On the campaign trail, candidates are fighting over major health care plans and who has the best ideas for universal coverage. Meanwhile, Congress is unlikely to pass any major health bill, preferring a bite-sized approach.

Among the small-ball proposals are changes to Medicare rules as well as bipartisan bills related to mental health parity, electronic medical records and effectiveness of treatments — hardly the agenda of a 30-second commercial.

“It’s difficult to do anything major legislatively in an election year,” said an aide to Senate Finance Chairman Max Baucus (D-Mont.). A senior Republican House aide agreed, saying the presidential election will “suck the oxygen out of the debate on the Hill.”

Regardless of the inhospitable terrain, Baucus and the committee’s ranking member, Sen. Chuck Grassley (R-Iowa), will push health care legislation this year. “While important policy debates and decisions most often get sidelined or polarized during [a] presidential election year, the challenges never go away, and lawmakers have a responsibility to stay focused on solutions,” Grassley told Roll Call.

One option could be an omnibus health care bill that would contain Medicare legislation that the Finance Committee might take up in April. Finance members introduced similar legislation last year, only to have it thwarted by a threatened presidential veto.

The proposed package would adjust doctors’ Medicare reimbursement rates, permit the use of performance measures to determine Medicare reimbursements, implement electronic prescribing rules and restrict alleged private Medicare plan advertising abuses, the Baucus aide said. The proposal likely would include language to require greater public disclosure of gifts to doctors from medical device manufacturers and pharmaceutical companies.

Baucus and Grassley say the package has bipartisan support and could become law.

“All of these ideas deserve a place on the legislative calendar, even in an election year,” Grassley said.

The centerpiece of any Medicare legislation would be an effort to delay July’s scheduled 10 percent cut in doctors’ reimbursement rates, known as the sustainable growth rate. Senate Finance is considering delaying the cuts by up to 18 months at a cost of about $13 billion.

The Medicare package could be in jeopardy because of pay-as-you-go budget rules, which require any spending increases to be offset by cuts elsewhere.

Democrats want to find the savings by cutting private Medicare Advantage plans. But the White House and Congressional Republicans oppose such cuts and succeeded in derailing efforts last year. Those plans play a bigger role in rural areas, and the greater reimbursement rates are intended to attract health care providers to those regions.

Without those cuts, Democrats might be hard-pressed to find other offsets to pay for permanently delaying the rate hike. As a result, Congress is likely to back a six-month freeze in doctors’ reimbursements rates, aides and lobbyists said. Congress made the same move last year, with the current extension expiring on June 30.

Despite a likely White House veto threat, Democratic leaders remain optimistic. “We are hopeful that the prospect of the upcoming elections and the public’s focus on the health care positions of the two political parties will cause more Republicans to support Democratic efforts and increase the likelihood that we can enact good health care legislation,” Reid told CongressNow.

Another legislative option — and one that would not have to meet PAYGO requirements — would be to attach the Medicare provisions to a follow-up economic stimulus package. Karen Ignagni, president and CEO of America’s Health Insurance Plans, said she believed if Congress passed another stimulus bill this year, it likely would contain health care provisions.

Lawmakers also want to base Medicare reimbursement rates for doctors on meeting performance measures. Critics have long argued that Medicare is based on quantity of care, rather than on quality. There also is a push to use electronic medical records to save money by avoiding duplicative and incorrect treatments.

Baucus is expected to introduce legislation soon that would implement comparative effectiveness measures for making health treatment decisions. This approach compares the effectiveness of medical procedures, drugs, devices and biologics to find the best treatment available. It’s “an important avenue for improving the quality and efficiency of American health care,” a Baucus aide said.

Lawmakers also are working on legislation to institute a pathway for the federal government to approve generic versions of biologics, which include vaccines and antitoxins made from living organisms that are used to treat or prevent diseases. First, Congress must find a way to compromise on a key sticking point — the length of patent protections for brand biologics manufacturers.

Finally, the House and the Senate are struggling to reach a deal on legislation to ensure that patients receive mental health treatment equal to other care they received for physical aliments under their insurance plans.