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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2020
Jun. 30, 2019
Operating activities:    
Net income $ 454,000 $ 394,000
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation and amortization 41,000 47,000
Deferred income taxes 6,000 19,000
Share-based compensation 28,000 19,000
Loss (gain) on debt repayment 5,000 (17,000)
Other, net (1,000) 7,000
Changes in operating assets and liabilities:    
Receivables (174,000) 91,000
Prepaid expenses and other current assets (157,000) 18,000
Medical claims and benefits payable 106,000 (194,000)
Amounts due government agencies 201,000 17,000
Accounts payable, accrued liabilities and other 251,000 (61,000)
Deferred revenue (195,000) (181,000)
Income taxes 184,000 (3,000)
Net cash provided by operating activities 749,000 156,000
Investing activities:    
Purchases of investments (670,000) (1,162,000)
Proceeds from sales and maturities of investments 750,000 791,000
Purchases of property, equipment and capitalized software (45,000) (20,000)
Other, net 3,000 (2,000)
Net cash provided by (used in) investing activities 38,000 (393,000)
Financing activities:    
Proceeds from senior notes offering, net of issuance costs 789,000 0
Repayment of term loan facility (600,000) 0
Common stock purchases (453,000) 0
Proceeds from borrowings under term loan facility 380,000 220,000
Cash paid for partial termination of warrants (30,000) (424,000)
Cash paid for partial settlement of conversion option (27,000) (473,000)
Cash received for partial settlement of call option 27,000 473,000
Repayment of principal amount of convertible senior notes (12,000) (185,000)
Other, net (3,000) 27,000
Net cash provided by (used in) financing activities 71,000 (362,000)
Net increase (decrease) in cash, cash equivalents, and restricted cash and cash equivalents 858,000 (599,000)
Cash, cash equivalents, and restricted cash and cash equivalents at beginning of period 2,508,000 2,926,000
Cash, cash equivalents, and restricted cash and cash equivalents at end of period 3,366,000 2,327,000
Schedule of non-cash investing and financing activities:    
Common stock used for share-based compensation (8,000) (7,000)
Details of change in fair value of derivatives, net:    
Change in fair value of derivatives, net 0 0
Call option    
Details of change in fair value of derivatives, net:    
Change in fair value of derivatives, net (2,000) 166,000
Conversion option    
Details of change in fair value of derivatives, net:    
Change in fair value of derivatives, net $ 2,000 $ (166,000)