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Income Taxes - Reconciliation of Total Income Taxes to the Amount Computed Using the Nominal Federal Income Tax Rate (Details) - USD ($)
$ in Millions
12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
$      
Tax expense at nominal rate $ 2,282 $ 1,380 $ 752
Effect of U.S. tax reform legislation 0 0 (4)
Impact of sale of business 104 0 0
Effect of foreign earnings (61) 24 74
Health insurance industry tax 93 0 78
State income tax (net of federal income tax benefit) 24 32 10
Other (63) 14 25
Total income taxes $ 2,379 $ 1,450 $ 935
%      
Tax expense at nominal rate 21.00% 21.00% 21.00%
Effect of U.S. tax reform legislation 0.00% 0.00% (0.10%)
Impact of sale of business 1.00% 0.00% 0.00%
Effect of foreign earnings (0.60%) 0.40% 2.10%
Health insurance industry tax 0.90% 0.00% 2.20%
State income tax (net of federal income tax benefit) 0.20% 0.50% 0.30%
Other (0.60%) 0.20% 0.60%
Total income taxes 21.90% 22.10% 26.10%