Members of the Maine Legislature have not sat idly by as declining demand and competition from abroad has stressed Maine’s paper mills. While we have not been able to turn back the global tide and rescue every Maine mill — five have closed in the past two years — there has been bipartisan consensus that we ought to do all we can as a state to give our mills a fighting chance.

Another important group of vital Maine institutions — community hospitals — are also under stress due to forces beyond their control. But unlike with the paper mills, state lawmakers have not stepped up to do all we can to provide these organizations with that fighting chance.

In my district, Franklin Community Health Network, which operates Franklin Memorial Hospital in Farmington, just announced more than $4 million in annual operational and staff cuts that will mean 40 fewer full-time jobs in the region. The plan is aimed at stemming a string of losses dating back to 2011 that total more than $15 million.

FCHN is still one of the region’s largest employers with more than 700 full- and part-time employees. Perhaps more importantly, it is a critical community asset, providing high quality primary, acute and emergency care in a rural area.

There are a lot of forces working against Franklin and Maine’s other community hospitals. Those stressors can be aggravated by a rural setting, but community hospitals in urban and suburban settings — Rockland’s Pen Bay Health Care and Biddeford’s Southern Maine Medical Center are examples — are feeling the pressure, too.

So what’s going on?

Some of the stress can be traced to the changing nature of health care. As we learn about the importance of good primary care and management of chronic conditions such as diabetes, mental illness and COPD, local hospitals must shift their focus. This new approach is vital to the health of our communities, but is not necessarily as profitable as treating acute needs.

Not insignificant are changes to federal Medicare reimbursement rates tied to the federal Affordable Care Act. At Franklin Memorial Hospital, for instance, management estimates the 10-year impact of the changes, from 2011-2020, to be $10.9 million.

That reduction was supposed to be offset by more than $3 million in new Medicaid revenue. Unfortunately, Maine’s governor and most of my fellow Republican legislators decided not to take advantage of the opportunity by expanding Maine’s Medicaid program (MaineCare), despite the fact that the federal government would pay no less than 90 percent of the cost.

Rep. Russell Black, R-Wilton, understood the economics and supported that effort. His vote for expansion was a vote to help this community and its hospital.

Meanwhile, nonprofit community hospitals in Maine are still committed to providing care to all who walk through their doors, regardless of ability to pay. At Franklin Memorial, that amounts to about $1.8 million worth of free care provided each year.

And on top of all this, hospitals continue to experience the “temporary” Medicare sequestration cuts that took effect several years ago as part of a federal budget deal.

We in the Legislature can’t mitigate all these factors, just as we can’t stem the declining demand for paper in the electronic age or put a halt to foreign competition in that industry. But we are not powerless.

I know that expansion of MaineCare under the federal Affordable Care Act is an idea met with deep skepticism among most of my fellow Republicans. They are loath to tacitly endorse Obamacare. They worry that the federal government won’t hold up its end of the deal to fund no less than 90 percent of the cost of expansion. And they see even a 10 percent share of MaineCare costs as perhaps beyond the state’s means.

But my expansion bill, which could not garner the votes needed to even get to the governor’s desk this past session, would have injected a needed dose of personal responsibility into the MaineCare program. It would have leveraged hundreds of millions of federal dollars that we know are available to our state right now. And while we must be good fiscal stewards, leveraging $93 million over three years to bring $1.2 billion to the state over the same time seems a good plan dollars-and-cents-wise.

Would passage of this plan solve all the problems at Maine’s community hospitals? No. Our health care industry leaders have a lot of hard work in front of them if community hospitals are to thrive. But it seems we have an obligation to give these institutions that are so important to our communities the best possible shot at survival and success.

State Sen. Thomas Saviello, R-Wilton, represents Maine State Senate District 17, which includes all of Franklin County and four towns in Kennebec County.