Patient access to healthcare, paying for it and staffing needs were on the minds of area hospital leaders Wednesday at the Fort Bend Chamber of Commerce. Administrators from CHI St. Luke's Health—Sugar Land, Memorial Hermann, Houston Methodist Sugar Land Hospital and OakBend Medical Center each highlighted different areas of providing healthcare in Fort Bend County where they saw a need for revamped efforts. Mental healthcare, industry employment, payment options and potential changes to the Affordable Care Act, also known as Obamacare, were all on the table for the talk at Safari Texas Ranch in Richmond. "I think the idea is that there's not a lot of support here in the county for mental health," said Wes Garrison, vice president of patient care services and administration for CHI St. Luke's Health—Sugar Land. "I'd say 90 percent of the patients we see for behavioral health are from Fort Bend County." Garrison said many of the patients seeking mental health treatments are housed in emergency facilities because the county has few psychiatric facilities to which CHI St. Luke's can refer uninsured individuals for behavior health. Chris Siebenaler, regional senior vice president and chief executive officer of Houston Methodist Sugar Land Hospital, said healthcare workforce turnover is a point of concern. The rate is particularly noticeable with nurses, he said, as nearly 41 percent registered nurses in Texas were at least 50 years old in 2013, according to the Texas Department of State Health Services. Texas' median facility turnover rate for nurses was nearly 22 percent in 2016, according to department data. "It is a challenging environment for us to attract people who want to work in an environment that is 24/7," he said of hospitals. Leaders wary of "repeal and replace" When it came to Obamacare and pledges by Congressional Republicans and President Donald Trump to "repeal and replace" the law, Joe Freudenberger, chief executive officer of Oakbend Medical Center, said a dialogue change was needed. "You've got 20 million people that are covered in some form under Obamacare. You repeal it, you still have to find a way to cover those 20 million people," he said. "Why not fix what we can?" The Congressional Budget Office reported in January that repealing portions of the Affordable Care Act would actually increase the number of uninsured persons by 18 million in the first year. Greg Haralson, senior vice president and chief executive officer of Memorial Hermann Southwest Hospital and Sugar Land Hospital, said keeping the law in place while changing certain pieces was preferable to repealing the entire legislation at once. "[Coverage of] pre-existing conditions—there's elements of Obamacare that make sense," he said. "The burden it placed on employers—we have to look at those things and see what we can do ... " Siebenaler said that aside from a change in the law, improved patient accountability was needed to financially sustain the country's healthcare system. Patients who decline to get primary care may contribute to higher healthcare costs for more serious conditions, he said. "Are patients willing to share their burden of the cost and their burden of the accountability," he said.