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With Dan Golberg, Alice Miranda Ollstein and Renuka Rayasam

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— The VA knew its scheduling system was rife with issues but deployed it anyway, according to a new watchdog report.

— One of the president’s top science advisors is a polarizing figure, sparking discussions about how to handle the Science and Tech leader.

— Texas’ abortion law is back in court, with health advocates arguing it’s unconstitutional.

WELCOME TO THURSDAY PULSE — Happy Veteran’s Day! And happy (belated) birthday to the Marine Corps, which counts Sarah’s father, grandfather and great uncle and many more brave souls in its ranks.

Speaking of Sarah, she’s been out for a few days. Tell her and Adam what she’s missed: [email protected] and [email protected].

VA SCHEDULING SYSTEM RIFE WITH ISSUES — The Department of Veterans Affairs deployed a digital scheduling system despite knowing about significant problems, like giving veterans misleading information about their appointments, according to a new watchdog report, POLITICO’s Darius Tahir writes.

The finding is more fodder for observers of the troubled digital health overhaul at the VA. A scandal over falsified wait times at a VA facility in Phoenix helped prompt the development of the scheduling system — which was later folded into a broader electronic health record modernization that’s been delayed as part of a “strategic review” initiated by VA Secretary Denis McDonough.

The scheduling system’s inability to easily send appointment reminders — or show certain providers as unavailable for care when they were available — could have led to delays in treatment, the VA Office of Inspector General concluded in the report. As of this summer, schedulers couldn’t complete required audits on wait time for veterans’ care. The audits are part of the post-Phoenix reforms to track and address lengthy wait times.

Broader troubles: The concerns raised by staff mirror critiques issued by health care providers who used the broader medical record system in Spokane, Wash. There, too, providers said training was ineffective and their feedback was unaddressed. And there, too, the new system hurt productivity.

The broader project has been delayed for the past year as part of a “strategic review” initiated by McDonough.

WHITE HOUSE SCIENCE LEAD GRATES OTHER AIDES — Eric Lander, director of the White House Office of Science and Technology Policy — and a vocal supporter of the president’s biomedical research agency vision — has become a polarizing figure in the West Wing, Alex Thompson and Adam report in POLITICO’s West Wing Playbook.

The latest: Lander ruffled feathers recently when he lobbied senators directly to increase pandemic planning funds instead of first consulting with the White House’s Office of Legislative Affairs, according to several officials familiar with the matter. Besides working around the legislative office, Lander pushed for changes after a deal had already been struck and endorsed by the White House.

That incident was the latest in an increasingly rocky relationship between the longtime geneticist and other WH aides, some of whom argue he is condescending and inserts his office into unrelated issues. It’s gotten to the point that discussions are ongoing about how to constructively address them, said one person with knowledge of the dynamic.

And yet: Others cast the pioneering scientist — one of the Human Genome Project’s original leaders — as a brilliant scientist with a difficult mandate. After all, Biden elevated the OSTP director position to a Cabinet-level agency on par with HHS. But OSTP has few resources and little power, meaning Lander has been fighting turf battles from the beginning, Alex and Adam write.

“Director Lander’s background and expertise — including his important work before the administration on COVID-19 response issues — are a critical asset to the President’s work to help prepare the United States for future pandemics,” a White House official said in a statement.

TEXAS ABORTION BAN RETURNS TO COURT — The state’s six-week abortion ban that delegates enforcement to private citizens came back before a state judge Wednesday for the first hearing to date on the law’s merits.

The difference: While the U.S. Supreme Court considers two separate petitions to temporarily block the law while litigation continues, Planned Parenthood and other abortion providers in the state argue it should be permanently struck down as unconstitutional, Alice Miranda Ollstein writes.

Because they can’t sue the state since it has no official role in enforcing the law, the clinics are suing the state’s leading anti-abortion group, Texas Right to Life, which put out a public call for Texans to report anyone suspected of performing an abortion or helping someone obtain one.

The arguments: Texas Right to Life argued Wednesday they can’t be sued because they haven’t yet brought any lawsuits to enforce the ban.

“Their problem is with the law itself. It’s not with Texas Right to Life,” the group’s attorney said.

The clinics countered that the group doesn’t need to sue because the chilling effect created by their threat to do so has virtually halted all abortions in the state after six weeks of pregnancy.

HOW COVID INFLUENCED HEALTH BENEFITS — The Covid-19 pandemic had an apparent effect on how employers structured their health benefit programs, according to the latest annual Kaiser Family Foundation survey on workplace coverage.

Companies were more apt to offer telehealth and mental health services in 2021, the survey found. Nearly one-third of businesses with at least 50 employees expanded how enrollees could receive mental health treatment or substance abuse services, and 16 percent developed new resources such as an employee assistance program, Dan Goldberg writes.

Meanwhile, telehealth offerings exploded. In 2021, 95 percent of firms with at least 50 employees offered some health care services through telemedicine in their largest health plan, compared to 85 percent last year and 67 percent three years ago.

These changes are likely to outlast the pandemic, with nearly half of employers with at least 50 employees agreeing that telemedicine would be important going forward, compared to 4 percent who said it would not be important in the future.

“Employers clearly view this as something that is here to stay,“ said Gary Claxton, a senior vice president at the Kaiser Family Foundation.

AMERICA’S FORGOTTEN ENTITLEMENT — The social spending package inching its way through Congress contains billions of dollars for something that everyday Americans and politicians don’t like to think about: long-term care.

Though Washington has addressed the issue only haltingly over the years, Congress may be poised to target $150 billion in new Medicaid spending if the bill is passed — a historic sum that still barely scrapes the surface of what’s needed, Joanne Kenen writes in POLITICO Magazine.

The money would most directly help the very poor or those who become poor after using up their life savings on caregiving or foregoing paid work to care for a loved one. But it won’t create a comprehensive national system or give everyone the option to stay at home for care instead of spending their final days, months or years in a nursing home. Nor will it stop the cycle of impoverishment that often accompanies long-term disability or a prolonged end-of-life decline.

MINNESOTA, NY GET COVERAGE FUNDING BUMP — The Centers for Medicare and Medicaid is providing extra funds to basic health programs in Minnesota and New York after a change in its formula for calculating payments, the agency announced Wednesday.

The update, driven by the American Rescue Plan, means CMS will disperse roughly $850 million more for 2022, plus some added funds for this year and 2020 to New York’s Basic Health Program and MinnesotaCare. Both are coverage programs aimed at people whose income level puts them outside the range eligible for Medicaid and CHIP but who still need essential coverage.

New York (which will receive $750 million more) and Minnesota ($100 million more) are the only states currently implementing basic health plans, but the Biden administration is keen to expand the program.

BLOOMBERG EXPANDS OPIOID FUNDS AMID WORSENING CRISIS — Bloomberg Philanthropies announced Wednesday that Kentucky, New Jersey, New Mexico, North Carolina and Wisconsin would each receive $10 million over five years to address opioid overdose deaths.

Pennsylvania and Michigan, which the organization has supported since 2018, will receive an additional $4 million over the next three years. The money will be used to expand treatment programs and implement harm reduction strategies such as syringe services and naloxone distribution, Renuka Rayasam writes.

A tragic record: Opioid overdose trends have worsened during the pandemic, growing 30 percent in 2020 to more than 93,000 deaths — the highest number of opioid deaths ever recorded.

That’s because more people were using drugs at home alone and couldn’t access treatment services, said Kelly Henning, who heads Bloomberg Philanthropies Public Health program. The crisis has shifted over the years from a prescription drug crisis to a street drug crisis and from a rural epidemic to an urban one. Opioid overdose deaths among Black people are also outpacing white people. “There is no question that this is not an epidemic that is over,” Henning said. “There is a big scale-up that is coming.”

Read more: Soaring overdose numbers have outpaced treatment supplies according to a new Urban Institute analysis of opioid use disorder in six states and D.C., all part of the Bloomberg initiative. Researchers said that even if the treatment capacity was doubled in the counties examined, it would fill just between 7 percent and 28 percent of the need.

— Zachary Kiser is now director of government relations and advocacy for NephCure Kidney International. He previously worked for the House Select Subcommittee on the Coronavirus Crisis and Sen. Sherrod Brown (D-Ohio).

— Boehringer Ingelheim named Alexandra Rothenburger as senior associate director of public policy and Kirby Consier as senior associate director for state government affairs covering the southeast. Rothenburger was most recently manager of strategic and policy analytics at the Children’s Hospital Association, and Consier was most recently at Novartis, where she was associate director for state government affairs.

— Linda Beza has joined the National Health Council as vice president of finance and administration. She most recently was the senior director of finance and administration at the Pool and Hot Tub Alliance.

The National Institutes of Health plans to defend its claim as co-owner of patents on Moderna’s coronavirus vaccine, NIH Director Francis Collins told Reuters’ Julie Steenhuysen.

Ten states filed a lawsuit Wednesday to block the Biden administration’s vaccine requirement for health care workers shortly after a court decision stalling the broader mandate. The New York Times’ Reed Abelson lays out what the latest lawsuit means.

Whole genome sequencing helped diagnose a quarter of people in a British study targeting rare diseases, amplifying the case for genetic sequencing but exposing what we don’t know about genetics’ role in health, Andrew Joseph writes in Stat News.