FRANKFORT — Throughout her 40-year career with the U.S. Postal Service in Lexington, B.J. Hayes paid Medicare taxes.

Now a resident at Richmond Place, a senior living center in east Lexington, Hayes says she "couldn't live without Medicare. I don't pay a penny when I go to the doctor.

"I'm concerned now with what politicians might do to it."

Hayes, like many elderly Americans, is keeping a close watch on the government health insurance program, primarily for people 65 and older, and what political candidates in this fall's elections are saying about it.

Debate over Medicare has intensified in this year's races for president and Congress, especially in Central Kentucky's 6th Congressional District.

Republicans and Democrats have accused one another of threatening the future of Medicare, turning the political war of words to win votes into what pundits have dubbed "Mediscare." But both sides agree that changes are needed in the national social insurance program to keep it solvent.

If nothing is done, Medicare is predicted to start running a deficit in 2024. According to the Congressional Budget Office, Medicare spending is expected to jump from $523 billion in 2010 to $932 billion by 2020.

Enrollment is projected to increase from 49 million to 79 million by 2030, and the program that relies on employee payroll taxes to pay for recipient services is expected to see a drop in the ratio of workers paying into the program to Medicare enrollees.

There now are 3.7 workers for every person receiving Medicare benefits. That is expected to drop to 2.4 workers for every retiree in 2030 and two workers per retiree in 2075.

The two major candidates in the 6th District race — Democratic incumbent Ben Chandler of Versailles and Republican Andy Barr of Lexington — disagree on how Medicare should change.

Chandler said in a recent interview that Congress should "wait until the economy gets better" to make changes in Medicare.

"You can take care of some of the solvency issues by the economy getting better," he said.

Chandler also said reducing health care costs, cutting Medicare's administrative costs, and removing fraud and abuse in the program would help.

Asked if the eligibility age for Medicare should be raised, Chandler said, "Every option needs to be on the table."

He declined to say whether he would support raising the eligibility age from 65 to 67.

Barr is backing a Medicare plan offered by U.S. Rep. Paul Ryan of Wisconsin, who is Republican Mitt Romney's running mate for vice president.

"The scariest thing to do is nothing, and that's what my opponent is suggesting," Barr said in a recent interview in Lexington.

Ryan's plan attempts to slow the increase in government spending on Medicare by implementing a system of payments to senior citizens, who would use the money to buy health insurance.

Ryan, Barr and other supporters call them premium-support payments. Chandler, President Barack Obama and other detractors call them vouchers.

The premise of the plan is that competition among insurance companies would lead to lower prices. Barr emphasizes that seniors already in Medicare would stay in the current program.

But in 2023, people older than 65 would select an insurance plan in a new Medicare system, with a version of traditional Medicare competing with other insurers for their business.

The Ryan plan depends on repeal of the Obama administration's Affordable Care Act, which Barr and other Republicans claim cuts $716 billion from Medicare. Although the law does reduce the expected growth in Medicare spending during the next decade by $716 billion, those reductions come at the expense of insurance companies and hospitals. It does not cut guaranteed benefits for seniors.

Dennis Carraco, a Vietnam War veteran who meets regularly for an early breakfast with seven to eight other men at Brenda's restaurant in Simpsonville, says "the best thing to do for Medicare is to leave it alone."

Told about its poor financial footing, Carraco and his fellow diners at a recent breakfast agreed that other government programs should be cut to prevent changes in Medicare.

Their suggestions for the financial chopping block included foreign aid, pay and pensions for members of Congress, the Environmental Protection Agency and the Department of Transportation.

"There are EPA regulations about the dust stirred up by a combine," Carraco said.

Bob Barker, a World War II veteran and a member of VFW Post 475 in Frankfort, also thinks politicians should leave Medicare alone and find ways to fund it through other cuts.

"I fell two years ago, went to UK and Medicare paid my bills. Can't you see why no senior would want it changed?" he asked.

But Sue Ann Ritchko, who moved from New York about a year ago to Lexington's Richmond Place, said she is worried about whether Medicare and other government entitlement programs such as Medicaid and Social Security will be available for her children and grandchildren.

Ritchko peppered Chandler with questions about the future of Medicare during a recent campaign stop at Richmond Place, telling him that residents there "are well taken care of with Medicare" and the Ryan plan is "at least an idea to keep the program."

"My concern is with the next generation," she said, adding that she knows nothing about Barr.

The Rev. Albert Pennybacker, a Disciples of Christ minister who taught at Lexington Theological Seminary and now lives at Richmond Place with his wife, Martha, said politicians should realize that "older folks like me" are concerned about a variety of political issues.

Pennybacker, 80, said Medicare is "probably the No. 1 issue" for senior citizens in this fall's elections, but "we want to know, like other people, about other social programs, health issues, the economy, America's role in the world.

"We're still here and remain interested, and we tend to vote."

Jack Brammer: (502) 227-1198. Twitter: @BGPolitics. Blog: Bluegrasspolitics.bloginky.com.