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Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Operating activities:      
Net income $ 659 $ 673 $ 737
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 131 88 89
Deferred income taxes (24) (19) 10
Share-based compensation 72 57 39
Loss (gain) on debt repayment 25 15 (15)
Other, net 33 12 0
Changes in operating assets and liabilities, net of the effect of acquisitions:      
Receivables (415) (100) (76)
Prepaid expenses and other current assets (19) (16) 28
Medical claims and benefits payable 471 544 (107)
Amounts due government agencies 1,046 446 (303)
Accounts payable, accrued liabilities and other 138 86 9
Deferred revenue (5) 126 38
Income taxes 7 (14) (15)
Net cash provided by operating activities 2,119 1,898 434
Investing activities:      
Purchases of investments (2,713) (670) (2,536)
Proceeds from sales and maturities of investments 1,329 1,097 2,302
Net cash paid in business combinations (129) (755) 0
Purchases of property, equipment and capitalized software (77) (74) (57)
Other, net (63) 2 (2)
Net cash (used in) provided by investing activities (1,653) (400) (293)
Financing activities:      
Proceeds from senior notes offerings, net of issuance costs 740 1,429 0
Repayment of senior notes (723) (338) 0
Common stock purchases (128) (606) (47)
Common stock withheld to settle employee tax obligations (53) (8) (7)
Contingent consideration liabilities settled (20) 0 0
Repayment of term loan facility 0 (600) 0
Proceeds from borrowings under term loan facility 0 380 220
Cash paid for partial termination of warrants 0 (30) (514)
Cash paid for partial settlement of conversion option 0 (27) (578)
Cash received for partial settlement of call option 0 27 578
Repayment of principal amount of convertible senior notes 0 (12) (240)
Other, net 1 2 29
Net cash (used in) provided by financing activities (183) 217 (559)
Net increase (decrease) in cash and cash equivalents, and restricted cash and cash equivalents 283 1,715 (418)
Cash and cash equivalents, and restricted cash and cash equivalents at beginning of period 4,223 2,508 2,926
Cash and cash equivalents, and restricted cash and cash equivalents at end of period 4,506 4,223 2,508
Cash paid during the period for:      
Income taxes 235 321 239
Interest $ 127 $ 112 $ 78