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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions | 12 Months Ended
--- | ---
Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Cash flows from operating activities: |  |  |
Net earnings | $ 894 | $ 808 | $ 561
Adjustments to reconcile net earnings to net cash provided by operating activities |  |  |
Depreciation and amortization | 495 | 361 | 278
Stock compensation expense | 145 | 135 | 148
Debt extinguishment costs | 0 | 0 | (7)
Deferred income taxes | (129) | (108) | 92
Changes in assets and liabilities |  |  |
Premium and trade receivables | (1,173) | (50) | 74
Other assets | (38) | (146) | 167
Medical claims liabilities | 1,325 | 359 | 145
Unearned revenue | (52) | 19 | 43
Accounts payable and accrued expenses | (533) | 53 | 402
Other long-term liabilities | 258 | 68 | (61)
Other operating activities, net | 42 | (10) | 9
Net cash provided by operating activities | 1,234 | 1,489 | 1,851
Cash flows from investing activities: |  |  |
Capital expenditures | (675) | (422) | (306)
Purchases of investments | (3,846) | (2,656) | (2,432)
Sales and maturities of investments | 1,991 | 1,862 | 1,566
Investments in acquisitions, net of cash acquired | (2,055) | (50) | (1,297)
Other investing activities, net | 0 | 12 | 0
Net cash used in investing activities | (4,585) | (1,254) | (2,469)
Cash flows from financing activities: |  |  |
Proceeds from the issuance of common stock | 2,779 | 0 | 0
Proceeds from borrowings | 6,077 | 1,400 | 8,946
Payment of long-term debt | (4,083) | (1,353) | (6,076)
Common stock repurchases | (71) | (65) | (63)
Purchase of noncontrolling interest | (74) | (66) | (14)
Debt issue costs | (25) | (3) | (76)
Other financing activities, net | 9 | 5 | 0
Net cash provided by (used in) financing activities | 4,612 | (82) | 2,717
Effect of exchange rate changes on cash, cash equivalents and restricted cash | 0 | 0 | (1)
Net increase in cash, cash equivalents and restricted cash | 1,261 | 153 | 2,098
Cash, cash equivalents, and restricted cash and cash equivalents, beginning of period | 4,089 | 3,936 | 1,838
Cash, cash equivalents, and restricted cash and cash equivalents, end of period | 5,350 | 4,089 | 3,936
Supplemental disclosures of cash flow information: |  |  |
Interest paid | 323 | 237 | 165
Income taxes paid | 448 | 496 | 556
Equity issued in connection with acquisitions | $ 507 | $ 0 | $ 3,105

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- Definition Amount of cash inflow (outflow) from financing activities classified as other. + References Reference 1: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 235 -SubTopic 10 -Section S99 -Paragraph 3 -Subparagraph (SX 210.12-04(a)) -URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e24072-122690 Reference 2: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 14 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3255-108585 Reference 3: http://www.xbrl.org/2009/role/commonPracticeRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3291-108585 + Details
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- Definition The cash inflow associated with the sale, maturity and collection of all investments such as debt, security and so forth during the period. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 12 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3179-108585 + Details
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- Definition The consolidated profit or loss for the period, net of income taxes, including the portion attributable to the noncontrolling interest. + References Reference 1: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 220 -SubTopic 10 -Section 45 -Paragraph 1A -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=114867106&loc=SL7669619-108580 Reference 2: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 50 -Paragraph 1A -Subparagraph (a)(1) -URI http://asc.fasb.org/extlink&oid=109239629&loc=SL4573702-111684 Reference 3: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 220 -SubTopic 10 -Section 45 -Paragraph 1B -Subparagraph (a) -URI http://asc.fasb.org/extlink&oid=114867106&loc=SL7669625-108580 Reference 4: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 50 -Paragraph 1A -Subparagraph (c)(1) -URI http://asc.fasb.org/extlink&oid=109239629&loc=SL4573702-111684 Reference 5: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 22 -URI http://asc.fasb.org/extlink&oid=115929826&loc=d3e8736-108599 Reference 6: http://www.xbrl.org/2003/role/exampleRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4J -URI http://asc.fasb.org/extlink&oid=84234705&loc=SL4591551-111686 Reference 7: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 2 -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3000-108585 Reference 8: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 45 -Paragraph 19 -URI http://asc.fasb.org/extlink&oid=108774443&loc=SL4569616-111683 Reference 9: http://www.xbrl.org/2003/role/disclosureRef -Publisher FASB -Name Accounting Standards Codification -Topic 280 -SubTopic 10 -Section 50 -Paragraph 32 -Subparagraph (c) -URI http://asc.fasb.org/extlink&oid=115929826&loc=d3e8933-108599 Reference 10: http://www.xbrl.org/2003/role/exampleRef -Publisher FASB -Name Accounting Standards Codification -Topic 810 -SubTopic 10 -Section 55 -Paragraph 4K -URI http://asc.fasb.org/extlink&oid=84234705&loc=SL4591552-111686 + Details
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- Definition The cash outflow for debt initially having maturity due after one year or beyond the normal operating cycle, if longer. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 230 -SubTopic 10 -Section 45 -Paragraph 15 -Subparagraph (b) -URI http://asc.fasb.org/extlink&oid=109223946&loc=d3e3291-108585 + Details
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