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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Cash flows from operating activities:      
Net earnings $ 1,202 $ 1,336 $ 1,794
Adjustments to reconcile net earnings to net cash provided by operating activities      
Depreciation and amortization 1,553 1,476 1,259
Stock compensation expense 234 203 281
Impairment 2,318 229 72
(Gain) loss on debt extinguishment (25) 125 57
(Gain) on acquisition (2) (309) 0
Deferred income taxes (631) (132) (51)
(Gain) on divestitures (772) (88) (104)
Loss on disposal of equipment 221 12 5
Other adjustments, net (31) (23) (5)
Changes in assets and liabilities      
Premium and trade receivables (1,627) (2,453) (52)
Other assets 128 (99) (30)
Medical claims liabilities 2,397 1,802 1,117
Unearned revenue 31 (109) (528)
Accounts payable and accrued expenses 421 1,141 585
Other long-term liabilities 842 1,093 1,078
Other operating activities, net 2 1 25
Net cash provided by operating activities 6,261 4,205 5,503
Cash flows from investing activities:      
Capital expenditures (1,004) (910) (869)
Purchases of investments (6,736) (7,400) (7,402)
Sales and maturities of investments 3,802 5,458 4,921
Acquisitions, net of cash acquired (1,460) (534) (4,049)
Divestiture proceeds, net of divested cash 2,477 68 466
Other investing activities, net 0 19 (22)
Net cash (used in) investing activities (2,921) (3,299) (6,955)
Cash flows from financing activities:      
Proceeds from long-term debt 360 9,267 5,107
Payments and repurchases of long-term debt (1,490) (7,434) (4,067)
Common stock repurchases (3,096) (297) (626)
Proceeds from common stock issuances 70 35 28
Payments for debt extinguishment (14) (157) (81)
Debt issuance costs 0 (72) (120)
Other financing activities, net (27) 20 19
Net cash (used in) provided by financing activities (4,197) 1,362 260
Effect of exchange rate changes on cash, cash equivalents, and restricted cash (11) (11) 18
Net increase (decrease) in cash, cash equivalents, and restricted cash and cash equivalents (868) 2,257 (1,174)
Cash and cash equivalents reclassified (to) from held for sale (16) 0 0
Cash, cash equivalents, and restricted cash and cash equivalents, beginning of period 13,214 10,957 12,131
Cash, cash equivalents, and restricted cash and cash equivalents, end of period 12,330 13,214 10,957
Supplemental disclosures of cash flow information:      
Interest paid 657 658 725
Income taxes paid 1,222 678 1,191
Equity issued in connection with acquisitions 60 0 11,526
Cash and cash equivalents      
Cash and cash equivalents 12,074 13,118 10,800
Restricted cash and cash equivalents, included in restricted deposits 256 96 157
Total cash, cash equivalents, and restricted cash and cash equivalents $ 12,330 $ 13,214 $ 10,957