking at economic inactivity – that it is actually a sign of progress. That it represents a move towards freedom from the drudgery of work and the ability of some people to live as they wish.

There are utopian visions of the future, for example, which suggest that individual and collective freedom could be dramatically increased by paying people a universal basic income.

In the meantime, for plenty of working age people, economic inactivity is a direct result of ill health and sickness. So it may be that the levels of economic inactivity right now merely show how far we are from being a society which actually supports its citizens’ wellbeing.

David Spencer has received funding from the ESRC.

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Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

By Autumn Spredemann of The Epoch Times

Tens of thousands of illegal…

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Illegal Immigrants Leave US Hospitals With Billions In Unpaid Bills

By Autumn Spredemann of The Epoch Times

Tens of thousands of illegal immigrants are flooding into U.S. hospitals for treatment and leaving billions in uncompensated health care costs in their wake.

The House Committee on Homeland Security recently released a report illustrating that from the estimated $451 billion in annual costs stemming from the U.S. border crisis, a significant portion is going to health care for illegal immigrants.

With the majority of the illegal immigrant population lacking any kind of medical insurance, hospitals and government welfare programs such as Medicaid are feeling the weight of these unanticipated costs.

Apprehensions of illegal immigrants at the U.S. border have jumped 48 percent since the record in fiscal year 2021 and nearly tripled since fiscal year 2019, according to Customs and Border Protection data.

Last year broke a new record high for illegal border crossings, surpassing more than 3.2 million apprehensions.

And with that sea of humanity comes the need for health care and, in most cases, the inability to pay for it.

In January, CEO of Denver Health Donna Lynne told reporters that 8,000 illegal immigrants made roughly 20,000 visits to the city’s health system in 2023.

The total bill for uncompensated care costs last year to the system totaled $140 million, said Dane Roper, public information officer for Denver Health. More than $10 million of it was attributed to “care for new immigrants,” he told The Epoch Times.

Though the amount of debt assigned to illegal immigrants is a fraction of the total, uncompensated care costs in the Denver Health system have risen dramatically over the past few years.

The total uncompensated costs in 2020 came to $60 million, Mr. Roper said. In 2022, the number doubled, hitting $120 million.

He also said their city hospitals are treating issues such as “respiratory illnesses, GI [gastro-intenstinal] illnesses, dental disease, and some common chronic illnesses such as asthma and diabetes.”

“The perspective we’ve been trying to emphasize all along is that providing healthcare services for an influx of new immigrants who are unable to pay for their care is adding additional strain to an already significant uncompensated care burden,” Mr. Roper said.

He added this is why a local, state, and federal response to the needs of the new illegal immigrant population is “so important.”

Colorado is far from the only state struggling with a trail of unpaid hospital bills.

EMS medics with the Houston Fire Department transport a Mexican woman the hospital in Houston on Aug. 12, 2020. (John Moore/Getty Images)

Dr. Robert Trenschel, CEO of the Yuma Regional Medical Center situated on the Arizona–Mexico border, said on average, illegal immigrants cost up to three times more in human resources to resolve their cases and provide a safe discharge.

“Some [illegal] migrants come with minor ailments, but many of them come in with significant disease,” Dr. Trenschel said during a congressional hearing last year.

“We’ve had migrant patients on dialysis, cardiac catheterization, and in need of heart surgery. Many are very sick.”

He said many illegal immigrants who enter the country and need medical assistance end up staying in the ICU ward for 60 days or more.

A large portion of the patients are pregnant women who’ve had little to no prenatal treatment. This has resulted in an increase in babies being born that require neonatal care for 30 days or longer.

Dr. Trenschel told The Epoch Times last year that illegal immigrants were overrunning healthcare services in his town, leaving the hospital with $26 million in unpaid medical bills in just 12 months.

ER Duty to Care

The Emergency Medical Treatment and Labor Act of 1986 requires that public hospitals participating in Medicare “must medically screen all persons seeking emergency care … regardless of payment method or insurance status.”

The numbers are difficult to gauge as the policy position of the Centers for Medicare & Medicaid Services (CMS) is that it “will not require hospital staff to ask patients directly about their citizenship or immigration status.”

In southern California, again close to the border with Mexico, some hospitals are struggling with an influx of illegal immigrants.

American patients are enduring longer wait times for doctor appointments due to a nursing shortage in the state, two health care professionals told The Epoch Times in January.

A health care worker at a hospital in Southern California, who asked not to be named for fear of losing her job, told The Epoch Times that “the entire health care system is just being bombarded” by a steady stream of illegal immigrants.

“Our healthcare system is so overwhelmed, and then add on top of that tuberculosis, COVID-19, and other diseases from all over the world,” she said.

A Salvadorian man is aided by medical workers after cutting his leg while trying to jump on a truck in Matias Romero, Mexico, on Nov. 2, 2018. (Spencer Platt/Getty Images)

A newly-enacted law in California provides free healthcare for all illegal immigrants residing in the state. The law could cost taxpayers between $3 billion and $6 billion per year, according to recent estimates by state and federal lawmakers.

In New York, where the illegal immigration crisis has manifested most notably beyond the southern border, city and state officials have long been accommodating of illegal immigrants’ healthcare costs.

Since June 2014, when then-mayor Bill de Blasio set up The Task Force on Immigrant Health Care Access, New York City has worked to expand avenues for illegal immigrants to get free health care.

“New York City has a moral duty to ensure that all its residents have meaningful access to needed health care, regardless of their immigration status or ability to pay,” Mr. de Blasio stated in a 2015 report.

The report notes that in 2013, nearly 64 percent of illegal immigrants were uninsured. Since then, tens of thousands of illegal immigrants have settled in the city.

“The uninsured rate for undocumented immigrants is more than three times that of other noncitizens in New York City (20 percent) and more than six times greater than the uninsured rate for the rest of the city (10 percent),” the report states.

The report states that because healthcare providers don’t ask patients about documentation status, the task force lacks “data specific to undocumented patients.”

Some health care providers say a big part of the issue is that without a clear path to insurance or payment for non-emergency services, illegal immigrants are going to the hospital due to a lack of options.

“It’s insane, and it has been for years at this point,” Dana, a Texas emergency room nurse who asked to have her full name omitted, told The Epoch Times.

Working for a major hospital system in the greater Houston area, Dana has seen “a zillion” migrants pass through under her watch with “no end in sight.” She said many who are illegal immigrants arrive with treatable illnesses that require simple antibiotics. “Not a lot of GPs [general practitioners] will see you if you can’t pay and don’t have insurance.”

She said the “undocumented crowd” tends to arrive with a lot of the same conditions. Many find their way to Houston not long after crossing the southern border. Some of the common health issues Dana encounters include dehydration, unhealed fractures, respiratory illnesses, stomach ailments, and pregnancy-related concerns.

“This isn’t a new problem, it’s just worse now,” Dana said.

Emergency room nurses and EMTs tend to patients in hallways at the Houston Methodist The Woodlands Hospital in Houston on Aug. 18, 2021. (Brandon Bell/Getty Images)

Medicaid Factor

One of the main government healthcare resources illegal immigrants use is Medicaid.

All those who don’t qualify for regular Medicaid are eligible for Emergency Medicaid, regardless of immigration status. By doing this, the program helps pay for the cost of uncompensated care bills at qualifying hospitals.

However, some loopholes allow access to the regular Medicaid benefits. “Qualified noncitizens” who haven’t been granted legal status within five years still qualify if they’re listed as a refugee, an asylum seeker, or a Cuban or Haitian national.

Yet the lion’s share of Medicaid usage by illegal immigrants still comes through state-level benefits and emergency medical treatment.

A Congressional report highlighted data from the CMS, which showed total Medicaid costs for “emergency services for undocumented aliens” in fiscal year 2021 surpassed $7 billion, and totaled more than $5 billion in fiscal 2022.

Both years represent a significant spike from the $3 billion in fiscal 2020.

An employee working with Medicaid who asked to be referred to only as Jennifer out of concern for her job, told The Epoch Times that at a state level, it’s easy for an illegal immigrant to access the program benefits.

Jennifer said that when exceptions are sent from states to CMS for approval, “denial is actually super rare. It’s usually always approved.”

She also said it comes as no surprise that many of the states with the highest amount of Medicaid spending are sanctuary states, which tend to have policies and laws that shield illegal immigrants from federal immigration authorities.

Moreover, Jennifer said there are ways for states to get around CMS guidelines. “It’s not easy, but it can and has been done.”

The first generation of illegal immigrants who arrive to the United States tend to be healthy enough to pass any pre-screenings, but Jennifer has observed that the subsequent generations tend to be sicker and require more access to care. If a family is illegally present, they tend to use Emergency Medicaid or nothing at all.

The Epoch Times asked Medicaid Services to provide the most recent data for the total uncompensated care that hospitals have reported. The agency didn’t respond.

Continue reading over at The Epoch Times

Tyler Durden Fri, 03/15/2024 - 09:45

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