Democrats see those votes, and Ryan's newfound prominence, as a political gift to down-ballot races that had been subsumed by the Obama-Romney main event.
"With Paul Ryan on the ballot, House Republicans' toxic agenda is on the front page of newspapers and front and center for middle-class voters who know Medicare should be protected," the Democratic Congressional Campaign Committee's regional spokesman, Josh Schwerin, said in an e-mail.
With both parties sensing opportunity, the issue seems sure to remain at the forefront of the debate between now and the Nov. 6 vote.
Gerlach is adopting a defiant stance. He did not back away from his votes for Ryan's budgets, saying the public recognized changes were needed in Medicare to preserve the popular program.
"Voters are tired of Democrats blaming officials who try to put something forward to solve the problem," Gerlach said.
He spoke just days after Speaker John A. Boehner of Ohio urged House Republicans to "play offense" on Medicare, according to various news reports, even though GOP strategists were widely quoted as fretting that the added focus on Ryan's proposals - especially the Medicare overhaul - could hurt Republicans in congressional races.
Although the economy will likely remain the top issue in the fall campaign, Medicare could prove critical in the closely balanced suburban districts around Philadelphia. In those districts, senior citizens constitute 20 percent to 25 percent of the population.
That's why Democratic challengers in three of those districts staged a quick-strike event Monday in front of a South Philadelphia senior center to highlight their opponents' votes for Ryan's proposals. They followed up with robocalls to voters in each district to drive home the point.
Gerlach and other Republicans have responded in two ways. First, by painting their votes as tough decisions that will curb Medicare's costs and preserve it.
Second, they have tried to flip the story - portraying President Obama as the one who has cut Medicare and by tying the issue to his health-care overhaul, which polls poorly.
Lines of counterattack
"We want this fight," the National Republican Congressional Committee's political director, Mike Shields, wrote last week in a memo. "Any opportunity we have to talk about Obamacare, and the $700 billion in Medicare cuts that paid for it, is an opportunity that we will never pass up."
That line of counterattack swiftly surfaced in local races. A Friday evening e-mail from Romney campaign aide Kate Meriwether - announcing that Runyan would talk issues at a GOP clambake Sunday in Northeast Philadelphia - said in part that "the Obama plan is to raid Medicare for current seniors to pay for Obamacare and keep Medicare on a path to bankruptcy."
Democratic strategists see bashing Ryan's Medicare proposal as a battle-tested strategy. They point to its use in recent special-election wins in New York and Arizona congressional races.
Romney tried to create some separation from the Ryan budgets last week, saying he would undo the $700 billion in Medicare savings that Obama approved and that Ryan's proposal also counts on. But congressional Republicans are tied to the proposal: They voted for it.
"Like it or not," Muhlenberg College political scientist Chris Borick said, Republican incumbents "are going to have to deal with the subject and in some ways embrace it in their own campaigns, because it's going to be put upon them. If they try to duck it or avoid it, it will cause them as much problem as if they take it head-on."
The argument about making tough choices to save Medicare requires nuance in the face of a torrent of criticism, Borick said, but the GOP is helped by the fact that many voters realize the program is threatened by huge financial demands.
The issue is pressing. There are roughly 49 million Medicare beneficiaries in the country, a number expected to reach 60 million in less than a decade. Costs are projected to soar from about $586 billion in 2011 to more than $1 trillion in 2021.
"It is exactly the policy questions that the American voters need to be thinking about," Gerlach said.
That doesn't mean voters like Ryan's answers. Borick said, "What's problematic for Republicans is that the approach that has so far been outlined by Paul Ryan in his budget plan simply isn't that popular."
That plan, overwhelmingly approved by House Republicans in two slightly different versions but blocked by Senate Democrats, relies on government subsidies to help seniors buy health coverage from private insurers. In the later version, Medicare would remain an option, but beneficiaries would pay the difference between the cost and their subsidy. The plan would not affect those already 55 or older, but Democrats point to nonpartisan analyses that say the initial Ryan proposal could eventually cost Medicare beneficiaries an added $6,000 per year.
The Congressional Budget Office has said the plan, part of Ryan's sweeping proposal to cut government spending and taxes, would raise health-care costs for most seniors.
Gerlach's Democratic challenger, Manan Trivedi, said: "As a primary-care physician, I know it's my middle-class patients who significantly rely upon Medicare, and under the Romney-Ryan plan, it would be devastated."
Trivedi was speaking Monday at the South Philadelphia event with fellow Democrats Kathy Boockvar, who is challenging Fitzpatrick, and George Badey, Meehan's opponent.
That was before the Republican incumbents began hitting back.
Contact Jonathan Tamari at firstname.lastname@example.org or follow on Twitter @JonathanTamari.