Thus far, more than 500 bills have been introduced in the 109 th Congress that apply, in whole or in part, specifically to Indians, federal Indian programs, or Native Hawaiians. Among the major Native American policy issues of concern to the 109 th Congress are: Indian health care, Indian trust fund management reform, Indian gaming lands, and Native Hawaiian recognition. Each of these issues is briefly discussed in this report. Congress has for more than five years been wrestling with the reauthorization of the Indian Health Care Improvement Act (IHCIA; P.L. 94-437 , as amended). Federal responsibility for Indian health care is met primarily through the Indian Health Service (IHS) in the Department of Health and Human Services (HHS). While IHS's permanent authorizing legislation, the Snyder Act of 1921, is very broad, the IHCIA authorizes a great many specific IHS programs, including health professional recruitment and retention, mental health services, urban Indian health services, construction and repair of health facilities, various special IHS funds, and IHS reimbursement by Social Security Act health programs (Medicare and Medicaid) and other public and private health insurance programs. Authorizations of appropriations for IHCIA programs expired at the end of FY2001, but Congress continues to appropriate funds for the programs. Leading Indian health proponents in and out of Congress suggested major changes in IHCIA. A number of significant changes have not been acceptable to HHS or other agencies, however, and ongoing negotiations have produced a succession of IHCIA reauthorization bills through the 106 th -109 th Congresses. The first IHCIA reauthorization bill introduced in this Congress, S. 1057 , was referred to the Senate Indian Affairs Committee and reported on March 16, 2006 ( S.Rept. 109-222 ). A House bill ( H.R. 5312 ), very similar to S. 1057 as reported, was referred to three House committees, and ordered reported by one committee, the Resources Committee, on June 21. A Senate Finance Committee bill, S. 3524 , amending the Social Security Act regarding Indian health provisions in Medicaid, Medicare, and SCHIP, was reported by the Committee July 12 ( S.Rept. 109-278 ). For detailed discussion of these bills and Indian health issues, see CRS Report RL33022, Indian Health Service: Health Care Delivery, Status, Funding, and Legislative Issues . Congress faces a possibly multi-billion-dollar problem stemming from Indian trust funds. The federal government's management of Indian trust funds and lands has led to financial claims against the United States by Indian individuals and tribes. The Indian individual claimants alone suggest they are owed as much as $176 billion. Besides lawsuits, the issue has also led to the controversial reorganization of two agencies, the Bureau of Indian Affairs (BIA) and the Office of Special Trustee for American Indians (OST) within DOI. The BIA has long managed funds, lands, and related physical assets held in trust for Indian tribes and individuals. Trust lands total about 56 million acres (almost 46 million acres for tribes and 10 million acres for individuals). The funds' asset value recently totaled about $3.3 billion, of which about $2.9 billion was in about 1,400 tribal accounts and $400 million was in more than 260,000 Individual Indian Money (IIM) accounts. The Treasury Department houses the accounts, including making payments to beneficiaries. Historically, the BIA was frequently criticized for its management of trust lands and funds. Investigations and audits in the 1980s and after showed that, among other problems, the BIA could not document the asset values of all trust fund accounts and could not link all trust lands to their owners and accounts. Congress enacted the American Indian Trust Fund Management Reform Act of 1994 to reform the management of Indian trust funds and assets; the act directed the Secretary of the Interior to account for trust fund balances and created the OST to oversee trust management reforms. Two years later, based on the 1994 act and general trust law, IIM account holders filed a class action suit in the federal district court for the District of Columbia against the various U.S. officials, demanding an accounting of their funds and correction of fund mismanagement ( Cobell v. Norton , Civil No. 96-1285, D.D.C.). In addition, at least 25 tribal suits have been filed, covering specific tribes' funds. These events have led to the current reorganization of the BIA and OST and to congressional consideration of the settlement of IIM and tribal claims arising from trust fund and lands mismanagement. In the first of two stages of the Cobell case, the district court in 1999 found that DOI and Treasury had breached their trust duties regarding (1) the document retention and data gathering necessary for an accounting and (2) the business systems and staffing to fix trust management. The court ordered DOI and Treasury to bring trust management up to current trust standards. The final stage of the lawsuit will determine the amount of money that ought to be in the IIM plaintiffs' accounts. In an intervening stage, the district court decided what historical accounting method should be used to determine the amount owed the plaintiffs. DOI in 2003 proposed reconciling all trust account transactions above a certain value but only a sampling of transactions below that value, back to 1938, while the plaintiffs had proposed using production and mapping databases and DOI data to estimate the total amount due. DOI estimated its method would show IIM losses in the tens of millions, while the plaintiffs' methods have shown estimated losses (including interest) of well over $100 billion. The district court has twice issued orders (September 2003 and February 2005) requiring the DOI to perform a historical accounting of all IIM trust account transactions and assets since 1887, without using statistical sampling. After the second order, DOI estimated that compliance would cost $12-13 billion. Both times the U.S. Court of Appeals for the D.C. Circuit overturned the district court's order. To date the district court has not issued another order on historical accounting. The DOI continues to carry out its historical accounting plan. Congress has acted on the Cobell suit chiefly through oversight hearings and through provisions in Interior appropriation acts and reports. Both the House Appropriations Committee and the conference committee, in their reports on the FY2006 Interior appropriations act ( P.L. 109-54 ), stated that they rejected the position that Congress intended in the 1994 Act to require an historical accounting on the scale of that ordered by the district court, but no bills have been introduced in this Congress to amend the 1994 Act to delineate the extent of the historical accounting obligation. Congress has long been concerned that the costs of the Cobell lawsuit may jeopardize DOI trust reform implementation, reduce spending on other Indian programs, and be difficult to fund. Current costs include the expenses of the ongoing litigation. Possible future costs include $12-$13 billion for the court-ordered historical accounting, a Cobell settlement that might cost as much as the court-ordered historical accounting, the $27.5 billion that the Cobell plaintiffs have proposed as a settlement amount (in their statement of principles for settlement legislation), or the more than $100 billion that Cobell plaintiffs estimate their IIM accounts are owed. Among the funding sources for these large costs are discretionary appropriations and the Treasury Department's "Judgment Fund," although some senior appropriators consider the Fund insufficient for a $12-$13 billion dollar settlement, much less a larger one. Among other options, Congress may await further court actions, delay a court-ordered accounting, delineate DOI's historical accounting obligations, or direct a settlement. Thus far two settlement bills, S. 1439 and H.R. 4322 , have been introduced in the 109 th Congress. Both bills would establish an IIM accounting-claim settlement fund (whose size was left blank in the introduced bills) from which payments would be distributed to IIM claimants (under a formula to be determined by the Treasury Secretary), establish a commission to review and recommend changes in Indian trust asset management, allow increased payments for fractionated individual Indian trust interests, create a tribal trust management demonstration project, combine BIA and OST under a new Under Secretary for Indian Affairs, and require an annual independent audit of all Indian trust funds (for detailed discussion, see CRS Report RS22343, Indian Trust Fund Litigation: Legislation to Resolve Accounting Claims in Cobell v. Norton ). The Senate Indian Affairs Committee held hearings on S. 1439 in July 2005 (S.Hrg. 109-194) and March 28, 2006 (S.Hrg. 109-483), and, with the House Resources Committee, on both bills on March 1, 2006 (S.Hrg. 109-441). H.R. 4322 awaits further committee action. Senate Indian Affairs Committee mark-up of an amended S. 1439 , with a settlement amount of $8 billion, was scheduled for August 2 but withdrawn at the Administration's request, pending more negotiations over including IIM land mismanagement claims as well as IIM accounting and funds mismanagement claims under the $8-billion settlement. The DOI, BIA, and OST have undertaken, or proposed, a number of administrative and organizational changes to implement trust management reform since the 1994 Act. One of the more important changes was the 1996 transfer from BIA to OST of the office that manages the trust funds; management of trust lands and other physical assets stayed with BIA. In April 2003 the DOI undertook a new, and ongoing, reorganization that splits the BIA trust management operations off from other BIA services at the regional and agency levels, and creates OST field operations (by placing fiduciary trust officers and administrators at BIA regional and agency offices) to oversee trust management and provide information to Indian trust beneficiaries.