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Good morning. This is the last edition of Vitals until Jan. 6, meaning we all get a much-needed break.

  • Happy holidays, and remember that you can send thoughts or tips to caitlin@axios.com if you start to miss my name in your inbox.

Situational awareness: Democrats on last night's debate stage didn't use this week's news on the court case threatening the Affordable Care Act to hammer home the same arguments that won them the House last year, to some strategists' dismay.

Today's word count is 638, or a 2-minute read.

1 big thing: The health care industry's happy holidays

Illustration: Eniola Odetunde/Axios

The year-end spending bill in Congress epitomizes the power of health care interests, Axios' Bob Herman writes.

The big picture: There are lots of goodies for the industry, while patients will get the worst kind of holiday surprise — more medical bills.

The bill includes some of the usual health care "extenders" — keeping money flowing to rural hospitals and community health centers, and again delaying cuts to hospitals that treat the poorest patients.

  • But in the weeds of the negotiations, the industry came out even better than you may have realized.
  • This was the bill that, once upon a time, might have been the vehicle for deals to reduce drug prices and crack down on unscrupulous billing practices. Instead, it became an industry giveaway.

The bill repeals several Affordable Care Act taxes — a particularly big win for health insurers that sell Medicare Advantage plans.

  • The bill also gives more drugs — for example, some that treat diabetes or osteoporosis — 12 years of market exclusivity instead of the five years they would have gotten.
  • Hospitals that perform certain stem cell transplants will now get paid by Medicare for the costs associated with acquiring those stem cells, a policy that will add an average of $50,000 to $65,000 in extra pay for each procedure.
  • Companies that make some radioactive substances for PET scans will get an extra nine months of higher pay from Medicare.
  • Clinical labs got a one-year delay on price-reporting requirements. This will give them more time to collect data from higher-priced labs, which will be used to drive up their pay in the face of recent Medicare cuts.

The big picture: All of these policies will materially benefit pretty much every sector within an industry that already wields more financial power than ever.

2. The political risk of overturning the ACA
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Data: Urban Institute Health Policy Center; Note: Uninsured rate is among the nonelderly population. Map: Danielle Alberti/Axios

Swing states and red states stand to lose the most if the courts ultimately throw out the Affordable Care Act, according to a new analysis by the Urban Institute.

Why it matters: President Trump and Republican attorneys general could pay a steep political price if they succeed in their quest to kill the law.

Details: Michigan, Pennsylvania, Ohio and New Hampshire would see their uninsured rates shoot up by more than 100%.

  • Maine would be hit harder than almost any other state, and is home to one of the GOP's most vulnerable senators up for reelection, Susan Collins.
  • States like Arkansas, Louisiana, Kentucky, West Virginia and Montana don't have competitive Senate races at this point, but the pending lawsuit could put GOP incumbents in those states in a bind.

Bonus: The analysis found that providers also take a financial hit.

Go deeper: The ACA legal fight isn't even close to over

3. A lottery for children's gene therapy

Novartis is giving away about 100 doses a year of the most expensive drug in the world, Zolgensma — a gene therapy that cures children of a deadly disease, the Wall Street Journal reports.

Between the lines: The free drug will be offered via a lottery system, which some patient groups say is inappropriate and unfair, as it fails to account for need.

  • The program is designed to make the drug accessible to a limited number of patients outside of the U.S. There's a high demand for the $2.1 million drug in countries where it hasn't yet been approved.

My thought bubble: This is great news for a lucky few patients, but it's not a long-term solution to the world's issues with access to pricey drugs.

4. Cancer researchers resign over China ties

Top executives and researchers from a Florida cancer center were forced out amid problems with a Chinese partnership that could have put American-funded research at risk, the Tampa Bay Times reports.

  • The CEO, a vice president and four researchers from the H. Lee Moffitt Cancer Center & Research Institute in Florida stepped down after an internal investigation.

Why it matters: The FBI and other federal agencies are on high alert for potential Chinese theft of American cancer research, and prominent researchers from other institutions have already been forced to step down, Axios' Marisa Fernandez writes.

Go deeper: