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Investments (Notes)
 12 Months Ended
Dec. 31, 2023
Investments [Abstract]  
Investments [Text Block] Investments
A summary of debt securities by major security type is as follows:
(in millions)Amortized
Cost		Gross
Unrealized
Gains		Gross
Unrealized
Losses		Fair
Value
December 31, 2023
Debt securities - available-for-sale:
U.S. government and agency obligations$4,674 $3 $(234)$4,443 
State and municipal obligations7,636 39 (322)7,353 
Corporate obligations23,136 67 (1,186)22,017 
U.S. agency mortgage-backed securities8,982 22 (708)8,296 
Non-U.S. agency mortgage-backed securities3,023 3 (240)2,786 
Total debt securities - available-for-sale47,451 134 (2,690)44,895 
Debt securities - held-to-maturity:
U.S. government and agency obligations506 1 (6)501 
State and municipal obligations28 — (2)26 
Corporate obligations69 — — 69 
Total debt securities - held-to-maturity603 1 (8)596 
Total debt securities$48,054 $135 $(2,698)$45,491 
December 31, 2022
Debt securities - available-for-sale:
U.S. government and agency obligations$4,093 $1 $(285)$3,809 
State and municipal obligations7,702 25 (479)7,248 
Corporate obligations23,675 17 (1,798)21,894 
U.S. agency mortgage-backed securities7,379 15 (808)6,586 
Non-U.S. agency mortgage-backed securities3,077 1 (294)2,784 
Total debt securities - available-for-sale45,926 59 (3,664)42,321 
Debt securities - held-to-maturity:
U.S. government and agency obligations578 — (14)564 
State and municipal obligations29 — (3)26 
Corporate obligations89 — — 89 
Total debt securities - held-to-maturity696 — (17)679 
Total debt securities$46,622 $59 $(3,681)$43,000 
Nearly all of the Company’s investments in mortgage-backed securities were rated “Double A” or better as of December 31, 2023.
The Company held $4.9 billion and $3.7 billion of equity securities as of December 31, 2023 and 2022, respectively. The Company’s investments in equity securities primarily consist of venture investments, employee savings plan related investments and shares of Brazilian real denominated fixed-income funds with readily determinable fair values. Additionally, the Company’s investments included $1.4 billion and $1.5 billion of equity method investments primarily in operating businesses in the health care sector, as of December 31, 2023 and 2022, respectively. The allowance for credit losses on held-to-maturity securities as of December 31, 2023 and 2022 was not material.
The amortized cost and fair value of debt securities as of December 31, 2023, by contractual maturity, were as follows:
Available-for-SaleHeld-to-Maturity
(in millions)Amortized
Cost		Fair
Value		Amortized
Cost		Fair
Value
Due in one year or less$4,286 $4,260 $313 $310 
Due after one year through five years15,124 14,556 246 244 
Due after five years through ten years10,844 10,036 26 25 
Due after ten years5,192 4,961 18 17 
U.S. agency mortgage-backed securities8,982 8,296 — — 
Non-U.S. agency mortgage-backed securities3,023 2,786 — — 
Total debt securities$47,451 $44,895 $603 $596 
The fair value of available-for-sale debt securities with gross unrealized losses by major security type and length of time that individual securities have been in a continuous unrealized loss position were as follows:
 Less Than 12 Months12 Months or Greater Total
(in millions)Fair
Value		Gross
Unrealized
Losses		Fair
Value		Gross
Unrealized
Losses		Fair
Value		Gross
Unrealized
Losses
December 31, 2023
U.S. government and agency obligations$1,270 $(7)$2,077 $(227)$3,347 $(234)
State and municipal obligations907 (7)4,063 (315)4,970 (322)
Corporate obligations1,826 (17)14,696 (1,169)16,522 (1,186)
U.S. agency mortgage-backed securities
1,337 (12)5,069 (696)6,406 (708)
Non-U.S. agency mortgage-backed securities
279 (6)2,202 (234)2,481 (240)
Total debt securities - available-for-sale$5,619 $(49)$28,107 $(2,641)$33,726 $(2,690)
December 31, 2022
U.S. government and agency obligations$2,007 $(96)$1,290 $(189)$3,297 $(285)
State and municipal obligations4,630 (288)1,178 (191)5,808 (479)
Corporate obligations13,003 (893)6,637 (905)19,640 (1,798)
U.S. agency mortgage-backed securities
3,561 (345)2,239 (463)5,800 (808)
Non-U.S. agency mortgage-backed securities
1,698 (128)976 (166)2,674 (294)
Total debt securities - available-for-sale$24,899 $(1,750)$12,320 $(1,914)$37,219 $(3,664)
The Company’s unrealized losses from all securities as of December 31, 2023 were generated from approximately 30,000 positions out of a total of 40,000 positions. The Company believes it will timely collect the principal and interest due on its debt securities that have an amortized cost in excess of fair value. The unrealized losses were primarily caused by interest rate increases and not by unfavorable changes in the credit quality associated with these securities which impacted the Company’s assessment on collectability of principal and interest. At each reporting period, the Company evaluates available-for-sale debt securities for any credit-related impairment when the fair value of the investment is less than its amortized cost. The Company evaluated the expected cash flows, the underlying credit quality and credit ratings of the issuers, noting no significant credit deterioration since purchase. As of December 31, 2023, the Company did not have the intent to sell any of the securities in an unrealized loss position. Therefore, the Company believes these losses to be temporary. The allowance for credit losses on available-for-sale debt securities as of December 31, 2023 and 2022 was not material.