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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Operating activities:      
Net income $ 1,091 $ 792 $ 659
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 171 176 131
Deferred income taxes (31) (66) (24)
Share-based compensation 115 103 72
Loss on debt repayment 0 0 25
Impairment 0 208 0
Other, net 2 8 33
Changes in operating assets and liabilities, net of the effect of acquisitions:      
Receivables (778) (95) (415)
Prepaid expenses and other current assets (69) (124) (19)
Medical claims and benefits payable 580 153 471
Amounts due government agencies 196 (428) 1,046
Accounts payable, accrued liabilities and other 328 55 138
Deferred revenue 59 (11) (5)
Income taxes (2) 2 7
Net cash provided by operating activities 1,662 773 2,119 Close
Investing activities:      
Purchases of investments (1,433) (1,913) (2,713)
Proceeds from sales and maturities of investments 772 1,398 1,329
Net cash paid in business combinations (3) (134) (129)
Purchases of property, equipment and capitalized software (84) (91) (77)
Other, net 4 (50) (63)
Net cash used in investing activities (744) (790) (1,653) Close
Financing activities:      
Common stock purchases 0 (400) (128)
Common stock withheld to settle employee tax obligations (60) (54) (53)
Contingent consideration liabilities settled 0 (20) (20)
Proceeds from senior notes offerings, net of issuance costs 0 0 740
Repayment of senior notes 0 0 (723)
Other, net 2 33 1
Net cash used in financing activities (58) (441) (183) Close
Net increase (decrease) in cash and cash equivalents, and restricted cash and cash equivalents 860 (458) 283 Close
Cash and cash equivalents, and restricted cash and cash equivalents at beginning of period 4,048 4,506 4,223
Cash and cash equivalents, and restricted cash and cash equivalents at end of period 4,908 4,048 4,506
Cash paid during the period for:      
Income taxes, net 405 340 235
Interest $ 108 $ 108 $ 127