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Income Taxes - Reconciliation to Nominal Tax Rate (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2019
Dec. 31, 2018
Dec. 31, 2017
Reconciliation of total taxes to nominal federal rate, amount [Abstract]      
Tax expense at nominal rate $ 1,380 $ 752 $ 1,262
Effect of U.S. tax reform legislation 0 (4) 232
Effect of undistributed foreign earnings 24 74 (70)
Health insurance industry tax 0 78 0
State income taxes (net of federal income tax benefit) 32 10 23
Other 14 25 (73)
Total income taxes $ 1,450 $ 935 $ 1,374
Reconciliation of total taxes to nominal federal rate, percent [Abstract]      
Tax expense at nominal rate 21.00% 21.00% 35.00%
Effect of U.S. tax reform legislation 0.00% (0.10%) 6.40%
Effect of undistributed foreign earnings 0.40% 2.10% (1.90%)
Health insurance industry tax 0.00% 2.20% 0.00%
State income taxes (net of federal income tax benefit) 0.50% 0.30% 0.60%
Other 0.20% 0.60% (2.00%)
Total income taxes 22.10% 26.10% 38.10%