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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 9 Months Ended
Sep. 30, 2019
Sep. 30, 2018
Operating activities:    
Net income $ 569 $ 506
Adjustments to reconcile net income to net cash provided by (used in) operating activities:    
Depreciation and amortization 68 104
Deferred income taxes 7 (32)
Share-based compensation 29 20
Amortization of convertible senior notes and finance lease liabilities 5 18
(Gain) loss on debt extinguishment (15) 25
Non-cash restructuring costs 0 17
Gain on sale of subsidiary 0 (37)
Other, net (5) 6
Changes in operating assets and liabilities:    
Receivables 50 (507)
Prepaid expenses and other current assets (6) (117)
Medical claims and benefits payable 14 (144)
Amounts due government agencies (355) (511)
Accounts payable and accrued liabilities 37 398
Deferred revenue (4) (55)
Income taxes 4 118
Net cash provided by (used in) operating activities 398 (191)
Investing activities:    
Purchases of investments (1,938) (1,202)
Proceeds from sales and maturities of investments 1,890 2,070
Purchases of property, equipment and capitalized software (30) (24)
Other, net (2) (23)
Net cash (used in) provided by investing activities (80) 821
Financing activities:    
Repayment of principal amount of 1.125% Convertible Notes (240) (236)
Cash paid for partial settlement of 1.125% Conversion Option (578) (477)
Cash received for partial termination of 1.125% Call Option 578 477
Cash paid for partial termination of 1.125% Warrants (514) (419)
Proceeds from borrowings under Term Loan Facility 220 0
Repayment of Credit Facility 0 (300)
Repayment of 1.625% Convertible Notes 0 (64)
Other, net 24 7
Net cash used in financing activities (510) (1,012)
Net decrease in cash, cash equivalents, and restricted cash and cash equivalents (192) (382)
Cash, cash equivalents, and restricted cash and cash equivalents at beginning of period 2,926 3,290
Cash, cash equivalents, and restricted cash and cash equivalents at end of period 2,734 2,908
Schedule of non-cash investing and financing activities:    
Common stock used for share-based compensation (7) (6)
Details of sale of subsidiary:    
Decrease in carrying amount of assets 0 (243)
Decrease in carrying amount of liabilities 0 59
Transaction costs 0 (12)
Receivable from buyer - recorded in prepaid expenses and other current assets 0 233
Gain on sale of subsidiary 0 37
Details of change in fair value of derivatives, net:    
Change in fair value of derivatives, net 0 0
1.625% Convertible Notes exchange transaction:    
Common stock issued in exchange for 1.625% Convertible Notes 0 131
Component allocated to additional paid-in capital, net of income taxes 0 (23)
Net increase to additional paid-in capital 0 108
1.125% Call Option    
Details of change in fair value of derivatives, net:    
Change in fair value of derivatives, net 124 321
1.125% Conversion Option    
Details of change in fair value of derivatives, net:    
Change in fair value of derivatives, net $ (124) $ (321)