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Investments (Notes) | 6 Months Ended
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Jun. 30, 2025
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
June 30, 2025 |  |  |  |  |  |  |  |
Debt securities - available-for-sale: |  |  |  |  |  |  |  |
U.S. government and agency obligations |  | $ | 4,189 |  |  | $ | 3 |  |  | $ | (186) |  |  | $ | 4,006 |
State and municipal obligations |  | 7,234 |  |  | 7 |  |  | (375) |  |  | 6,866 |
Corporate obligations |  | 24,044 |  |  | 106 |  |  | (735) |  |  | 23,415 |
U.S. agency mortgage-backed securities |  | 10,341 |  |  | 8 |  |  | (783) |  |  | 9,566 |
Non-U.S. agency mortgage-backed securities |  | 2,875 |  |  | 7 |  |  | (127) |  |  | 2,755 |
Total debt securities - available-for-sale |  | 48,683 |  |  | 131 |  |  | (2,206) |  |  | 46,608 |
Debt securities - held-to-maturity: |  |  |  |  |  |  |  |
U.S. government and agency obligations |  | 448 |  |  | 1 |  |  | (1) |  |  | 448 |
State and municipal obligations |  | 26 |  |  | — |  |  | (3) |  |  | 23 |
Corporate obligations |  | 19 |  |  | — |  |  | — |  |  | 19 |
Total debt securities - held-to-maturity |  | 493 |  |  | 1 |  |  | (4) |  |  | 490 |
Total debt securities |  | $ | 49,176 |  |  | $ | 132 |  |  | $ | (2,210) |  |  | $ | 47,098 |
December 31, 2024 |  |  |  |  |  |  |  |
Debt securities - available-for-sale: |  |  |  |  |  |  |  |
U.S. government and agency obligations |  | $ | 4,600 |  |  | $ | 1 |  |  | $ | (274) |  |  | $ | 4,327 |
State and municipal obligations |  | 7,357 |  |  | 2 |  |  | (375) |  |  | 6,984 |
Corporate obligations |  | 24,391 |  |  | 56 |  |  | (1,140) |  |  | 23,307 |
U.S. agency mortgage-backed securities |  | 10,577 |  |  | 1 |  |  | (994) |  |  | 9,584 |
Non-U.S. agency mortgage-backed securities |  | 2,890 |  |  | 2 |  |  | (175) |  |  | 2,717 |
Total debt securities - available-for-sale |  | 49,815 |  |  | 62 |  |  | (2,958) |  |  | 46,919 |
Debt securities - held-to-maturity: |  |  |  |  |  |  |  |
U.S. government and agency obligations |  | 444 |  |  | — |  |  | (2) |  |  | 442 |
State and municipal obligations |  | 28 |  |  | — |  |  | (2) |  |  | 26 |
Corporate obligations |  | 40 |  |  | — |  |  | — |  |  | 40 |
Total debt securities - held-to-maturity |  | 512 |  |  | — |  |  | (4) |  |  | 508 |
Total debt securities |  | $ | 50,327 |  |  | $ | 62 |  |  | $ | (2,962) |  |  | $ | 47,427 |
The Company held $5.4 billion and $4.9 billion of equity securities as of June 30, 2025 and December 31, 2024, respectively. The Company’s investments in equity securities primarily consist of venture investments and employee savings plan related investments. Additionally, the Company’s investments included $3.4 billion and $3.8 billion of equity method investments primarily in operating businesses in the health care sector as of June 30, 2025 and December 31, 2024, respectively. The allowance for credit losses on held-to-maturity securities at June 30, 2025 and December 31, 2024 was not material. The amortized cost and fair value of debt securities as of June 30, 2025, by contractual maturity, were as follows:
|  | Available-for-Sale |  | Held-to-Maturity
(in millions) |  | Amortized Cost |  | Fair Value |  | Amortized Cost |  | Fair Value
Due in one year or less |  | $ | 3,530 |  |  | $ | 3,506 |  |  | $ | 319 |  |  | $ | 319 |
Due after one year through five years |  | 14,415 |  |  | 14,106 |  |  | 152 |  |  | 152 |
Due after five years through ten years |  | 11,983 |  |  | 11,485 |  |  | 5 |  |  | 5 |
Due after ten years |  | 5,539 |  |  | 5,190 |  |  | 17 |  |  | 14 |
U.S. agency mortgage-backed securities |  | 10,341 |  |  | 9,566 |  |  | — |  |  | — |
Non-U.S. agency mortgage-backed securities |  | 2,875 |  |  | 2,755 |  |  | — |  |  | — |
Total debt securities |  | $ | 48,683 |  |  | $ | 46,608 |  |  | $ | 493 |  |  | $ | 490 |
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 Months |  | 12 Months or Greater |  | Total
(in millions) |  | Fair Value |  | Gross Unrealized Losses |  | Fair Value |  | Gross Unrealized Losses |  | Fair Value |  | Gross Unrealized Losses
June 30, 2025 |  |  |  |  |  |  |  |  |  |  |  |
Debt securities - available-for-sale: |  |  |  |  |  |  |  |  |  |  |  |
U.S. government and agency obligations |  | $ | 1,377 |  |  | $ | (21) |  |  | $ | 1,833 |  |  | $ | (165) |  |  | $ | 3,210 |  |  | $ | (186) |
State and municipal obligations |  | 2,116 |  |  | (93) |  |  | 4,037 |  |  | (282) |  |  | 6,153 |  |  | (375) |
Corporate obligations |  | 4,988 |  |  | (80) |  |  | 10,214 |  |  | (655) |  |  | 15,202 |  |  | (735) |
U.S. agency mortgage-backed securities |  | 3,914 |  |  | (110) |  |  | 4,561 |  |  | (673) |  |  | 8,475 |  |  | (783) |
Non-U.S. agency mortgage-backed securities |  | 300 |  |  | (2) |  |  | 1,636 |  |  | (125) |  |  | 1,936 |  |  | (127) |
Total debt securities - available-for-sale |  | $ | 12,695 |  |  | $ | (306) |  |  | $ | 22,281 |  |  | $ | (1,900) |  |  | $ | 34,976 |  |  | $ | (2,206) |
December 31, 2024 |  |  |  |  |  |  |  |  |  |  |  |
Debt securities - available-for-sale: |  |  |  |  |  |  |  |  |  |  |  |
U.S. government and agency obligations |  | $ | 1,475 |  |  | $ | (51) |  |  | $ | 2,152 |  |  | $ | (223) |  |  | $ | 3,627 |  |  | $ | (274) |
State and municipal obligations |  | 2,593 |  |  | (58) |  |  | 4,085 |  |  | (317) |  |  | 6,678 |  |  | (375) |
Corporate obligations |  | 7,402 |  |  | (213) |  |  | 11,449 |  |  | (927) |  |  | 18,851 |  |  | (1,140) |
U.S. agency mortgage-backed securities |  | 4,791 |  |  | (191) |  |  | 4,674 |  |  | (803) |  |  | 9,465 |  |  | (994) |
Non-U.S. agency mortgage-backed securities |  | 416 |  |  | (5) |  |  | 1,863 |  |  | (170) |  |  | 2,279 |  |  | (175) |
Total debt securities - available-for-sale |  | $ | 16,677 |  |  | $ | (518) |  |  | $ | 24,223 |  |  | $ | (2,440) |  |  | $ | 40,900 |  |  | $ | (2,958) |
The Company’s unrealized losses from debt securities as of June 30, 2025 were generated from approximately 28,000 positions out of a total of 43,000 positions. The Company believes that 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 June 30, 2025, the Company did not have the intent to sell any of the available-for-sale debt 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 at June 30, 2025 and December 31, 2024 was not material.

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