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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Millions | 3 Months Ended
--- | ---
Mar. 31, 2019 | Mar. 31, 2018
Cash flows from operating activities: |  |
Net earnings | $ 519 | $ 338
Adjustments to reconcile net earnings to net cash provided by operating activities |  |
Depreciation and amortization | 155 | 104
Stock compensation expense | 38 | 33
Deferred income taxes | 23 | 30
Changes in assets and liabilities |  |
Premium and trade receivables | (662) | (176)
Other assets | 20 | 51
Medical claims liabilities | 548 | 485
Unearned revenue | (22) | 317
Accounts payable and accrued expenses | 357 | 157
Other long-term liabilities | 347 | 477
Other operating activities, net | (7) | 30
Net cash provided by operating activities | 1,316 | 1,846
Cash flows from investing activities: |  |
Capital expenditures | (176) | (218)
Purchases of investments | (580) | (765)
Sales and maturities of investments | 383 | 445
Acquisitions, net of cash acquired | 0 | (226)
Net cash used in investing activities | (373) | (764)
Cash flows from financing activities: |  |
Proceeds from long-term debt | 1,018 | 2,015
Payments of long-term debt | (927) | (1,491)
Common stock repurchases | (35) | (9)
Other financing activities, net | 2 | (2)
Net cash provided by financing activities | 58 | 513
Net increase in cash, cash equivalents and restricted cash and cash equivalents | 1,001 | 1,595
Cash, cash equivalents, and restricted cash and cash equivalents, beginning of period | 5,350 | 4,089
Cash, cash equivalents, and restricted cash and cash equivalents, end of period | 6,351 | 5,684
Supplemental disclosures of cash flow information: |  |
Interest paid | 87 | 73
Income taxes paid | 6 | 1
Equity issued in connection with acquisitions | 0 | 324
The following table provides a reconciliation of cash, cash equivalents, and restricted cash and cash equivalents reported within the Consolidated Balance Sheets to the totals above: |  |
Cash and cash equivalents | 6,345 | 5,668
Restricted cash and cash equivalents, included in restricted deposits | 6 | 16
Cash, cash equivalents, and restricted cash and cash equivalents, end of period | $ 6,351 | $ 5,684

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