As Beltway insiders squabble over how, or whether, to overhaul Obamacare and Medicaid, one overlooked reform deserves widespread support: ending the ability of labor unions to siphon Medicaid dollars from the paychecks of caregivers serving the elderly and disabled.

One of the few bright spots for unions in recent years has been the state-by-state unionization of independent contractor home care aides serving Medicaid-eligible clients. In states like Illinois, union-beholden governors reclassified caregivers as "public employees for collective bargaining purposes" by executive order. Elsewhere, deceptive, union-backed ballot measures and legislative action set up the legal framework necessary for unionization.

Once unionized, typically by SEIU or AFSCME, caregivers were forced to pay union dues as a condition of serving their clients, most often relatives or close friends. Beyond periodically negotiating caregivers' reimbursement rate with the state, the unions provide little in return. The nature of the work means these unions don't provide traditional workplace representation. A mother, for example, simply can't file a grievance against her disabled child, her legal employer.

In 2014, the U.S. Supreme Court's decision in Harris v. Quinn denounced this arrangement as simply a money-making "scheme" for unions and struck down as unconstitutional state laws requiring caregivers to pay union fees.

Unfortunately, unions responded to Harris by seeking to pressure caregivers into union membership using any means necessary.

For instance, though caregivers can cancel the deductions in writing, the state of Washington currently withholds SEIU 775 dues from every caregiver automatically, even if the caregiver never authorized the deductions and refused union membership.

In Oregon, SEIU 503 only permits caregivers to cancel their dues deductions in writing during an arbitrary, 15-day annual window period unique to each caregiver, but known only to the union.

Within months of Harris, unions secured passage of a California law requiring new home care aides to endure a 30-minute union membership pitch. In Washington, social workers have reported instances of new caregivers being brought to tears by the "rude," "aggressive" and "bullying" behavior of union organizers pressuring them to sign membership forms at similar state-mandated orientations.

Meanwhile, caregivers in Minnesota report SEIU forging their signatures on union membership forms.

While caregivers are pushing back against many of these outrageous practices in court, the root of the problem is that unions get to write the rules governing how and from whom the state withholds union dues when making caregivers' payments. Making unions collect their own dues would neutralize many of the unions' unsavory methods.

States like Michigan, Wisconsin and Ohio have already put an end to the unions' dues skimming, but as many as a dozen states still siphon off hundreds of millions of dollars each year in union dues from caregivers' Medicaid payments. Bringing change to states governed by union-backed politicians will likely require federal intervention.

Thankfully, it is well within the regulatory authority of the newly-confirmed heads of the Department of Health and Human Services, Tom Price, and the Centers for Medicare and Medicaid Services, Seema Verma, to direct states to cease diverting Medicaid funds for union dues. Given President Trump's recent demonstrations of the reversibility of the "pen and phone" approach to governing, Congress should promptly follow up with a more permanent fix.

Ending unions' ability to siphon off Medicaid funds meant for society's most vulnerable won't stop unions from bargaining with public employers, nor prevent caregivers from voluntarily making their own dues payment arrangements if they wish. But taking states out of the dues collection business would go a long way towards giving caregivers meaningful control over their union participation and protecting them against the predatory tactics employed by dues-hungry unions.

Maxford Nelsen (@MaxfordNelsen) is director of labor policy for the Freedom Foundation.

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