It was of great concern to read recently of the financial distress facing Franklin Memorial Hospital. It was disappointing to me, however, that in the very week of the disclosure of deficits and layoffs, there was no evidence that the hospital’s leadership was asking some important questions of Gov. Paul LePage during his recent visit, and of concerned elected officials who were hearing the news directly from Rebecca Ryder, hospital CEO.

As she expressed the hospital’s concerns over declining revenues, increasing costs and “charity” (uncompensated) care, below are some points I didn’t hear mentioned:

On his own, the governor is refusing to allow Maine to participate in the Medicaid expansion that is part of the Affordable Care Act. According to Maine Equal Justice Partners, a low-income advocacy group, “The ACA increases the amount of money Maine receives from the federal government to pay for Medicaid. The federal government will pay 100 percent of the costs of covering ‘newly eligible’ individuals in Maine from Jan. 1, 2014, through Dec. 31, 2016.”

By his refusal, the governor is leaving $100 million per year “on the table,” where it will be redistributed to other states, many of which, by the way, have Republican governors — New Jersey, Florida, Arizona and Ohio, for instance.

In the 28 states that have agreed to expansion, the most convincing cases have often been made by hospitals, that will directly benefit from having more patients covered by insurance.

Has the CEO of Franklin Memorial projected what the dramatic increase in “charity” care she cited last week will be during 2014-2016? Has she presented that statistic to the governor and elected officials? Have she and other health care leaders spoken of the favorable impact on uncompensated care that having an additional 69,000 Maine residents covered by MaineCare would have? Is there a plan among those we have elected to address the deteriorating financial picture?

There is one simple answer that I can provide for them: With an expansion of Medicaid (fully funded by the feds for three years and 90 percent funded after that), charity care will decrease and people with insurance will see rate relief. Providing insurance for people living in or near poverty will reduce emergency room use and dramatically reduce charity care.

It is as simple as that.

In addition to impacts on medical care for those who don’t have insurance, there are additional concerns for Franklin Memorial and all health care providers in Maine (to say nothing of low-income elderly and disabled residents) in the governor’s proposed budget.

The program that provides low-cost drugs for the elderly will be eliminated. Some 80,000 low-income elders and those with disabilities will lose coverage for prescription drugs.

The Medicare Savings Program will be cut and those same elders and disabled will lose help paying for Medicare premiums, co-payments and deductibles and prescription drug costs.

Unless those residents go without health care (which, sadly, many will do), that is another hit to “charity” care for hospitals, nursing homes, pharmacies and physicians, to say nothing of the impact on quality of life.

I think that Maine is better than that.

I work every day as a health care provider, and I witness every day the anguish of disease, dementia, loneliness, depression and mental illness in those we serve and the pain which all of this creates in their families. I fully understand, as well, the deteriorating financial conditions under which we work.

But, that is precisely my point. In the face of this struggle, it is not enough to tell our citizens, “Good luck. You are on your own” while, at the same time, telling the health care system that we are going to stop paying for the essential work it does.

We are all in this together.

It is time for leadership, tough decisions, new revenues and full use of the resources being made available to us. Nothing less will do.

Irving Faunce is a licensed nursing home administrator. He lives in Wilton.