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Consolidated Statements of Cash Flows - USD ($)
$ in Millions
9 Months Ended
Sep. 30, 2019
Sep. 30, 2018
Cash Flows from Operating Activities    
Net Income $ 4,136 $ 2,499
Adjustments to reconcile net income to net cash provided by (used in) operating activities:    
Depreciation and amortization 2,724 438
Realized investment (gains) losses (84) 36
Deferred income taxes (benefits) (400) 17
Net changes in assets and liabilities, net of non-operating effects:    
Accounts receivable (1,171) (243)
Inventories 661 84
Deferred policy acquisition costs (162) (195)
Reinsurance recoverables and other assets (92) 355
Insurance liabilities 590 408
Pharmacy and service costs payable 210 9
Accounts payable, accrued expenses and other liabilities 23 177
Other, net 257 59
Net cash provided by (used in) operating activities 6,692 3,644
Proceeds from investments sold:    
Debt and equity securities 2,639 1,930
Investment maturities and repayments:    
Debt and equity securities 1,281 1,394
Commercial mortgage loans 174 181
Other sales, maturities and repayments (primarily short-term and other long-term investments) 978 588
Investments purchased or originated:    
Debt and equity securities (3,347) (4,461)
Commercial mortgage loans (221) (288)
Other (primarily short-term and other long-term investments) (1,214) (660)
Property and equipment purchases (740) (346)
Acquisitions, net of cash acquired (6) 0
Other, net (7) (12)
Net cash provided by (used in) investing activities (463) (1,674)
Cash Flows from Financing Activities    
Deposits and interest credited to contractholder deposit funds 731 816
Withdrawals and benefit payments from contractholder deposit funds (845) (872)
Net change in short-term debt (479) (109)
Repayment of long-term debt (3,340) (131)
Net proceeds on issuance of long-term debt 0 19,884
Repurchase of common stock (1,540) (310)
Issuance of common stock 101 41
Other, net (108) (204)
Net cash provided by (used in) financing activities (5,480) 19,115
Effect of foreign currency rate changes on cash and cash equivalents (27) (25)
Net increase / (decrease) in cash and cash equivalents 722 21,060
Cash and cash equivalents, January 1, 3,855 2,972
Cash and cash equivalents, ending balance 4,577 24,032
Supplemental Disclosure of Cash Information:    
Income taxes paid, net of refunds 1,607 767
Interest paid $ 1,257 $ 167