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Molina Healthcare, Inc
(NYSE:MOH) 

MOH stock logo

Molina Healthcare, Inc. provides managed health care services to low-income families and individuals under the Medicaid and Medicare programs and through the state insurance marketplaces. The company operates in two segments, Health Plans and Other. As of December 31, 2020, it served approximately 4...

Founded: 1980
Full Time Employees: 10,000
CEO: Joseph Zubretsky  
Sector: Healthcare
Industry: Healthcare Plans

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At a glance:
  • Specializes in Government-Sponsored Healthcare: Molina Healthcare primarily provides managed care services for individuals and families participating in Medicaid, Medicare, and state health insurance marketplaces across multiple states.
  • Consistent Revenue Growth Driven by Membership: The company has demonstrated a track record of increasing revenues, largely fueled by organic membership growth in its core government programs and strategic market expansions.
  • Focus on Medical Cost Management and Profitability: A key operational focus for Molina is effectively managing its medical care ratio (MCR) and administrative expenses to ensure sustainable profitability while delivering quality healthcare services.
  • Navigating Regulatory and Policy Landscape: As a major player in government-sponsored programs, Molina's operations and financial performance are significantly influenced by changes in healthcare policy, regulations, and state contract renewals.
Bull Thesis:
  • Strong Position in Government-Sponsored Healthcare Programs: Molina Healthcare is a leading provider in the growing government-sponsored healthcare market, including Medicaid, Medicare, and ACA marketplaces. Demographic trends and ongoing policy support for these programs provide a robust and expanding addressable market for MOH.
  • Stabilization and Re-enrollment in Medicaid: Following the post-COVID Medicaid redetermination process, the churn is stabilizing, and a significant portion of eligible members are re-enrolling. Molina is well-positioned to recapture and grow its membership as states complete redeterminations and individuals seek coverage, leveraging its deep expertise in this segment.
  • Consistent Profitability and Margin Expansion: Molina has demonstrated a strong track record of consistent profitability and effective margin management. Its operational efficiency and ability to manage medical loss ratios (MLR) within its specialized niche contribute to healthy financial performance and shareholder returns.
  • Effective Medical Cost Management: The company has shown a strong capability to manage medical costs and administrative expenses, which is crucial in the government-sponsored healthcare sector. This discipline allows Molina to maintain competitive pricing while delivering quality care and sustaining profitability.
Bear Thesis:
  • Lingering Impact of Medicaid Redeterminations: While stabilization is expected, the ongoing Medicaid redetermination process could continue to exert pressure on membership numbers and revenue in the short to medium term. Slower-than-anticipated re-enrollment or higher-than-expected disenrollment rates pose a risk.
  • Government Reimbursement and Policy Risk: As a company heavily reliant on government contracts, Molina is exposed to risks associated with changes in federal and state healthcare policies, reimbursement rates, and budget allocations. Any adverse changes could directly impact revenue and profitability.
  • Intense Competitive Landscape: The government-sponsored healthcare market is highly competitive, with large national players and regional plans vying for market share. This intense competition could pressure pricing, increase marketing costs, and limit Molina's ability to expand its footprint or retain members.
  • Medical Cost Trend Inflation: Rising healthcare costs, driven by factors such as pharmaceutical price increases, higher utilization rates, and labor shortages, could lead to an increase in Molina's medical loss ratio (MLR). If these costs outpace premium adjustments, it could compress profit margins.
Main Competitors:
  • Centene Corporation ($CNC) (Medicaid, Medicare, Marketplace (Ambetter)), Centene is a direct and often larger competitor to Molina, specializing heavily in government-sponsored healthcare programs, particularly Medicaid and ACA marketplace plans (Ambetter). They compete for state contracts, member enrollment, and provider networks in similar geographic regions, often serving the same low-income and underserved populations.
  • UnitedHealth Group ($UNH) (UnitedHealthcare Community & State (Medicaid), UnitedHealthcare Medicare & Retirement (Medicare Advantage)), While a much larger and more diversified healthcare company, UnitedHealth Group's government-sponsored segments (Medicaid and Medicare Advantage) directly compete with Molina for members and state contracts. They leverage their vast scale, extensive provider networks, and technological capabilities to offer comprehensive plans.
  • Elevance Health ($ELV) (Amerigroup (Medicaid), Anthem Medicare (Medicare Advantage)), Elevance Health, through its various brands (like Amerigroup for Medicaid and Anthem for Medicare), is a significant competitor in the government programs space. They compete for state Medicaid contracts and Medicare Advantage enrollment, often operating in the same states as Molina and targeting similar beneficiary populations.
  • Humana Inc. ($HUM) (Medicare Advantage, Medicaid), Humana is a major player in the Medicare Advantage market and also has a growing presence in Medicaid. They compete with Molina for Medicare beneficiaries, offering a wide range of plans and services, and in some states, for Medicaid contracts and members, particularly those with complex health needs.
Moat:
Molina Healthcare's primary moat lies in its deep specialization and operational efficiency within government-sponsored healthcare programs (Medicaid, Medicare, ACA Marketplace). This niche requires specific expertise in navigating complex regulatory environments, managing the unique needs of lower-income and underserved populations, and building tailored provider networks. Their long-standing relationships with state governments and focused business model provide a competitive advantage. Competition is intense, characterized by large, well-capitalized players like UnitedHealth Group and Elevance Health, who leverage scale and diversified revenue streams, as well as specialized peers like Centene and Humana. Key competitive factors include winning state contracts, attracting and retaining members, managing medical costs effectively, building robust provider networks, and demonstrating quality outcomes amidst evolving regulatory landscapes and state budgetary pressures.
Income Statements:
Quarterly
Annual
    Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-12-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 2015-06-30 2015-03-31 2014-12-31 2014-09-30 2014-06-30 2014-03-31 2013-12-31 2013-09-30 2013-06-30 2013-03-31 2012-12-31 2012-09-30 2012-06-30 2012-03-31 2011-12-31 2011-09-30 2011-06-30 2011-03-31 2010-12-31 2010-09-30 2010-06-30 2010-03-31 2009-12-31 2009-09-30 2009-06-30 2009-03-31 2008-12-31 2008-09-30 2008-06-30 2008-03-31 2007-12-31 2007-09-30 2007-06-30 2007-03-31 2006-12-31 
                                                                                  
      revenue:
                                                                                  
      premium revenue
    10,172,000,000 10,715,000,000 10,841,000,000 10,868,000,000 10,628,000,000 9,983,000,000 9,694,000,000 9,446,000,000 9,504,000,000 8,362,000,000 8,240,000,000 8,042,000,000 7,885,000,000 7,917,000,000 7,636,000,000 7,799,000,000 7,531,000,000 7,166,000,000 6,800,000,000 6,583,000,000 6,306,000,000 4,855,000,000 4,768,000,000 4,372,000,000 4,304,000,000 4,123,000,000 4,084,000,000 4,049,000,000 3,952,000,000 4,438,000,000 4,337,000,000 4,514,000,000 4,323,000,000 4,689,000,000 4,777,000,000 4,740,000,000 4,648,000,000 4,177,000,000 4,191,000,000 4,029,000,000 3,995,000,000 3,588,946,000 3,377,030,000 3,304,372,000 2,970,652,000 2,598,273,000 2,316,759,000 2,167,142,000 1,940,337,000 1,595,352,000 1,584,656,000 1,548,612,000 1,534,608,000 1,518,052,000 1,488,718,000 1,492,272,000 1,327,449,000   1,128,770,000 1,081,438,000 1,042,889,000 1,005,115,000 976,685,000 965,220,000 962,411,000 914,805,000 925,507,000 857,484,000 808,895,000 791,554,000 761,153,000 729,638,000 670,605,000 628,402,000 607,127,000 556,235,000  
      premium tax revenue
    504,000,000 538,000,000 506,000,000 431,000,000 388,000,000 383,000,000 508,000,000 298,000,000 297,000,000 552,000,000 176,000,000 169,000,000 172,000,000 227,000,000 223,000,000 215,000,000 208,000,000 211,000,000 204,000,000 185,000,000 187,000,000 172,000,000 170,000,000 157,000,000 150,000,000 122,000,000 119,000,000 110,000,000 138,000,000 97,000,000 110,000,000 106,000,000 104,000,000 107,000,000 106,000,000 114,000,000 111,000,000 123,000,000 127,000,000 109,000,000 109,000,000 107,997,000 99,047,000 94,609,000 95,347,000 91,335,000 81,240,000 70,120,000 51,693,000                              
      investment income
    98,000,000 98,000,000 108,000,000 106,000,000 108,000,000 111,000,000 118,000,000 115,000,000 108,000,000 114,000,000 112,000,000 97,000,000 71,000,000 61,000,000 49,000,000 22,000,000 11,000,000 13,000,000 20,000,000 10,000,000 9,000,000                 6,250,000 9,000,000 8,000,000 8,000,000 6,325,000 4,832,000 3,828,000 3,015,000 2,478,000 2,041,000 1,945,000 1,629,000 2,006,000 1,740,000 1,628,000 1,529,000 1,192,000 1,171,000 1,108,000 1,717,000   1,446,000 1,594,000 1,379,000 1,760,000 1,599,000 1,521,000 1,813,000 1,707,000 2,082,000 3,547,000 3,609,000 4,775,000 5,338,000 7,404,000 9,024,000 7,632,000 6,761,000 6,668,000  
      other revenue
    22,000,000 24,000,000 22,000,000 22,000,000 23,000,000 22,000,000 20,000,000 21,000,000 22,000,000 20,000,000 20,000,000 19,000,000 21,000,000 18,000,000 19,000,000 18,000,000 20,000,000 19,000,000 16,000,000 22,000,000 20,000,000                 1,000,000 1,000,000 2,000,000 1,000,000 4,000 1,745,000 948,000 2,303,000 3,551,000 2,327,000 2,938,000 3,258,000                              
      total revenue
    10,796,000,000 11,375,000,000 11,477,000,000 11,427,000,000 11,147,000,000 10,499,000,000 10,340,000,000 9,880,000,000 9,931,000,000 9,048,000,000 8,548,000,000 8,327,000,000 8,149,000,000 8,223,000,000 7,927,000,000 8,054,000,000 7,770,000,000 7,409,000,000 7,040,000,000 6,800,000,000 6,522,000,000 5,235,000,000 5,021,000,000 4,618,000,000 4,549,000,000 4,274,000,000 4,243,000,000 4,193,000,000 4,119,000,000 4,664,000,000 4,697,000,000 4,883,000,000 4,646,000,000 4,949,000,000 5,031,000,000 4,999,000,000 4,904,000,000 4,534,000,000 4,546,000,000 4,359,000,000 4,343,000,000 3,870,624,000 3,611,363,000 3,524,890,000 3,171,123,000 2,800,968,000 2,484,351,000 2,312,039,000 2,069,243,000 1,705,622,000 1,687,079,000 1,605,834,000 1,590,587,000 1,578,569,000 1,540,190,000 1,536,424,000 1,373,580,000   1,167,104,000 1,119,706,000 1,080,752,000 1,039,146,000 999,338,000 966,741,000 964,224,000 916,512,000 927,589,000 861,031,000 812,504,000 796,329,000 766,491,000 737,042,000 679,629,000 636,034,000 613,888,000 562,903,000  
      yoy
    -3.15% 8.34% 11.00% 15.66% 12.24% 16.04% 20.96% 18.65% 21.87% 10.03% 7.83% 3.39% 4.88% 10.99% 12.60% 18.44% 19.14% 41.53% 40.21% 47.25% 43.37% 22.48% 18.34% 10.14% 10.44% -8.36% -9.67% -14.13% -11.34% -5.76% -6.64% -2.32% -5.26% 9.15% 10.67% 14.68% 12.92% 17.14% 25.88% 23.66% 36.95% 38.19% 45.36% 52.46% 53.25% 64.22% 47.26% 43.98% 30.09% 8.05% 9.54% 4.52% 15.80%   31.64% 22.67%   16.79% 15.82% 12.09% 13.38% 7.73% 12.28% 18.67% 15.09% 21.02% 16.82% 19.55% 25.20% 24.86% 30.94%      
      qoq
    -5.09% -0.89% 0.44% 2.51% 6.17% 1.54% 4.66% -0.51% 9.76% 5.85% 2.65% 2.18% -0.90% 3.73% -1.58% 3.66% 4.87% 5.24% 3.53% 4.26% 24.58% 4.26% 8.73% 1.52% 6.43% 0.73% 1.19% 1.80% -11.69% -0.70% -3.81% 5.10% -6.12% -1.63% 0.64% 1.94% 8.16% -0.26% 4.29% 0.37% 12.20% 7.18% 2.45% 11.16% 13.22% 12.74% 7.45% 11.73% 21.32% 1.10% 5.06% 0.96% 0.76% 2.49% 0.25% 11.86%    4.23% 3.60% 4.00% 3.98% 3.37% 0.26% 5.21% -1.19% 7.73% 5.97% 2.03% 3.89% 4.00% 8.45% 6.85% 3.61% 9.06%   
      operating expenses:
                                                                                  
      medical care costs
    9,270,000,000 10,136,000,000 10,044,000,000 9,829,000,000 9,479,000,000 9,003,000,000 8,643,000,000 8,368,000,000 8,414,000,000 7,454,000,000 7,306,000,000 7,038,000,000 6,871,000,000 6,992,000,000 6,748,000,000 6,872,000,000 6,563,000,000 6,362,000,000 6,049,000,000 5,819,000,000 5,474,000,000 4,408,000,000 4,098,000,000 3,598,000,000 3,716,000,000 3,545,000,000 3,523,000,000 3,466,000,000 3,371,000,000 3,775,000,000 3,790,000,000 3,850,000,000 3,722,000,000 4,251,000,000 4,220,000,000 4,491,000,000 4,111,000,000 3,844,000,000 3,748,000,000 3,594,000,000 3,588,000,000 3,213,311,000 3,015,371,000 2,929,534,000 2,635,784,000 2,322,538,000 2,097,836,000 1,934,299,000 1,721,658,000 1,414,290,000 1,383,213,000 1,294,706,000 1,288,754,000 1,273,624,000 1,314,571,000 1,377,577,000 1,130,988,000   949,359,000 913,532,000 862,491,000 845,937,000 839,613,000 822,816,000 842,371,000 792,771,000 803,206,000 737,888,000 684,781,000 669,355,000 640,829,000 626,347,000 560,839,000 525,902,000    
      general and administrative expenses
    779,000,000 795,000,000 729,000,000 711,000,000 774,000,000 665,000,000 676,000,000 691,000,000 711,000,000 645,000,000 608,000,000 618,000,000 591,000,000 629,000,000 560,000,000 551,000,000 571,000,000 579,000,000 532,000,000 484,000,000 473,000,000 450,000,000 368,000,000 345,000,000 317,000,000 343,000,000 323,000,000 328,000,000 302,000,000 335,000,000 311,000,000 335,000,000 352,000,000 367,000,000 383,000,000 405,000,000 439,000,000 359,000,000 343,000,000 351,000,000 340,000,000 315,723,000 287,691,000 286,496,000 256,090,000 204,488,000 178,879,000 193,239,000 188,087,000 187,006,000 176,233,000 161,479,000 141,407,000 153,419,000 127,500,000 131,485,000 120,223,000   96,921,000 94,436,000 100,374,000 88,660,000 78,079,000 113,426,000 115,933,000 97,635,000 94,073,000 91,508,000 91,565,000 88,030,000 87,074,000 78,092,000 80,464,000 74,235,000 67,208,000 63,388,000  
      premium tax expenses
    504,000,000 538,000,000 506,000,000 431,000,000 388,000,000 383,000,000 508,000,000 298,000,000 297,000,000 552,000,000 176,000,000 169,000,000 172,000,000 227,000,000 223,000,000 215,000,000 208,000,000 211,000,000 204,000,000 185,000,000 187,000,000 172,000,000 170,000,000 157,000,000 150,000,000 122,000,000 119,000,000 110,000,000 138,000,000 97,000,000 110,000,000 106,000,000 104,000,000 107,000,000 106,000,000 114,000,000 111,000,000 123,000,000 127,000,000 109,000,000 109,000,000 107,997,000 99,047,000 94,609,000 95,347,000 91,335,000 81,240,000 70,120,000 51,693,000 44,411,000 43,723,000 46,883,000 37,000,000 38,038,000 37,894,000 39,629,000 43,430,000   37,709,000 36,550,000 35,197,000 35,037,000 34,995,000               
      depreciation and amortization
    39,000,000 44,000,000 45,000,000 58,000,000 48,000,000 48,000,000 47,000,000 46,000,000 45,000,000 43,000,000 42,000,000 42,000,000 44,000,000 47,000,000 45,000,000 44,000,000 40,000,000 35,000,000 32,000,000 31,000,000 33,000,000 24,000,000 23,000,000 21,000,000 20,000,000 21,000,000 21,000,000 22,000,000 25,000,000 23,000,000 25,000,000 25,000,000 26,000,000 28,000,000 33,000,000 37,000,000 39,000,000 37,000,000 36,000,000 34,000,000 32,000,000 28,013,000 25,843,000 25,152,000 24,992,000 25,082,000 24,242,000 22,902,000 20,691,000 20,294,000 18,871,000 17,015,000 16,565,000 16,258,000 16,034,000 16,387,000 15,025,000   12,490,000 12,667,000 12,470,000 11,954,000 11,219,000 10,061,000 9,642,000 9,832,000 9,584,000 9,052,000 8,691,000 8,515,000 8,330,000 8,152,000 7,693,000 7,082,000 6,749,000 6,443,000  
      impairment
    93,000,000                                                                              
      other
    28,000,000 24,000,000 16,000,000 25,000,000 25,000,000 20,000,000 -1,000,000 43,000,000 38,000,000 38,000,000 57,000,000 17,000,000 16,000,000 15,000,000 16,000,000 11,000,000 16,000,000 31,000,000 2,000,000 8,000,000 20,000,000 22,000,000 3,000,000 2,000,000 4,000,000                                                      
      total operating expenses
    10,713,000,000 11,537,000,000 11,340,000,000 11,054,000,000 10,714,000,000 10,119,000,000 9,873,000,000 9,446,000,000 9,505,000,000 8,732,000,000 8,189,000,000 7,884,000,000 7,694,000,000 8,118,000,000 7,592,000,000 7,693,000,000 7,398,000,000 7,218,000,000 6,819,000,000 6,527,000,000 6,187,000,000 5,144,000,000 4,732,000,000 4,194,000,000 4,275,000,000 4,032,000,000 3,986,000,000 3,928,000,000 3,839,000,000 4,340,000,000 4,439,000,000 4,541,000,000 4,424,000,000 5,218,000,000 5,112,000,000 5,286,000,000 4,822,000,000 4,540,000,000 4,428,000,000 4,254,000,000 4,254,000,000 3,794,335,000 3,498,510,000 3,409,262,000 3,088,893,000 2,704,524,000 2,444,572,000 2,279,612,000 2,044,976,000                              
      operating income
    83,000,000 -162,000,000 137,000,000 373,000,000 433,000,000 380,000,000 467,000,000 434,000,000 426,000,000 316,000,000 359,000,000 443,000,000 455,000,000 105,000,000 335,000,000 361,000,000 372,000,000 191,000,000 221,000,000 273,000,000 335,000,000 91,000,000 289,000,000 424,000,000 274,000,000 242,000,000 257,000,000 265,000,000 280,000,000 272,000,000 295,000,000 342,000,000 222,000,000 -269,000,000 -81,000,000 -287,000,000 82,000,000 -6,000,000 118,000,000 105,000,000 89,000,000 76,289,000 112,853,000 115,628,000 82,230,000 96,444,000 39,779,000 32,427,000 24,267,000 -2,685,000 24,926,000 46,446,000 67,091,000 54,133,000 7,187,000 -59,267,000 33,420,000   31,410,000 31,300,000 33,432,000 29,953,000 21,178,000 20,438,000 -3,722,000 16,274,000 20,726,000 24,115,000 27,467,000 30,429,000 30,258,000 24,451,000 30,633,000 28,815,000 22,284,000 16,595,000  
      yoy
    -80.83% -142.63% -70.66% -14.06% 1.64% 20.25% 30.08% -2.03% -6.37% 200.95% 7.16% 22.71% 22.31% -45.03% 51.58% 32.23% 11.04% 109.89% -23.53% -35.61% 22.26% -62.40% 12.45% 60.00% -2.14% -11.03% -12.88% -22.51% 26.13% -201.12% -464.20% -219.16% 170.73% 4383.33% -168.64% -373.33% -7.87% -107.86% 4.56% -9.19% 8.23% -20.90% 183.70% 256.58% 238.86% -3691.96% 59.59% -30.18% -63.83% -104.96% 246.82% -178.37% 100.75%   -288.69% 6.77%   48.31% 53.15% -998.23% 84.05% 2.18% -15.25% -113.55% -46.52% -31.50% -1.37% -10.34% 5.60% 35.78% 47.34%      
      qoq
    -151.23% -218.25% -63.27% -13.86% 13.95% -18.63% 7.60% 1.88% 34.81% -11.98% -18.96% -2.64% 333.33% -68.66% -7.20% -2.96% 94.76% -13.57% -19.05% -18.51% 268.13% -68.51% -31.84% 54.74% 13.22% -5.84% -3.02% -5.36% 2.94% -7.80% -13.74% 54.05% -182.53% 232.10% -71.78% -450.00% -1466.67% -105.08% 12.38% 17.98% 16.66% -32.40% -2.40% 40.62% -14.74% 142.45% 22.67% 33.63% -1003.80% -110.77% -46.33% -30.77% 23.94% 653.21% -112.13% -277.34%    0.35% -6.38% 11.61% 41.43% 3.62% -649.11% -122.87% -21.48% -14.05% -12.20% -9.73% 0.57% 23.75% -20.18% 6.31% 29.31% 34.28%   
      operating margin %
    0.77% -1.42% 1.19% 3.26% 3.88% 3.62% 4.52% 4.39% 4.29% 3.49% 4.20% 5.32% 5.58% 1.28% 4.23% 4.48% 4.79% 2.58% 3.14% 4.01% 5.14% 1.74% 5.76% 9.18% 6.02% 5.66% 6.06% 6.32% 6.80% 5.83% 6.28% 7.00% 4.78% -5.44% -1.61% -5.74% 1.67% -0.13% 2.60% 2.41% 2.05% 1.97% 3.12% 3.28% 2.59% 3.44% 1.60% 1.40% 1.17% -0.16% 1.48% 2.89% 4.22% 3.43% 0.47% -3.86% 2.43%  NaN% 2.69% 2.80% 3.09% 2.88% 2.12% 2.11% -0.39% 1.78% 2.23% 2.80% 3.38% 3.82% 3.95% 3.32% 4.51% 4.53% 3.63% 2.95%  
      interest expense
    54,000,000 52,000,000 49,000,000 48,000,000 43,000,000 34,000,000 29,000,000 28,000,000 27,000,000 27,000,000 27,000,000 27,000,000 28,000,000 27,000,000 28,000,000 27,000,000 28,000,000 30,000,000 30,000,000 30,000,000 30,000,000 30,000,000 27,000,000 24,000,000 21,000,000 20,000,000 22,000,000 22,000,000 23,000,000 24,000,000 26,000,000 32,000,000 33,000,000 33,000,000 32,000,000 27,000,000 26,000,000 25,000,000 26,000,000 25,000,000 25,000,000 20,909,000 15,269,000 14,946,000 14,876,000 14,577,000 14,419,000 13,993,000 13,822,000 13,835,000 13,532,000 11,667,000 13,037,000 4,348,000 4,315,000 3,808,000 4,298,000   3,683,000 3,603,000 -3,453,000 -4,600,000 -4,099,000 -3,357,000 -3,860,000 -3,279,000 -3,223,000 -3,415,000 -2,155,000 -1,980,000 -2,307,000 -2,272,000 -2,251,000 -530,000 -725,000 -1,125,000  
      income before income tax expense
    29,000,000 -214,000,000 88,000,000 325,000,000 390,000,000 346,000,000 438,000,000 406,000,000 399,000,000 289,000,000 332,000,000 416,000,000 427,000,000 78,000,000 307,000,000 334,000,000 344,000,000 136,000,000 191,000,000 243,000,000 305,000,000 51,000,000 262,000,000 395,000,000 253,000,000 222,000,000 233,000,000 257,000,000 260,000,000   305,000,000 179,000,000 -316,000,000 -113,000,000 -314,000,000 131,000,000 -31,000,000 92,000,000 80,000,000 64,000,000                                      
      income tax expense
    15,000,000 -54,000,000 9,000,000 70,000,000 92,000,000 95,000,000 112,000,000 105,000,000 98,000,000 73,000,000 87,000,000 107,000,000 106,000,000 22,000,000 77,000,000 86,000,000 86,000,000 33,000,000 48,000,000 58,000,000 77,000,000 17,000,000 77,000,000 119,000,000 75,000,000 54,000,000 58,000,000 61,000,000 62,000,000   103,000,000 72,000,000 -54,000,000 -16,000,000 -84,000,000 54,000,000 16,000,000 50,000,000 47,000,000 40,000,000 26,665,000 51,329,000 61,783,000 39,223,000 47,942,000 8,427,000 10,702,000 5,655,000 -7,475,000 3,865,000  24,270,000            6,491,000    8,489,000    9,024,000 6,223,750 10,772,000 8,245,000 5,878,000  
      net income
    14,000,000 -160,000,000 79,000,000 255,000,000 298,000,000 251,000,000 326,000,000 301,000,000 301,000,000 216,000,000 245,000,000 309,000,000 321,000,000 56,000,000 230,000,000 248,000,000 258,000,000 103,000,000 143,000,000 185,000,000 228,000,000 34,000,000 185,000,000 276,000,000 178,000,000 168,000,000 175,000,000 196,000,000 198,000,000 201,000,000 197,000,000 202,000,000 107,000,000 -262,000,000 -97,000,000 -230,000,000 77,000,000 -47,000,000 42,000,000 33,000,000 24,000,000 29,605,000 46,299,000 38,943,000 28,153,000 33,792,000 16,122,000 7,811,000 4,498,000 -9,126,000 7,569,000 24,571,000 29,915,000 25,643,000 3,364,000 -37,306,000 18,089,000   17,440,000 17,388,000 17,628,000 16,173,000 10,579,000 10,590,000 -4,472,000 8,564,000 14,565,000 12,211,000 15,541,000 17,186,000 16,516,000 13,155,000 17,911,000 17,513,000 13,314,000 9,592,000  
      yoy
    -95.30% -163.75% -75.77% -15.28% -1.00% 16.20% 33.06% -2.59% -6.23% 285.71% 6.52% 24.60% 24.42% -45.63% 60.84% 34.05% 13.16% 202.94% -22.70% -32.97% 28.09% -79.76% 5.71% 40.82% -10.10% -16.42% -11.17% -2.97% 85.05% -176.72% -303.09% -187.83% 38.96% 457.45% -330.95% -796.97% 220.83% -258.76% -9.29% -15.26% -14.75% -12.39% 187.18% 398.57% 525.90% -470.28% 113.00% -68.21% -84.96% -135.59% 125.00% -165.86% 65.38%   -313.91% 4.03%   64.85% 64.19% -494.19% 88.85% -27.37% -13.27% -128.78% -50.17% -11.81% -7.18% -13.23% -1.87% 24.05% 37.15%      
      qoq
    -108.75% -302.53% -69.02% -14.43% 18.73% -23.01% 8.31% 0.00% 39.35% -11.84% -20.71% -3.74% 473.21% -75.65% -7.26% -3.88% 150.49% -27.97% -22.70% -18.86% 570.59% -81.62% -32.97% 55.06% 5.95% -4.00% -10.71% -1.01% -1.49% 2.03% -2.48% 88.79% -140.84% 170.10% -57.83% -398.70% -263.83% -211.90% 27.27% 37.50% -18.93% -36.06% 18.89% 38.33% -16.69% 109.60% 106.40% 73.65% -149.29% -220.57% -69.20% -17.86% 16.66% 662.28% -109.02% -306.24%    0.30% -1.36% 9.00% 52.88% -0.10% -336.81% -152.22% -41.20% 19.28% -21.43% -9.57% 4.06% 25.55% -26.55% 2.27% 31.54% 38.80%   
      net income margin %
    0.13% -1.41% 0.69% 2.23% 2.67% 2.39% 3.15% 3.05% 3.03% 2.39% 2.87% 3.71% 3.94% 0.68% 2.90% 3.08% 3.32% 1.39% 2.03% 2.72% 3.50% 0.65% 3.68% 5.98% 3.91% 3.93% 4.12% 4.67% 4.81% 4.31% 4.19% 4.14% 2.30% -5.29% -1.93% -4.60% 1.57% -1.04% 0.92% 0.76% 0.55% 0.76% 1.28% 1.10% 0.89% 1.21% 0.65% 0.34% 0.22% -0.54% 0.45% 1.53% 1.88% 1.62% 0.22% -2.43% 1.32%  NaN% 1.49% 1.55% 1.63% 1.56% 1.06% 1.10% -0.46% 0.93% 1.57% 1.42% 1.91% 2.16% 2.15% 1.78% 2.64% 2.75% 2.17% 1.70%  
      net income per share
    0.27 2.953 1.51 4.75 5.47 4.013 5.67 5.18 5.21 3.795 4.24 5.37 5.58 3.185 4.29 4.45 2.408 2.49 3.2 3.95 2.7 3.14 4.72 2.95                                                      
      other expenses, net:
                                                                                  
      total other expenses
             27,000,000 27,000,000 27,000,000  27,000,000 28,000,000 27,000,000 28,000,000 55,000,000 30,000,000 30,000,000 30,000,000 40,000,000 27,000,000 29,000,000 21,000,000 20,000,000 24,000,000 8,000,000 20,000,000     47,000,000 32,000,000  -49,000,000         10,761,000 15,282,000 13,984,000 13,778,000 13,831,000 13,508,000                            
      other incomes, net:
                                                                                  
      total other incomes
                28,000,000                 29,000,000 36,000,000           19,991,000 15,229,000 14,914,000 14,866,000       15,169,000 12,906,000                          
      health insurer fees reimbursed
                         65,000,000 69,000,000 71,000,000 66,000,000     81,000,000 83,000,000 104,000,000 61,000,000                                              
      health insurer fees
                         68,000,000 70,000,000 71,000,000 68,000,000     87,000,000 87,000,000 99,000,000 75,000,000                                              
      other expense
                         1,250,000  5,000,000        5,000,000 10,000,000             202,500 863,000 -9,000  -4,000 -24,000                            
      investment income and other revenue
                         15,000,000 14,000,000 18,000,000 29,000,000 29,000,000 40,000,000 34,000,000 29,000,000 32,000,000 37,000,000 32,000,000 24,000,000 22,000,000 18,000,000 16,000,000 14,000,000                                          
      other income
                                     14,000,000   -75,000,000     -918,000 -40,000 -32,000 -10,000    -44,000   3,502,000 -131,000                          
      service revenue
                                 16,000,000 130,000,000 127,000,000 134,000,000 131,000,000 130,000,000 129,000,000 131,000,000 131,000,000 133,000,000 135,000,000 140,000,000 106,348,000 47,551,000 47,243,000 51,858,000 53,632,000 52,557,000 50,232,000 53,630,000 54,007,000 51,100,000 49,672,000 49,756,000 55,359,000 48,422,000 41,724,000 42,205,000   36,888,000 36,674,000 36,484,000 32,271,000 21,054,000               
      restructuring costs
                             1,000,000  2,000,000 3,000,000                                                  
      cost of service revenue
                                 15,000,000 111,000,000 118,000,000 120,000,000 123,000,000 123,000,000 124,000,000 122,000,000 123,000,000 119,000,000 116,000,000 127,000,000 89,706,000 34,573,000 32,819,000 35,902,000 38,933,000 40,067,000 37,107,000 40,657,000 42,306,000 40,113,000 39,305,000 39,770,000 43,097,000 37,004,000 30,613,000 30,494,000   39,215,000 31,221,000 36,788,000 27,605,000 14,254,000               
      gain on sale of subsidiary
                                 9,250,000 37,000,000                                                
      other expenses (income)
                             -3,750,000 2,000,000                                                    
      net income per share
    0.27 2.953 1.51 4.75 5.47 4.013 5.67 5.18 5.21 3.795 4.24 5.37 5.58 3.185 4.29 4.45 2.408 2.49 3.2 3.95 2.7 3.14 4.72 2.95                                                      
      basic
                             2.7 2.81 3.15 3.19 3.25 3.22 3.29 1.79 -4.63 -1.7 -4.1 1.38 0.448 0.77 0.58 0.44            0.65 0.55 0.07 -0.8 0.39   0.38 0.57 0.59 0.58 0.41 0.41 -0.17 0.34 0.56 0.46 0.57 0.63 0.59 0.46 0.63 0.62 0.47 0.34  
      diluted
                             2.67 2.75 3.06 2.99 3.01 2.9 3.02 1.64 -4.63 -1.7 -4.1 1.37 0.443 0.76 0.58 0.43            0.64 0.55 0.07 -0.8 0.39   0.38 0.56 0.59 0.57 0.41 0.41 -0.17 0.33 0.56 0.46 0.58 0.62 0.59 0.46 0.62 0.62 0.47 0.34  
      other expenses
                               -14,000,000 -3,000,000                                                  
      restructuring and separation costs
                                 8,000,000 5,000,000 8,000,000 25,000,000 73,000,000 118,000,000 43,000,000                                           
      impairment losses
                                     269,000,000 129,000,000 72,000,000                                           
      other incomes (income)
                                 6,250,000 10,000,000                                                
      income before income tax benefit
                                 185,750,000 259,000,000                                                
      income tax benefit
                                 59,250,000 62,000,000                     15,481,000                           
      other expenses (income), net:
                                                                                  
      total other expenses (income)
                                   37,000,000 43,000,000   27,000,000                                           
      health insurer fee revenue
                                         94,000,000 85,000,000 76,000,000 90,000,000 61,004,000 81,158,000 73,890,000 47,948,000 51,699,000 29,427,000 19,662,000 18,696,000                              
      health insurer fee expenses
                                         54,000,000 55,000,000 50,000,000 58,000,000 39,585,000 35,985,000 40,652,000 40,778,000 22,148,000 22,308,000 21,945,000 22,190,000                              
      income from continuing operations before income tax expense
                                             56,298,000 97,624,000 100,714,000 67,364,000 81,875,000 24,497,000 18,443,000 10,489,000 -16,516,000 11,418,000 31,277,000                           
      income from continuing operations
                                             29,633,000 46,295,000 38,931,000 28,141,000 33,933,000 16,070,000 7,741,000 4,834,000 -9,041,000 7,553,000 15,796,000                           
      income from discontinued operations, net of tax
                                             7,000 4,000 12,000 12,000 -53,500 52,000 70,000                               
      basic net income per share:
                                                                                  
      continuing operations
                                             0.553 0.84 0.78 0.58 0.155 0.34 0.17 0.11                              
      discontinued operations
                                                 -0.003   -0.01                              
      basic net income per share
                                             0.54 0.84 0.78 0.58 0.72 0.34 0.17 0.1 -0.2 0.17 0.54                           
      diluted net income per share:
                                                                                  
      diluted net income per share
                                             0.51 0.77 0.72 0.56 0.7 0.33 0.16 0.09 -0.2 0.16 0.53                           
      loss from discontinued operations, net of tax
                                                    -336,000                              
      premium tax receipts
                                                     31,901,500 43,723,000                            
      rental and other income
                                                     4,119,000 5,860,000 5,922,000 4,694,000                          
      expenses:
                                                                                  
      total expenses
                                                     1,186,016,750 1,662,153,000 1,559,388,000 1,523,496,000 1,524,436,000 1,533,003,000 1,595,691,000 1,340,160,000   1,135,694,000 1,088,406,000 1,047,320,000 1,009,193,000 978,160,000 946,303,000 967,946,000 900,238,000 906,863,000 838,448,000 785,037,000 765,900,000 736,233,000 712,591,000 648,996,000 607,219,000 591,604,000 546,308,000  
      other expenses:
                                                                                  
      income from discontinued operations, net of tax expense of 97, 1,474, (10,046), and (4,115), respectively
                                                     2,046,000 16,000                            
      basic income per share:
                                                                                  
      income from discontinued operations
                                                       0.19                           
      diluted income per share:
                                                                                  
      weighted-average shares outstanding:
                                                                                  
      basic
     52.8    57.4    57.7    57.8    57.8    59    62    61    56    55    52    46,935    45,717 45,699 45,446 45,981 46,380 46,546 46,355 45,998  45,756 45,897 30,392 27,449 28,118 25,741 25,646 25,843 25,539 25,788 26,530 27,676 27,449 27,997 28,457 28,275,000 28,306 28,233 28,152  
      diluted
     52.9    57.7    58.1    58.5    58.6    60    64    67    56    56    56    48,340    46,862 47,062 46,507 46,443 46,999 46,880 46,355 46,887  46,425 46,471 30,838 27,754 28,363 25,951 25,837 25,984 25,630 25,870 26,561 27,772 27,582 28,044 28,576 28,419,000 28,441 28,343 28,275  
      other incomes:
                                                                                  
      income from discontinued operations, net of tax benefit of 9,968, 4,502, 10,143, and 5,589, respectively
                                                       8,775,000                           
      basic income per share
                                                                                  
      diluted income per share
                                                                                  
      other incomes
                                                                                  
      income before income taxes
                                                        54,185,000 50,146,000 2,872,000 -63,075,000 29,122,000   27,727,000 27,697,000 29,979,000 25,353,000 17,079,000 17,081,000 -7,582,000 12,995,000 17,503,000 20,700,000 25,312,000 28,449,000 27,951,000 22,179,000 28,382,000 28,285,000 21,559,000 15,470,000  
      rental income
                                                         3,966,000 1,879,000 1,320,000 2,209,000                      
      income tax (benefit) expense
                                                         -3,807,000 -492,000                        
      benefit from income taxes
                                                           -25,769,000 11,033,000   10,287,000 10,309,000 12,351,000 9,180,000 6,500,000  -3,110,000 4,431,000 2,938,000  9,771,000 11,263,000        
      weighted-average shares outstanding :
                                                                                  
      basic
     52.8    57.4    57.7    57.8    57.8    59    62    61    56    55    52    46,935    45,717 45,699 45,446 45,981 46,380 46,546 46,355 45,998  45,756 45,897 30,392 27,449 28,118 25,741 25,646 25,843 25,539 25,788 26,530 27,676 27,449 27,997 28,457 28,275,000 28,306 28,233 28,152  
      diluted
     52.9    57.7    58.1    58.5    58.6    60    64    67    56    56    56    48,340    46,862 47,062 46,507 46,443 46,999 46,880 46,355 46,887  46,425 46,471 30,838 27,754 28,363 25,951 25,837 25,984 25,630 25,870 26,561 27,772 27,582 28,044 28,576 28,419,000 28,441 28,343 28,275  
      gain on retirement of convertible senior notes
                                                                     383,000   1,532,000          
      impairment charge on purchased software
                                                                               782,000   
      provision for income taxes
                                                                           11,435,000       
      other income:
                                                                                  
      total other income
                                                                             -2,251,000 -530,000 -725,000 -1,125,000  
      medical care costs:
                                                                                  
      medical services
                                                                               117,317,000 110,891,000  
      hospital and specialty services
                                                                               336,587,000 308,142,000  
      pharmacy
                                                                               62,961,000 57,444,000  
      total medical care costs
                                                                               516,865,000 476,477,000  
    Balance Sheets:
    Quarterly
    Annual
      Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-12-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 2015-06-30 2015-03-31 2014-12-31 2014-09-30 2014-06-30 2014-03-31 2013-12-31 2013-09-30 2013-06-30 2013-03-31 2012-12-31 2012-09-30 2012-06-30 2012-03-31 2011-09-30 2011-06-30 2011-03-31 2010-12-31 2010-09-30 2010-06-30 2010-03-31 2009-12-31 2009-09-30 2009-06-30 2009-03-31 2008-12-31 2008-09-30 2008-06-30 2008-03-31 2007-12-31 2007-09-30 2007-06-30 2007-03-31 2006-12-31 
                                                                                   
        assets
                                                                                   
        current assets:
                                                                                   
        cash and cash equivalents
      5,314,000,000 4,248,000,000 4,221,000,000 4,499,000,000 4,856,000,000 4,662,000,000 4,732,000,000 4,354,000,000 4,513,000,000 4,848,000,000 5,565,000,000 4,910,000,000 4,554,000,000 4,006,000,000 4,242,000,000 4,312,000,000 4,804,000,000 4,438,000,000 4,357,000,000 4,608,000,000 4,431,000,000 4,154,000,000 3,196,000,000 3,303,000,000 2,365,000,000 2,452,000,000 2,679,000,000 2,253,000,000 3,224,000,000 2,826,000,000 2,814,000,000 3,392,000,000 3,729,000,000 3,186,000,000 3,934,000,000 2,979,000,000 3,198,000,000 2,819,000,000 2,842,000,000 2,345,000,000 2,156,000,000 2,329,000,000 2,164,210,000 2,013,882,000 1,870,024,000 1,539,063,000 1,598,596,000 1,027,351,000 1,083,369,000 935,895,000 856,556,000 742,670,000 1,169,511,000 795,770,000 715,480,000 727,092,000 517,723,000 493,827,000 459,213,000 463,792,000 455,886,000 426,455,000 460,985,000 438,281,000 469,501,000 449,469,000 417,837,000 405,187,000 387,162,000 382,436,000 425,424,000 412,153,000 459,064,000 447,594,000 471,502,000 419,967,000 403,650,000 
        investments
      3,937,000,000 4,008,000,000 4,226,000,000 4,310,000,000 4,438,000,000 4,325,000,000 4,482,000,000 4,347,000,000 4,424,000,000 4,259,000,000 4,111,000,000 3,886,000,000 3,810,000,000 3,499,000,000 3,639,000,000 3,567,000,000 2,988,000,000 3,202,000,000 2,900,000,000 2,241,000,000 1,938,000,000 1,875,000,000 1,769,000,000 1,906,000,000 2,010,000,000 1,946,000,000 1,757,000,000 2,070,000,000 1,508,000,000 1,681,000,000 1,812,000,000 2,176,000,000 2,444,000,000 2,524,000,000 1,787,000,000 2,192,000,000 2,056,000,000 1,758,000,000 1,735,000,000 1,968,000,000 2,070,000,000 1,801,000,000 1,461,467,000 1,466,622,000 1,203,866,000 1,019,462,000 842,683,000 740,874,000 696,200,000 703,052,000 735,151,000 718,544,000 341,946,000 342,845,000 356,895,000 344,910,000 357,981,000 336,916,000 356,600,000 337,514,000 295,375,000 195,358,000 175,212,000 175,911,000 174,844,000 170,194,000 180,398,000 202,194,000 189,870,000 163,676,000 196,268,000 184,129,000 242,855,000 108,161,000 78,492,000 83,090,000 81,481,000 
        receivables
      3,420,000,000 3,533,000,000 3,515,000,000 3,865,000,000 3,491,000,000 3,299,000,000 3,259,000,000 3,231,000,000 3,350,000,000 3,104,000,000 2,460,000,000 2,385,000,000 2,536,000,000 2,302,000,000 2,220,000,000 2,240,000,000 2,156,000,000 2,177,000,000 1,912,000,000 1,857,000,000 1,776,000,000 1,672,000,000 1,775,000,000 1,580,000,000 1,603,000,000 1,406,000,000 1,280,000,000 1,239,000,000 1,359,000,000 1,330,000,000 1,346,000,000 1,148,000,000 950,000,000 871,000,000 1,002,000,000 1,006,000,000 1,006,000,000 974,000,000 1,053,000,000 1,012,000,000 863,000,000 597,000,000 619,891,000 631,124,000 491,430,000 596,456,000 425,683,000 473,514,000 338,232,000 298,935,000 293,967,000 213,776,000 150,251,000 149,682,000 156,909,000 161,007,000 222,254,000 167,898,000 172,674,000 170,418,000 168,190,000 225,547,000 155,380,000 128,600,000 136,654,000 144,129,000 151,440,000 158,175,000 128,562,000 169,760,000 113,597,000 117,553,000 111,537,000 124,145,000 106,309,000 107,993,000 110,835,000 
        prepaid expenses and other current assets
      655,000,000 655,000,000 590,000,000 438,000,000 472,000,000 487,000,000 408,000,000 399,000,000 381,000,000 331,000,000 332,000,000 260,000,000 259,000,000 277,000,000 391,000,000 213,000,000 198,000,000 247,000,000 197,000,000 168,000,000 163,000,000 175,000,000 213,000,000 273,000,000 346,000,000 134,000,000 140,000,000 132,000,000 124,000,000 149,000,000 486,000,000 344,000,000 411,000,000 185,000,000 174,000,000 159,000,000 142,000,000 131,000,000 169,000,000 197,000,000 260,000,000 192,000,000 120,438,000 148,615,000 193,498,000 50,884,000 82,062,000 93,862,000 112,916,000 42,484,000 50,061,000 47,817,000 39,577,000 28,386,000 30,002,000 29,780,000 24,715,000 19,435,000 23,246,000 28,608,000 22,772,000 25,185,000 23,843,000 15,051,000 15,583,000 14,312,000 14,034,000 17,678,000 14,766,000 14,402,000 14,484,000 13,778,000 12,521,000 11,424,000 10,616,000 11,512,000  
        total current assets
      13,326,000,000 12,444,000,000 12,552,000,000 13,112,000,000 13,257,000,000 12,773,000,000 12,881,000,000 12,331,000,000 12,668,000,000 12,542,000,000 12,468,000,000 11,441,000,000 11,159,000,000 10,084,000,000 10,492,000,000 10,332,000,000 10,146,000,000 10,064,000,000 9,366,000,000 8,874,000,000 8,308,000,000 7,876,000,000 6,953,000,000 7,062,000,000 6,324,000,000 5,967,000,000 5,877,000,000 5,863,000,000 6,731,000,000 6,462,000,000 7,301,000,000 8,027,000,000 8,196,000,000 7,511,000,000 7,708,000,000 7,169,000,000 6,402,000,000 5,988,000,000 6,113,000,000 5,545,000,000 5,764,000,000 5,306,000,000 4,910,324,000 4,806,227,000 4,275,570,000 3,245,397,000 2,987,520,000 2,371,845,000 2,281,231,000 2,039,664,000 1,966,215,000 1,744,802,000 1,727,038,000 1,349,126,000 1,314,349,000 1,321,036,000 1,152,013,000 1,048,082,000 1,028,156,000 1,015,727,000 957,939,000 882,880,000 821,303,000 765,254,000 811,406,000 785,365,000 770,538,000 787,383,000 728,982,000 744,446,000 761,330,000 736,322,000 834,593,000 691,901,000 672,142,000 626,682,000 613,502,000 
        property, equipment, and capitalized software
      300,000,000 301,000,000 323,000,000 305,000,000 287,000,000 288,000,000 306,000,000 305,000,000 295,000,000 270,000,000 290,000,000 285,000,000 274,000,000 259,000,000 412,000,000 401,000,000 393,000,000 396,000,000 385,000,000 383,000,000 378,000,000 391,000,000 395,000,000 399,000,000 385,000,000 385,000,000 379,000,000 373,000,000 376,000,000 241,000,000 264,000,000 276,000,000 318,000,000 342,000,000 397,000,000 449,000,000 447,000,000 454,000,000 450,000,000 448,000,000 419,000,000 393,000,000 374,862,000 363,244,000 344,727,000 340,778,000 328,547,000 317,630,000 310,364,000 292,083,000 267,277,000 249,298,000 237,735,000 221,443,000 210,972,000 206,489,000 198,564,000 190,934,000                    
        goodwill, and intangible assets
      2,092,000,000  2,202,000,000 2,168,000,000 2,175,000,000  1,923,000,000 1,913,000,000 1,927,000,000  1,471,000,000 1,348,000,000 1,369,000,000  1,263,000,000 1,286,000,000 1,305,000,000  915,000,000 929,000,000 923,000,000                                                         
        restricted investments
      312,000,000 299,000,000 300,000,000 291,000,000 311,000,000 286,000,000 289,000,000 268,000,000 261,000,000 261,000,000 261,000,000 249,000,000 242,000,000 238,000,000 242,000,000 219,000,000 221,000,000 212,000,000 156,000,000 145,000,000 138,000,000 136,000,000 93,000,000 87,000,000 82,000,000 79,000,000 79,000,000 98,000,000 100,000,000   80,000,000 77,000,000 169,000,000 326,000,000 325,000,000 115,000,000 110,000,000 116,000,000 107,000,000 116,000,000 109,000,000 101,970,000 110,956,000 101,366,000 102,479,000 93,119,000 84,440,000 82,036,000 63,093,000 65,225,000 56,935,000 55,117,000 44,101,000 44,488,000 43,608,000 41,947,000 46,164,000 50,330,000 49,307,000 42,100,000 45,047,000 41,028,000 36,930,000 36,274,000 42,400,000 44,736,000 37,757,000 38,202,000 36,510,000 29,875,000 29,806,000 29,019,000 27,762,000 23,480,000 23,354,000 20,154,000 
        deferred income taxes
      215,000,000 178,000,000 179,000,000 185,000,000 193,000,000 207,000,000 227,000,000 232,000,000 228,000,000 227,000,000 255,000,000 220,000,000 208,000,000 220,000,000 198,000,000 141,000,000 114,000,000 106,000,000 83,000,000 65,000,000 66,000,000 69,000,000 74,000,000 65,000,000 71,000,000 79,000,000 82,000,000 70,000,000 76,000,000 117,000,000 143,000,000 114,000,000 114,000,000 103,000,000 62,000,000 36,000,000 10,000,000 10,000,000    18,000,000 54,231,000 37,480,000 42,631,000 39,532,000 30,817,000 19,518,000 22,414,000 26,556,000 30,480,000 21,995,000 25,753,000 32,443,000 21,533,000 26,858,000 14,025,000 18,327,000 16,423,000 15,395,000 15,716,000 7,580,000 4,726,000 4,279,000 8,757,000 7,261,000 6,829,000 3,884,000 4,603,000 14,172,000 11,557,000 8,709,000 8,616,000 577,000 2,708,000 720,000 313,000 
        other assets
      146,000,000 147,000,000 142,000,000 148,000,000 163,000,000 138,000,000 132,000,000 136,000,000 134,000,000 143,000,000 125,000,000 118,000,000 119,000,000 123,000,000 186,000,000 193,000,000 181,000,000 179,000,000 128,000,000 134,000,000 137,000,000 119,000,000 101,000,000 99,000,000 99,000,000 105,000,000 108,000,000 106,000,000 111,000,000 24,000,000 30,000,000 28,000,000 135,000,000 40,000,000 42,000,000 47,000,000 43,000,000 41,000,000 40,000,000 39,000,000 37,000,000 28,000,000 36,612,000 37,814,000 34,064,000 44,326,000 51,108,000 45,654,000 39,730,000 35,564,000 35,736,000 35,773,000 29,449,000 19,621,000 20,098,000 20,400,000 19,759,000 17,099,000 14,788,000 17,598,000 17,368,000 17,463,000 19,242,000 19,322,000 19,988,000 20,113,000 21,718,000 21,450,000 34,321,000 19,846,000 22,247,000 22,435,000 21,675,000 14,492,000 12,926,000 12,521,000 12,854,000 
        total assets
      16,391,000,000 15,564,000,000 15,698,000,000 16,209,000,000 16,386,000,000 15,630,000,000 15,758,000,000 15,185,000,000 15,513,000,000 14,892,000,000 14,870,000,000 13,661,000,000 13,371,000,000 12,314,000,000 12,793,000,000 12,572,000,000 12,360,000,000 12,209,000,000 11,033,000,000 10,530,000,000 9,950,000,000 9,532,000,000 7,881,000,000 7,876,000,000 7,129,000,000 6,787,000,000                                         1,203,159,000 1,206,954,000 1,149,186,000 1,157,873,000 1,171,754,000 1,145,418,000 1,171,305,000 946,017,000 922,725,000 877,037,000 864,475,000 
        liabilities and stockholders’ equity
                                                                                   
        current liabilities:
                                                                                   
        medical claims and benefits payable
      4,941,000,000 4,887,000,000 4,844,000,000 4,885,000,000 4,804,000,000 4,640,000,000 4,732,000,000 4,577,000,000 4,571,000,000 4,204,000,000 4,235,000,000 3,677,000,000 3,824,000,000 3,528,000,000 3,622,000,000 3,775,000,000 3,601,000,000 3,363,000,000 3,191,000,000 2,942,000,000 2,839,000,000 2,696,000,000 2,289,000,000 1,960,000,000 1,981,000,000 1,854,000,000 1,975,000,000 1,767,000,000 1,995,000,000 1,961,000,000 2,042,000,000 1,920,000,000 2,023,000,000 2,192,000,000 2,478,000,000 2,077,000,000 1,926,000,000 1,929,000,000 1,871,000,000 1,766,000,000 1,940,000,000 1,685,000,000 1,559,570,000 1,492,252,000 1,448,132,000 1,200,522,000 1,123,846,000 924,182,000 819,541,000 669,787,000 632,706,000 465,487,000 491,145,000 494,530,000 536,463,000 525,538,000 455,833,000 402,476,000 341,613,000 351,382,000 354,356,000 355,140,000 345,600,000 326,973,000 316,516,000 303,114,000 308,707,000 311,627,000 292,442,000 298,787,000 305,541,000 311,776,000 311,606,000 308,722,000 303,239,000 280,188,000 290,048,000 
        amounts due government agencies
      1,685,000,000 1,326,000,000 1,440,000,000 1,821,000,000 1,863,000,000 1,874,000,000 2,026,000,000 2,273,000,000 2,501,000,000 2,294,000,000 2,476,000,000 2,589,000,000 2,349,000,000 2,079,000,000 2,139,000,000 2,722,000,000 2,613,000,000 2,472,000,000 2,081,000,000 2,072,000,000 1,718,000,000 1,253,000,000 640,000,000 865,000,000 777,000,000 664,000,000 612,000,000 984,000,000 932,000,000 967,000,000 1,030,000,000 1,746,000,000 1,714,000,000 1,542,000,000 1,324,000,000 1,844,000,000 1,575,000,000 1,202,000,000 1,232,000,000 1,238,000,000 910,000,000 729,000,000 980,317,000 824,934,000 622,158,000 527,193,000                                
        accounts payable, accrued liabilities and other
      1,161,000,000 1,093,000,000 1,124,000,000 1,113,000,000 1,119,000,000 1,331,000,000 1,215,000,000 973,000,000 1,114,000,000 1,252,000,000 1,090,000,000 857,000,000 787,000,000 889,000,000 818,000,000 715,000,000 809,000,000 842,000,000 797,000,000 651,000,000 695,000,000 641,000,000 566,000,000 876,000,000 743,000,000                                                     
        deferred revenue
      401,000,000 66,000,000 73,000,000 57,000,000 369,000,000 51,000,000 364,000,000 13,000,000 328,000,000 418,000,000 691,000,000 414,000,000 654,000,000 359,000,000 663,000,000 13,000,000 18,000,000 370,000,000 1,000,000 42,000,000 71,000,000 375,000,000 61,000,000 54,000,000 43,000,000 249,000,000 207,000,000 30,000,000 207,000,000 211,000,000 178,000,000 193,000,000 404,000,000 282,000,000 468,000,000 284,000,000 461,000,000 315,000,000 380,000,000 104,000,000 94,000,000 223,000,000 67,227,000 57,723,000 169,811,000 196,076,000 190,856,000 45,945,000 146,276,000 122,216,000 124,388,000 45,949,000 135,804,000 141,798,000 143,301,000 176,373,000 95,490,000 50,947,000 128,599,000 143,273,000 60,086,000 37,648,000 19,305,000 11,321,000 101,985,000 90,919,000 84,176,000 82,506,000 29,538,000 19,153,000 50,170,000 2,042,000 40,104,000 42,043,000 44,325,000 35,339,000 18,120,000 
        total current liabilities
      8,188,000,000 7,372,000,000 7,481,000,000 7,876,000,000 8,155,000,000 7,896,000,000 8,337,000,000 7,836,000,000 8,514,000,000 8,168,000,000 8,492,000,000 7,537,000,000 7,614,000,000 6,855,000,000 7,242,000,000 7,225,000,000 7,041,000,000 7,047,000,000 6,070,000,000 5,707,000,000 5,323,000,000 4,965,000,000 3,556,000,000 3,755,000,000 3,570,000,000 3,269,000,000 3,308,000,000 3,388,000,000 4,292,000,000 4,246,000,000 5,213,000,000 5,820,000,000 6,005,000,000 5,557,000,000 5,962,000,000 5,793,000,000 4,422,000,000 4,570,000,000 4,665,000,000 3,646,000,000 4,377,000,000 3,822,000,000 3,861,170,000 3,738,514,000 3,593,196,000 2,174,773,000 1,936,073,000 1,630,936,000 1,555,944,000 1,293,976,000 1,045,438,000 707,159,000 803,046,000 828,037,000 831,936,000 839,106,000 677,090,000 601,834,000 608,822,000 616,098,000 565,548,000 510,087,000 475,927,000 424,327,000 490,233,000 468,063,000 458,300,000 461,139,000 388,227,000 396,613,000 428,720,000 393,847,000 426,922,000 413,785,000 399,379,000 371,065,000 354,893,000 
        long-term debt
      3,767,000,000 3,766,000,000 3,664,000,000 3,375,000,000 3,574,000,000 2,923,000,000 2,332,000,000 2,181,000,000 2,180,000,000 2,180,000,000 2,179,000,000 2,178,000,000 2,177,000,000 2,176,000,000 2,175,000,000 2,175,000,000 2,174,000,000 2,173,000,000 2,130,000,000 2,129,000,000 2,128,000,000 2,127,000,000 1,813,000,000 1,812,000,000 1,596,000,000 1,237,000,000 1,239,000,000 1,241,000,000 1,121,000,000 1,020,000,000 1,019,000,000 1,019,000,000 1,318,000,000 1,318,000,000 1,317,000,000                  642,005,000 261,784,000 260,551,000 269,338,000 228,150,000 216,929,000 166,725,000 165,354,000 164,014,000 162,700,000 266,409,000 160,143,000 158,900,000 157,681,000 156,484,000 155,312,000 200,000,000 200,000,000 200,000,000 200,000,000 200,000,000 20,000,000 30,000,000 30,000,000  
        finance lease liabilities
      180,000,000 184,000,000 188,000,000 188,000,000 192,000,000 195,000,000 197,000,000 203,000,000 202,000,000 205,000,000 199,000,000 203,000,000 204,000,000 215,000,000 217,000,000 216,000,000 217,000,000 219,000,000 220,000,000 223,000,000 223,000,000 225,000,000 226,000,000 229,000,000 229,000,000 231,000,000 233,000,000 232,000,000 234,000,000                                                 
        other long-term liabilities
      176,000,000 173,000,000 174,000,000 167,000,000 155,000,000 120,000,000 122,000,000 122,000,000 124,000,000 124,000,000 121,000,000 122,000,000 88,000,000 104,000,000 118,000,000 126,000,000 134,000,000 140,000,000 95,000,000 101,000,000 112,000,000 119,000,000 85,000,000 84,000,000 87,000,000 90,000,000 90,000,000 93,000,000 97,000,000 44,000,000 60,000,000 68,000,000 59,000,000 61,000,000 48,000,000 54,000,000 44,000,000 42,000,000 39,000,000 38,000,000 38,000,000 37,000,000 32,270,000 31,095,000 33,349,000 33,487,000 28,300,000 28,719,000 27,736,000 26,351,000 25,152,000 23,943,000 23,839,000 24,787,000 22,101,000 22,301,000 22,243,000 21,782,000 20,474,000 19,580,000 19,711,000 19,004,000 16,862,000 16,073,000 15,403,000 14,140,000 14,156,000 22,797,000 22,928,000 18,740,000 17,139,000 14,892,000 14,529,000 11,808,000 9,723,000 8,416,000 4,793,000 
        total liabilities
      12,311,000,000 11,495,000,000 11,507,000,000 11,606,000,000 12,076,000,000 11,134,000,000 10,988,000,000 10,342,000,000 11,020,000,000 10,677,000,000 10,991,000,000 10,040,000,000 10,083,000,000 9,350,000,000 9,752,000,000 9,742,000,000 9,566,000,000 9,579,000,000 8,515,000,000 8,160,000,000 7,786,000,000 7,436,000,000 5,680,000,000 5,880,000,000 5,482,000,000 4,827,000,000 4,870,000,000 4,954,000,000 5,744,000,000 5,507,000,000 6,490,000,000 7,105,000,000 7,580,000,000 7,134,000,000 7,525,000,000 7,062,000,000 6,311,000,000 5,800,000,000 5,879,000,000 5,561,000,000 5,593,000,000 5,019,000,000 4,397,022,000 4,273,052,000 4,127,796,000 3,466,773,000 3,091,849,000 2,534,959,000 2,395,761,000 2,110,000,000 2,032,218,000 1,703,529,000 1,723,890,000 1,152,508,000 1,152,066,000 1,171,458,000 964,692,000 897,073,000 834,564,000 842,649,000 790,157,000 733,698,000 793,550,000 637,122,000 702,497,000 679,233,000 668,984,000 678,259,000 638,522,000 649,779,000 679,299,000 642,604,000 680,827,000 477,578,000 474,078,000 444,922,000 444,309,000 
        stockholders’ equity:
                                                                                   
        common stock, 0.001 par value...
                                                56,000 56,000 50,000 50,000 48,000 46,000 46,000 46,000 46,000 46,000 45,000 47,000 46,000 46,000 46,000 46,000 46,000 31,000 30,000 30,000 26,000 26,000 26,000 26,000 26,000 27,000 27,000 27,000 29,000 28,000 28,000 28,000 28,000 28,000 28,000 
        preferred stock, 0.001 par value...
                                                                                   
        additional paid-in capital
      471,000,000 452,000,000 420,000,000 454,000,000 434,000,000 462,000,000 453,000,000 439,000,000 390,000,000 410,000,000 373,000,000 341,000,000 296,000,000 328,000,000 289,000,000 251,000,000 218,000,000 236,000,000 205,000,000 191,000,000 170,000,000 199,000,000 181,000,000 166,000,000 140,000,000 175,000,000 160,000,000 240,000,000 543,000,000 643,000,000 760,000,000 1,055,000,000 1,153,000,000 1,044,000,000 870,000,000 865,000,000 841,000,000 841,000,000 831,000,000 822,000,000 806,000,000 803,000,000 789,907,000 782,433,000 398,141,000 396,059,000 383,300,000 351,546,000 340,429,000 340,848,000 331,958,000 324,360,000 234,236,000 285,524,000 280,728,000 275,556,000 267,876,000 266,022,000 262,988,000 255,803,000 251,627,000 247,845,000 134,076,000 130,272,000 129,902,000 127,317,000 138,058,000 170,411,000 146,179,000 163,648,000 191,326,000 187,144,000 185,808,000 181,841,000 179,815,000 176,675,000  
        accumulated other comprehensive income
      -7,000,000 15,000,000 9,000,000               -5,000,000 17,000,000 26,000,000 26,000,000 37,000,000 37,000,000 32,000,000 -15,000,000 4,000,000 5,000,000 5,000,000                 297,000   40,000                     -2,310,000 -4,537,000 -2,975,000 -1,883,000 272,000 111,000    
        retained earnings
      3,616,000,000 3,602,000,000 3,762,000,000 4,159,000,000 3,904,000,000 4,091,000,000 4,326,000,000 4,489,000,000 4,188,000,000 3,887,000,000 3,671,000,000 3,426,000,000 3,117,000,000 2,796,000,000 2,937,000,000 2,707,000,000 2,657,000,000 2,399,000,000 2,296,000,000 2,153,000,000 1,968,000,000 1,860,000,000 1,983,000,000 1,798,000,000 1,522,000,000 1,781,000,000 1,666,000,000 1,491,000,000 1,295,000,000 1,012,000,000 811,000,000 614,000,000 412,000,000 298,000,000 560,000,000 657,000,000 887,000,000 810,000,000 857,000,000 815,000,000 782,000,000 758,000,000 728,747,000 682,448,000 643,505,000 615,352,000 581,560,000 565,438,000 557,627,000 553,129,000 562,255,000 554,686,000 530,115,000 500,200,000 474,557,000 471,193,000 508,499,000 490,410,000 504,420,000 486,980,000 469,592,000 451,964,000 435,791,000 425,212,000 414,622,000 419,094,000 410,530,000 395,965,000 387,158,000 371,617,000 354,431,000 337,915,000 324,760,000 306,849,000 289,335,000 276,021,000 266,875,000 
        total stockholders’ equity
      4,080,000,000 4,069,000,000 4,191,000,000 4,603,000,000 4,310,000,000 4,496,000,000 4,770,000,000 4,843,000,000 4,493,000,000 4,215,000,000 3,879,000,000 3,621,000,000 3,288,000,000 2,964,000,000 3,041,000,000 2,830,000,000 2,794,000,000 2,630,000,000 2,518,000,000 2,370,000,000 2,164,000,000 2,096,000,000 2,201,000,000 1,996,000,000 1,647,000,000 1,960,000,000 1,831,000,000 1,736,000,000 1,835,000,000 1,647,000,000 1,561,000,000 1,658,000,000 1,553,000,000 1,337,000,000 1,429,000,000 1,521,000,000 1,727,000,000 1,649,000,000    1,557,000,000  1,463,107,000 1,041,993,000 1,010,442,000 964,291,000 917,070,000 897,720,000 892,937,000 892,848,000 876,387,000 764,199,000 782,314,000 755,001,000 746,010,000 775,312,000 755,073,000 765,857,000 740,505,000 719,057,000 697,732,000 567,854,000 553,826,000 542,738,000 544,772,000 534,175,000 528,695,000 510,664,000 508,094,000 492,455,000 502,814,000 490,478,000 468,439,000 448,647,000 432,115,000 420,166,000 
        total liabilities and stockholders’ equity
      16,391,000,000 15,564,000,000 15,698,000,000 16,209,000,000 16,386,000,000 15,630,000,000 15,758,000,000 15,185,000,000 15,513,000,000 14,892,000,000 14,870,000,000 13,661,000,000 13,371,000,000 12,314,000,000 12,793,000,000 12,572,000,000 12,360,000,000 12,209,000,000 11,033,000,000 10,530,000,000 9,950,000,000 9,532,000,000 7,881,000,000 7,876,000,000 7,129,000,000 6,787,000,000                                         1,203,159,000 1,206,954,000 1,149,186,000 1,157,873,000 1,171,754,000 1,145,418,000 1,171,305,000 946,017,000 922,725,000 877,037,000 864,475,000 
        goodwill and intangible assets
       2,195,000,000    1,938,000,000    1,449,000,000    1,390,000,000    1,252,000,000    941,000,000 265,000,000 164,000,000 168,000,000 172,000,000 176,000,000 180,000,000 185,000,000 190,000,000 195,000,000 201,000,000 250,000,000                               210,605,000  214,102,000 204,040,000 201,706,000  200,783,000 204,182,000 204,962,000  133,502,000 137,274,000 139,877,000  
        common stock, 0.001 par value per share...
                                                                                   
        preferred stock, 0.001 par value per share...
                                                                                   
        accumulated other comprehensive loss
         -10,000,000 -28,000,000 -57,000,000 -9,000,000 -85,000,000 -85,000,000 -82,000,000 -165,000,000 -146,000,000 -125,000,000 -160,000,000 -185,000,000 -128,000,000 -81,000,000            -3,000,000 -8,000,000 -10,000,000 -11,000,000 -12,000,000 -5,000,000 -1,000,000 -1,000,000 -1,000,000 -2,000,000    -4,000,000 -701,000 -1,830,000  -1,019,000 -617,000  -382,000 -1,086,000 -1,411,000 -2,705,000 -197,000 -457,000 -330,000 -785,000 -1,109,000 -1,405,000 -1,597,000 -2,309,000 -2,192,000 -2,107,000 -2,039,000 -1,684,000 -1,812,000 -1,665,000 -1,702,000 -2,342,000       -141,000 -219,000 -337,000 
        current portion of long-term debt
                              26,000,000 18,000,000 15,000,000 65,000,000 198,000,000 241,000,000 296,000,000 484,000,000 566,000,000 653,000,000 782,000,000 773,000,000 1,000,000 472,000,000 466,000,000 1,000,000 455,000,000  450,780,000 445,668,000 440,632,000                                 
        derivative asset
                               29,000,000 21,000,000 169,000,000 516,000,000 476,000,000 843,000,000 657,000,000 585,000,000 522,000,000 425,000,000 440,000,000  267,000,000 314,000,000  377,000,000 374,000,000 490,087,000 508,504,000 474,121,000 329,323,000 222,997,000 250,160,000 196,617,000 186,351,000 191,663,000 207,123,000 147,385,000                         
        accounts payable and accrued liabilities
                               455,000,000 478,000,000 373,000,000 444,000,000 390,000,000 824,000,000 754,000,000 713,000,000 366,000,000 485,000,000 375,000,000 438,000,000 385,000,000 383,000,000 537,000,000 601,000,000 362,000,000 274,131,000 399,186,000 427,644,000 241,654,000 609,444,000 475,358,000 406,414,000 319,965,000 282,727,000 180,227,000 159,986,000 184,034,000 151,029,000 136,065,000 124,649,000 147,214,000 133,005,000 113,697,000 137,930,000 117,299,000 111,022,000 86,033,000 71,732,000 72,093,000 60,016,000 67,006,000 66,247,000 70,918,000 61,872,000 66,949,000 69,266,000 61,778,000 51,815,000 55,538,000 46,725,000 
        derivative liability
                               29,000,000 21,000,000 169,000,000 516,000,000 476,000,000 843,000,000 657,000,000 585,000,000 522,000,000 425,000,000 440,000,000  267,000,000 314,000,000  377,000,000 374,000,000 489,940,000 508,355,000 473,983,000 329,194,000 222,877,000 250,038,000 196,503,000 186,239,000                            
        lease financing obligations
                                   197,000,000 198,000,000 198,000,000 198,000,000 198,000,000 198,000,000 198,000,000 198,000,000 198,000,000 198,000,000 198,000,000 198,000,000 198,000,000 161,553,000 161,323,000 161,013,000 160,710,000 160,412,000 160,121,000 159,754,000 159,394,000 178,188,000 175,666,000                          
        assets held for sale
                                     230,000,000                                              
        liabilities held for sale
                                     66,000,000                                              
        income taxes refundable
                                       54,000,000 60,000,000 68,000,000  39,000,000  23,000,000 38,000,000 13,000,000     7,679,000 16,726,000 28,100,000                             
        deferred contract costs
                                       101,000,000 97,000,000 93,000,000 89,000,000 86,000,000 83,000,000 80,000,000 79,000,000 81,000,000 73,619,000 65,410,000 57,314,000 53,675,000 51,179,000 47,969,000 44,740,000 45,675,000 48,768,000 51,319,000 53,813,000 58,313,000 67,516,000 71,344,000 64,414,000 54,582,000 42,557,000 37,891,000 28,444,000 20,255,000 8,018,000               
        intangible assets
                                       69,000,000 101,000,000 112,000,000 131,000,000 140,000,000 149,000,000 146,000,000 149,000,000 122,000,000 96,424,000 80,462,000 84,702,000 89,273,000 85,035,000 88,493,000 93,587,000 98,871,000 104,635,000 68,987,000 72,864,000 77,711,000 85,033,000 90,402,000 96,090,000 101,796,000 91,237,000 98,048,000 105,500,000 115,270,000 120,480,000  80,846,000    79,133,000    92,226,000    85,480,000 
        goodwill
                                       186,000,000 430,000,000 559,000,000 620,000,000 620,000,000 619,000,000 611,000,000 619,000,000 519,000,000 321,220,000 272,046,000 272,046,000 271,964,000 236,635,000 230,738,000 230,738,000 230,738,000                       114,997,000    57,659,000 
        senior notes
                                         1,017,000,000 1,455,000,000 975,000,000 971,000,000 1,428,000,000 965,000,000 962,000,000                                    
        income taxes payable
                                          21,000,000  19,000,000    39,205,000 10,396,000 10,836,000 8,987,000     5,508,000 15,496,000 14,944,000 6,520,000     5,605,000 7,746,000 13,176,000     1,937,000 5,401,000   7,755,000 11,137,000 13,080,000      
        accumulated other comprehensive gain
                                            3,000,000 4,000,000 2,000,000                                     
        total stockholders' equity
                                            1,691,000,000 1,641,000,000 1,590,000,000  1,518,009,000                                   
        current maturities of long-term debt
                                               449,000,000    341,000 11,927,000 185,451,000 183,713,000 182,008,000 109,000  1,167,000 1,155,000 1,143,000 1,130,000 1,118,000 1,197,000                    
        lease financing obligations - related party
                                                   40,241,000    27,092,000                            
        convertible senior notes
                                                275,050,000 272,930,000 270,836,000 704,097,000 697,210,000 425,709,000 421,004,000 416,368,000 591,884,000 585,825,000                          
        lease financing obligations – related party
                                                39,868,000 40,016,000 40,135,000  39,258,000 39,436,000 34,820,000                             
        income tax refundable
                                                       32,742,000     33,530,000 31,389,000 15,315,000 11,679,000       6,067,000    4,019,000         
        auction rate securities
                                                     11,025,000 10,928,000 10,898,000 11,674,000 12,527,000 13,600,000 13,419,000 13,523,000 13,101,000 16,129,000 16,134,000 18,958,000 20,187,000                  
        other long-term debt
                                                                                   
        45,871 shares at december 31, 2013 and 46,762 shares at december 31, 2012
                                                                                   
        treasury stock
                                                           -3,000,000             -12,737,000 -35,366,000 -20,390,000 -22,661,000 -50,356,000 -20,390,000 -20,390,000 -20,390,000 -20,390,000 -20,390,000 -20,390,000 
        goodwill and indefinite-lived intangible assets
                                                        230,783,000 153,152,000 151,088,000 151,088,000 151,088,000 151,088,000 151,088,000 153,954,000 212,484,000 212,484,000 212,228,000 213,261,000 205,749,000  133,408,000    113,466,000         
        derivative liabilities
                                                        191,556,000 207,017,000 223,647,000                         
        receivable for ceded life and annuity contracts
                                                               23,401,000 24,075,000 24,155,000 24,649,000 25,134,000 25,277,000 25,378,000 25,455,000 25,926,000 26,153,000 26,714,000 27,367,000 27,828,000 28,143,000 28,446,000 29,240,000 30,929,000 31,400,000 32,138,000 32,923,000 
        liability for ceded life and annuity contracts
                                                               23,401,000 24,075,000 24,155,000 24,649,000 25,134,000 25,277,000 25,378,000 25,455,000 25,926,000 26,153,000 26,714,000 27,367,000 27,828,000 28,143,000 28,446,000 29,240,000 30,929,000 31,400,000 32,138,000 32,923,000 
        46,762 shares at december 31, 2012 and 45,815 shares at december 31, 2011
                                                                                   
        stockholders’ equity :
                                                                                   
        45,815 shares at december 31, 2011 and 45,463 shares at december 31, 2010
                                                                                   
        property and equipment
                                                                117,836,000 107,757,000 100,537,000 91,826,000 83,562,000 77,879,000 78,171,000 76,244,000 73,957,000 70,116,000 65,058,000 64,633,000 59,191,000 53,962,000 49,555,000 47,431,000 45,503,000 42,465,000 41,903,000 
        income and related taxes refundable
                                                                   2,755,000 1,157,000 3,132,000              
        refundable income taxes
                                                                         265,000          
        income tax payable
                                                                              5,946,000 1,242,000    
        income tax receivable
                                                                                2,515,000 3,400,000 7,960,000 
        prepaid and other current assets
                                                                                  9,263,000 
        net liability for termination of commercial operations
                                                                                   
        long-term debt, less current maturities
                                                                                  45,000,000 
        paid-in capital
                                                                                  173,990,000 
      Cashflow Statements:
      Quarterly
      Annual
        Unit: USD2026-03-31 2025-12-31 2025-09-30 2025-06-30 2025-03-31 2024-12-31 2024-09-30 2024-06-30 2024-03-31 2023-12-31 2023-09-30 2023-06-30 2023-03-31 2022-12-31 2022-09-30 2022-06-30 2022-03-31 2021-12-31 2021-09-30 2021-06-30 2021-03-31 2020-12-31 2020-09-30 2020-06-30 2020-03-31 2019-12-31 2019-09-30 2019-06-30 2019-03-31 2018-12-31 2018-09-30 2018-06-30 2018-03-31 2017-12-31 2017-09-30 2017-06-30 2017-03-31 2016-12-31 2016-09-30 2016-06-30 2016-03-31 2015-12-31 2015-09-30 2015-06-30 2015-03-31 2014-12-31 2014-09-30 2014-06-30 2014-03-31 2013-12-31 2013-09-30 2013-06-30 2013-03-31 2012-12-31 2012-09-30 2012-06-30 2012-03-31 2011-09-30 2011-06-30 2011-03-31 2010-12-31 2010-09-30 2010-06-30 2010-03-31 2009-12-31 2009-09-30 2009-06-30 2009-03-31 2008-12-31 2008-09-30 2008-06-30 2008-03-31 2007-12-31 2007-09-30 2007-06-30 2007-03-31 
                                                                                    
          operating activities:
                                                                                    
          net income
        14,000,000 -160,000,000 79,000,000 255,000,000 298,000,000 251,000,000 326,000,000 301,000,000 301,000,000 216,000,000 245,000,000 309,000,000 321,000,000 56,000,000 230,000,000 248,000,000 258,000,000 103,000,000 143,000,000 185,000,000 228,000,000 34,000,000 185,000,000 276,000,000 178,000,000 168,000,000 175,000,000 196,000,000 198,000,000 201,000,000 197,000,000 202,000,000 107,000,000 -262,000,000 -97,000,000 -230,000,000 77,000,000 -47,000,000 42,000,000 33,000,000 24,000,000 29,605,000 46,299,000 38,943,000 28,153,000 33,792,000 16,122,000 7,811,000 4,498,000 -9,126,000 7,569,000 24,571,000 29,915,000 25,643,000 3,364,000 -37,306,000 18,089,000 18,950,000 17,440,000 17,388,000 17,628,000 16,173,000 10,579,000 10,590,000 -4,472,000 8,564,000 14,565,000 12,211,000 15,541,000 17,186,000 16,516,000 13,155,000 17,911,000 17,513,000 13,314,000 9,592,000 
          adjustments to reconcile net income to net cash from operating activities:
                                                                                    
          depreciation and amortization
        39,000,000 44,000,000 45,000,000 58,000,000 48,000,000 48,000,000 47,000,000 46,000,000 45,000,000 43,000,000 42,000,000 42,000,000 44,000,000 47,000,000 45,000,000 44,000,000 40,000,000 35,000,000 32,000,000 31,000,000 33,000,000 24,000,000 23,000,000 21,000,000 20,000,000 21,000,000 21,000,000 22,000,000 25,000,000 23,000,000 31,000,000 36,000,000 37,000,000 39,000,000 43,000,000 47,000,000 49,000,000 47,000,000 46,000,000 45,000,000 44,000,000 33,417,000 30,507,000 29,502,000 32,574,000 34,940,000 33,810,000 32,660,000 32,994,000 25,831,000 24,128,000 22,108,000 21,799,000 20,475,000 20,279,000 19,671,000 18,339,000 17,812,000 16,508,000 18,094,000 20,280,000 16,573,000 13,851,000 10,061,000 9,642,000 9,832,000 9,584,000 9,052,000 8,691,000 8,515,000 8,330,000 8,152,000 7,693,000 7,082,000 6,749,000 6,443,000 
          deferred income taxes
        -30,000,000 6,000,000 15,000,000 9,000,000 13,000,000 39,000,000 -7,000,000 -5,000,000 26,000,000 2,000,000 -29,000,000 -5,000,000 1,000,000 -31,000,000 -38,000,000 -13,000,000 16,000,000 -16,000,000 -15,000,000 1,000,000 6,000,000 -16,000,000 -9,000,000 -8,000,000 14,000,000 3,000,000 -12,000,000 4,000,000 15,000,000 26,000,000 -26,000,000 -6,000,000 -26,000,000 -27,000,000 -36,000,000 -5,000,000 2,000,000 -19,000,000 9,000,000 30,000,000 5,072,000 -19,477,000 6,308,000 1,097,000 8,353,000 -12,397,000 2,362,000 -670,000 7,395,000 -16,287,000 -22,139,000 -16,000 -11,053,000 1,787,000 -9,527,000 8,906,000 10,908,000 -4,458,000 1,619,000 -8,555,000 3,839,000 -2,470,000 3,094,000 -2,323,000 -923,000 -1,743,000 4,988,000 4,447,000 -486,000 -1,291,000 -4,358,000 -4,918,000 624,000 -1,764,000 -2,999,000 
          share-based compensation
        33,000,000 20,000,000 -3,000,000 3,000,000 27,000,000 18,000,000 30,000,000 32,000,000 36,000,000 27,000,000 33,000,000 30,000,000 25,000,000 23,000,000 23,000,000 23,000,000 34,000,000 23,000,000 14,000,000 11,000,000 24,000,000 14,000,000 15,000,000 16,000,000 12,000,000 10,000,000 10,000,000 10,000,000 9,000,000 7,000,000 7,000,000 7,000,000 6,000,000    6,000,000 2,000,000 8,000,000 9,000,000 7,000,000 6,774,000 6,985,000 3,566,000 5,675,000                                
          impairment
        93,000,000                                                                            
          other
         -1,000,000   2,000,000 4,000,000 2,000,000 2,000,000 -1,000,000 -2,000,000 5,000,000 11,000,000 3,000,000 2,000,000 -8,000,000 24,000,000 -1,000,000 -2,000,000 12,000,000 10,000,000 3,000,000 2,000,000 -3,000,000 -8,000,000 3,000,000 -2,000,000 2,000,000 2,000,000 2,000,000 8,000,000 6,000,000 4,000,000 3,000,000 2,000,000 3,000,000 5,000,000 6,000,000 5,788,000 4,571,000 5,077,000 3,564,000 2,347,000                               
          changes in operating assets and liabilities:
                                                                                    
          receivables
        113,000,000 -27,000,000 348,000,000 -376,000,000 -90,000,000 -47,000,000 -26,000,000 118,000,000 -123,000,000 -646,000,000 -49,000,000 151,000,000 -234,000,000 -80,000,000 28,000,000 -64,000,000 21,000,000 -168,000,000 -55,000,000 -94,000,000 -98,000,000 269,000,000 -195,000,000 23,000,000 -197,000,000 -126,000,000 -41,000,000 120,000,000 -29,000,000 -23,000,000 -192,000,000 -232,000,000 -83,000,000 131,000,000 4,000,000 -32,000,000 79,000,000 -12,000,000 -149,000,000 -266,000,000 79,429,000 11,239,000 -139,694,000 105,026,000 -170,773,000 47,831,000 -135,282,000 -39,297,000 -4,968,000 -80,191,000 -63,525,000 -569,000 7,227,000 4,098,000 61,247,000 -54,356,000 -7,365,000 -2,256,000 -2,168,000 57,357,000 -63,298,000 -9,652,000 8,054,000 7,475,000 7,311,000 6,735,000 -29,613,000 41,198,000 -56,163,000 3,956,000 -6,016,000 28,317,000 -17,836,000 1,684,000 2,842,000 
          prepaid expenses and other current assets
        -86,000,000 77,000,000 -35,000,000 66,000,000 -56,000,000 -51,000,000 -22,000,000 8,000,000 8,000,000 -75,000,000 -1,000,000 7,000,000 -14,000,000 -46,000,000 -32,000,000 -32,000,000 24,000,000 -37,000,000 9,000,000 -15,000,000 82,000,000 59,000,000 72,000,000 -229,000,000 34,000,000 -24,000,000 -2,000,000 20,000,000 123,000,000 64,000,000 58,000,000 -239,000,000                 4,488,000 -4,696,000 -13,900,000 -8,956,000 1,616,000 -222,000 -5,065,000 -5,287,000 961,000 5,362,000 -8,142,000 -1,449,000 -3,159,000 -5,680,000 532,000 -1,271,000 -278,000 3,644,000 -2,912,000 -364,000 82,000 -706,000 -1,257,000 -750,000 -808,000 896,000 -2,249,000 
          medical claims and benefits payable
        54,000,000 25,000,000 -107,000,000 31,000,000 -81,000,000 -105,000,000 113,000,000 -24,000,000 -24,000,000 -31,000,000 462,000,000 -147,000,000 296,000,000 -98,000,000 -154,000,000 142,000,000 263,000,000 -51,000,000 250,000,000 104,000,000 168,000,000 113,000,000 325,000,000 -21,000,000 127,000,000 -121,000,000 208,000,000 -228,000,000 34,000,000 -82,000,000 123,000,000 -104,000,000 -163,000,000 -286,000,000 401,000,000 151,000,000 -3,000,000 58,000,000 86,000,000 -173,000,000 255,000,000 122,952,000 67,318,000 44,120,000 247,610,000 76,676,000 199,664,000 104,641,000 149,754,000 37,081,000 167,219,000 -25,658,000 -3,385,000 -41,933,000 10,925,000 69,705,000 53,357,000 19,442,000 -9,769,000 -2,974,000 416,000 4,863,000 18,627,000 10,457,000 13,402,000 -5,593,000 -2,920,000 19,185,000 -6,345,000 -6,754,000 -6,235,000 170,000 -11,991,000 5,483,000 23,051,000 -9,860,000 
          amounts due government agencies
        359,000,000 -124,000,000 -386,000,000 -49,000,000 -32,000,000 -164,000,000 -246,000,000 -226,000,000 183,000,000 -181,000,000 -133,000,000 240,000,000 270,000,000 -68,000,000 -607,000,000 110,000,000 137,000,000 236,000,000 18,000,000 360,000,000 432,000,000 470,000,000 -225,000,000 88,000,000 113,000,000 52,000,000 -372,000,000 52,000,000 -35,000,000 -63,000,000 -716,000,000 33,000,000 172,000,000 219,000,000 -520,000,000 269,000,000 373,000,000 -30,000,000 -6,000,000 328,000,000 181,000,000 -251,124,000 155,383,000 202,776,000 94,965,000                                
          accounts payable, accrued liabilities and other
        79,000,000 -26,000,000 106,000,000 -33,000,000 -268,000,000 148,000,000 274,000,000 -92,000,000 -215,000,000 465,000,000 71,000,000 7,000,000 -215,000,000 95,000,000 107,000,000 -66,000,000 -81,000,000 9,000,000 144,000,000 -31,000,000 16,000,000 23,000,000 -196,000,000 4,000,000 247,000,000                                                    
          deferred revenue
        335,000,000 -7,000,000 15,000,000 -311,000,000 252,000,000 -314,000,000 352,000,000 -315,000,000 -90,000,000 -273,000,000 277,000,000 -240,000,000 295,000,000 -304,000,000 650,000,000 -5,000,000 -352,000,000 369,000,000 -41,000,000 -29,000,000 -304,000,000 314,000,000 7,000,000 11,000,000 -206,000,000 42,000,000 177,000,000 -177,000,000 -4,000,000 34,000,000 -13,000,000 -172,000,000 130,000,000 -187,000,000 185,000,000 -178,000,000 146,000,000 -65,000,000 276,000,000 10,000,000 -129,000,000 152,849,000 9,504,000 -112,088,000 -26,265,000 5,220,000 144,911,000 -100,331,000 24,060,000 -2,172,000 78,439,000 -89,855,000 -5,994,000 -1,503,000 -33,072,000 80,883,000 44,543,000 -26,898,000 -14,674,000 84,172,000 22,438,000 18,343,000 7,984,000 -90,664,000 26,800,000 6,743,000 1,670,000 52,968,000 10,385,000 -31,017,000 48,128,000 -38,062,000 -1,939,000 -2,282,000 8,986,000 17,219,000 
          income taxes
        79,000,000 -125,000,000 -200,000,000 47,000,000 77,000,000 -47,000,000 28,000,000 -64,000,000 65,000,000 -311,000,000 107,000,000 101,000,000 101,000,000 -57,000,000 13,000,000 -21,000,000 67,000,000 -16,000,000 9,000,000 -52,000,000 66,000,000 -48,000,000 -150,000,000 124,000,000 60,000,000 -19,000,000 7,000,000 -46,000,000 43,000,000 -67,000,000 -9,000,000 49,000,000 78,000,000 6,000,000 8,000,000 -89,000,000 59,000,000 -58,000,000 42,000,000 14,000,000 -24,000,000 -52,218,000 28,809,000 -440,000 1,849,000 16,666,000 9,047,000 11,374,000 4,642,000 -38,250,000 -9,988,000 552,000 8,424,000 40,050,000 -2,141,000 -16,074,000 -3,663,000 -11,386,000 -2,141,000 -5,430,000 15,931,000 -1,583,000 1,975,000 2,935,000 -7,610,000 -3,464,000 5,666,000 3,359,000 -11,774,000 -3,382,000 -1,943,000 7,134,000 4,704,000 3,757,000 886,000 4,346,000 
          net cash from operating activities
        1,082,000,000 -298,000,000 -125,000,000 -302,000,000 190,000,000 -224,000,000 873,000,000 -219,000,000 214,000,000 -690,000,000 949,000,000 487,000,000 916,000,000 -212,000,000 254,000,000 368,000,000 363,000,000 597,000,000 461,000,000 493,000,000 568,000,000 1,299,000,000 -158,000,000 613,000,000 136,000,000 29,000,000 242,000,000 -93,000,000 249,000,000 -123,000,000 -505,000,000 -80,000,000 394,000,000 -153,000,000 285,000,000 -47,000,000 719,000,000 40,000,000 355,000,000 139,000,000 139,000,000 219,214,000 258,076,000 94,077,000 553,633,000 219,059,000 605,738,000 24,563,000 210,897,000 78,339,000 223,492,000 -131,852,000 20,104,000 83,760,000 28,041,000 185,408,000 50,575,000 40,265,000 30,848,000 84,050,000 153,184,000 -16,841,000 51,787,000 -26,484,000 25,088,000 35,443,000 27,925,000 66,915,000 60,702,000 -59,724,000 62,895,000 -23,442,000 45,310,000 25,325,000 52,087,000 35,904,000 
          capital expenditures
        -27,000,000 1,000,000 -38,000,000 -42,000,000 -22,000,000 -11,000,000 -35,000,000 -27,000,000 -27,000,000 5,000,000 -26,000,000 -31,000,000 -32,000,000 -10,000,000 -31,000,000 -27,000,000 -23,000,000 -21,000,000 -27,000,000 -13,000,000 -16,000,000 -10,000,000 -19,000,000 -24,000,000 -21,000,000 -27,000,000 -10,000,000 -14,000,000 -6,000,000 -6,000,000 -10,000,000 -10,000,000 -4,000,000 -1,000,000 -25,000,000 -34,000,000 -26,000,000 -33,000,000 -41,000,000 -56,000,000 -46,000,000 -34,501,000 -40,886,000 -24,974,000 -43,163,000 -34,101,000 -19,882,000 -17,788,000 -33,623,000 -29,197,000 -24,062,000 -11,167,000 -25,597,000 -19,247,000 -19,796,000 -13,505,000 -15,055,000 -15,925,000 -14,941,000 -16,620,000 -14,395,000 -11,547,000 -5,905,000 -7,480,000 -8,466,000 -9,557,000 -10,228,000 -6,376,000 -12,270,000 -7,949,000 -7,554,000 -5,785,000 -6,074,000 -6,795,000 -3,645,000 
          free cash flows
        1,055,000,000 -297,000,000 -163,000,000 -344,000,000 168,000,000 -235,000,000 838,000,000 -246,000,000 187,000,000 -685,000,000 923,000,000 456,000,000 884,000,000 -222,000,000 223,000,000 341,000,000 340,000,000 576,000,000 434,000,000 480,000,000 552,000,000 1,289,000,000 -177,000,000 589,000,000 115,000,000 2,000,000 232,000,000 -107,000,000 243,000,000 -129,000,000 -515,000,000 -90,000,000 390,000,000 -154,000,000 260,000,000 -81,000,000 693,000,000 7,000,000 314,000,000 83,000,000 93,000,000 219,214,000 223,575,000 53,191,000 528,659,000 175,896,000 571,637,000 4,681,000 193,109,000 44,716,000 194,295,000 -155,914,000 8,937,000 58,163,000 8,794,000 165,612,000 37,070,000 25,210,000 14,923,000 69,109,000 136,564,000 -31,236,000 40,240,000 -32,389,000 17,608,000 26,977,000 18,368,000 56,687,000 54,326,000 -71,994,000 54,946,000 -30,996,000 39,525,000 19,251,000 45,292,000 32,259,000 
          investing activities:
                                                                                    
          purchases of investments
        -249,000,000 -144,000,000 -186,000,000 -232,000,000 -189,000,000 -143,000,000 -395,000,000 -214,000,000 -380,000,000 -138,000,000 -371,000,000 -278,000,000 -646,000,000 -149,000,000 -351,000,000 -1,010,000,000 -403,000,000 -695,000,000 -1,012,000,000 -618,000,000 -388,000,000 -92,000,000 -578,000,000 -598,000,000 -776,000,000 -977,000,000 -185,000,000 -242,000,000 -288,000,000 -525,000,000 -389,000,000 -822,000,000 -260,000,000 -903,000,000 -733,000,000 -485,000,000 -470,000,000 -363,000,000 -611,000,000 -611,769,000 -318,253,000 -554,387,000 -438,591,000 -337,031,000 -248,020,000 -226,159,000 -142,145,000 -142,130,000 -95,802,000 -456,139,000 -76,012,000 -71,972,000 -90,117,000 -56,149,000 -88,199,000 -74,562,000 -78,663,000 -104,984,000 -140,222,000 -70,852,000 -42,329,000 -49,439,000 -59,429,000 -55,153,000 -24,055,000 -48,127,000 -81,852,000 -17,930,000 -67,630,000 -95,817,000 -178,863,000 -42,436,000 -29,991,000 -12,825,000 
          proceeds from sales and maturities of investments
        295,000,000 391,000,000 300,000,000 386,000,000 331,000,000 240,000,000 365,000,000 295,000,000 211,000,000 102,000,000 124,000,000 175,000,000 371,000,000 316,000,000 203,000,000 366,000,000 513,000,000 364,000,000 343,000,000 314,000,000 308,000,000 206,000,000 141,000,000 257,000,000 493,000,000 412,000,000 1,099,000,000 425,000,000 366,000,000 375,000,000 735,000,000 792,000,000 543,000,000 233,000,000 664,000,000 441,000,000 433,000,000 454,000,000 700,000,000 464,000,000 348,000,000 263,428,000 321,522,000 285,441,000 255,609,000 158,964,000 147,188,000                              
          net cash paid in business combinations
         -245,000,000 -49,000,000 -295,000,000           -693,000,000                -40,000,000 -6,000,000 -2,000,000 -372,684,000 -69,310,000 -8,006,000 -36,633,000    -3,837,000        -3,253,000 -3,512,000                
          purchases of property, equipment and capitalized software
        -27,000,000 1,000,000 -38,000,000 -42,000,000 -22,000,000 -11,000,000 -35,000,000 -27,000,000 -27,000,000 5,000,000 -26,000,000 -31,000,000 -32,000,000 -10,000,000 -31,000,000 -27,000,000 -23,000,000 -21,000,000 -27,000,000 -13,000,000 -16,000,000 -10,000,000 -19,000,000 -24,000,000 -21,000,000 -27,000,000 -10,000,000 -14,000,000 -6,000,000 -6,000,000 -10,000,000 -10,000,000 -4,000,000 -1,000,000 -25,000,000 -34,000,000 -26,000,000 -33,000,000 -41,000,000 -56,000,000 -46,000,000  -34,501,000 -40,886,000 -24,974,000                                
          net cash from investing activities
        11,000,000 230,000,000 77,000,000 128,000,000 -123,000,000 19,000,000 -48,000,000 53,000,000 -488,000,000 -25,000,000 -280,000,000 -137,000,000 -302,000,000 148,000,000 -347,000,000 -665,000,000 74,000,000 -547,000,000 -698,000,000 -321,000,000 -87,000,000 -498,000,000 60,000,000 141,000,000 -103,000,000 -213,000,000 313,000,000 -564,000,000 171,000,000 322,000,000 423,000,000 253,000,000 145,000,000 -599,000,000 371,000,000 -506,000,000 -339,000,000 -71,000,000 142,000,000 41,000,000 -314,000,000 -754,925,000 -108,226,000 -329,059,000 -227,790,000 -274,449,000 -158,944,000 -74,845,000 -27,491,000 -1,895,000 -109,604,000 -410,612,000 -21,200,000 -2,790,000 -29,487,000 -18,589,000 -42,718,000 -3,885,000 -39,095,000 -79,682,000 -125,707,000 -24,495,000 -134,021,000 -4,849,000 -5,995,000 -3,837,000 -3,620,000 -24,261,000 -38,867,000 18,510,000 -20,536,000 -23,627,000 -209,839,000 -39,589,000 -1,440,000 -5,405,000 
          financing activities:
                                                                                    
          proceeds from borrowings under credit facility and term loans
                                                                                   
          common stock purchases
         -500,000,000 -500,000,000 -500,000,000        -200,000,000   -128,000,000 -153,000,000 -453,000,000                                                    
          common stock withheld to settle employee tax obligations
        -14,000,000 -1,000,000 -36,000,000 -1,000,000 -56,000,000 -1,000,000 -1,000,000 -58,000,000 -1,000,000 -1,000,000 -52,000,000 -1,000,000 -1,000,000 -51,000,000                                                        
          net cash from financing activities
        -20,000,000 92,000,000 -220,000,000 -189,000,000 147,000,000 67,000,000 -364,000,000 12,000,000 -62,000,000 3,000,000 -6,000,000 10,000,000 -65,000,000 -183,000,000 10,000,000 -191,000,000 -77,000,000 21,000,000 -4,000,000 7,000,000 -207,000,000 156,000,000 -2,000,000 189,000,000 -118,000,000 -42,000,000 -148,000,000 -314,000,000 -48,000,000 -181,000,000 -509,000,000 -498,000,000 -5,000,000 4,000,000 299,000,000 334,000,000 -1,000,000 8,000,000 9,000,000 2,000,000 700,564,000 478,000 378,840,000 5,118,000 -4,143,000 124,451,000 -5,736,000 -35,932,000 2,895,000 -2,000 115,623,000 374,837,000 -680,000 -10,166,000 42,550,000 16,039,000 -8,101,000 3,668,000 3,538,000 1,954,000 6,806,000 104,938,000 113,000 939,000 26,000 -11,655,000 -24,629,000 -17,109,000 -1,774,000 -29,088,000 158,000 175,999,000 -9,644,000 888,000 -14,182,000 
          net increase in cash, cash equivalents, and restricted cash and cash equivalents
        1,073,000,000    214,000,000  461,000,000 -154,000,000 -336,000,000  663,000,000 360,000,000 549,000,000  -83,000,000 -488,000,000 360,000,000  -241,000,000 179,000,000 274,000,000  -100,000,000 943,000,000 -85,000,000   -971,000,000 372,000,000 18,000,000 -591,000,000 -325,000,000 534,000,000                                            
          cash, cash equivalents, and restricted cash and cash equivalents at beginning of period
        4,348,000,000  4,741,000,000  4,908,000,000  4,048,000,000  4,506,000,000  4,223,000,000  2,508,000,000  2,926,000,000 3,290,000,000                                            
          cash, cash equivalents, and restricted cash and cash equivalents at end of period
        5,421,000,000  -268,000,000 -363,000,000 4,955,000,000  461,000,000 -154,000,000 4,572,000,000  663,000,000 360,000,000 4,597,000,000  -83,000,000 -488,000,000 4,866,000,000  -241,000,000 179,000,000 4,497,000,000  -100,000,000 943,000,000 2,423,000,000  407,000,000 -971,000,000 3,298,000,000 18,000,000 -591,000,000 -325,000,000 3,824,000,000                                            
          changes in operating assets and liabilities, net of the effect of acquisitions:
                                                                                    
          repayment of credit facility and term loans
         -740,000,000                                                                           
          proceeds from senior notes offerings, net of issuance costs
                                                                                    
          net increase in cash and cash equivalents, and restricted cash and cash equivalents
                                                                                    
          cash and cash equivalents, and restricted cash and cash equivalents at beginning of period
                                                                                    
          cash and cash equivalents, and restricted cash and cash equivalents at end of period
                                                                                    
          supplemental cash flow information:
                                                                                    
          cash paid during the period for interest
                                                                                    
          net decrease in cash, cash equivalents, and restricted cash and cash equivalents
          -268,000,000                                                                          
          proceeds from borrowings under credit facility and term loan
                                                                                    
          repayment of credit facility and term loan
                                                                                    
          proceeds from borrowings under credit facility
            150,000,000                                                                      
          proceeds from borrowings under term loan
            500,000,000                        100,000,000                                                
          repayment of credit facility
             -150,000,000                                                                     
          contingent consideration liabilities settled
                     -20,000,000 -20,000,000                         -12,230,000 -38,119,000                            
          loss on debt repayment
                             10,000,000                                                      
          repayment of senior notes
                                                                                    
          repayment of term loan facility
                                                                                  
          proceeds from borrowings under term loan facility
                             380,000,000                                                  
          cash paid for partial termination of warrants
                             -30,000,000                                                    
          cash paid for partial settlement of conversion option
                             -27,000,000                                                    
          cash received for partial settlement of call option
                             27,000,000                                                    
          repayment of principal amount of convertible senior notes
                             -12,000,000                                                    
          proceeds from senior notes offering, net of issuance costs
                                                                                  
          loss on sales of subsidiaries, net of gain
                                                                                    
          non-cash restructuring charges
                                         11,000,000                                           
          net cash received from sale of subsidiaries
                                                                                    
          gain on debt repayment
                                                                                    
          amortization of convertible senior notes and finance lease liabilities
                                 1,000,000 1,000,000 3,000,000                                                
          loss on debt extinguishment
                                 2,000,000 -14,000,000 -3,000,000 -3,000,000 10,000,000 5,000,000 10,000,000                                            
          impairment losses
                                         269,000,000 129,000,000                                          
          accounts payable and accrued liabilities
                                 -35,000,000 98,000,000 -31,000,000 -30,000,000 -353,000,000 49,000,000 30,000,000 319,000,000 -102,000,000 108,000,000 -68,000,000 50,000,000 -5,000,000 -146,000,000 -58,000,000 205,000,000 50,459,000 -124,193,000 -31,639,000 189,373,000 -303,294,000 136,894,000 75,280,000 102,217,000 40,005,000 37,959,000 14,879,000 -31,847,000 32,375,000 13,952,000 12,167,000 -35,149,000 8,961,000 17,081,000 -25,796,000 25,351,000 -12,827,000 12,824,000 15,134,000 -20,327,000 9,586,000 -12,804,000 -2,922,000 -4,238,000 9,954,000 -6,343,000 -4,277,000 3,937,000 10,027,000 -3,716,000 8,452,000 
          non-cash restructuring costs
                                      17,000,000                                            
          gain on sale of subsidiary
                                                             643,000 -2,390,000                    
          repayment of principal amount of 1.125% convertible notes
                                  -55,000,000 -139,000,000 -46,000,000                                                
          cash paid for partial settlement of 1.125% conversion option
                                  -105,000,000 -358,000,000 -115,000,000 -146,000,000 -343,000,000                                              
          cash received for partial termination of 1.125% call option
                                  105,000,000 358,000,000 115,000,000  343,000,000                                              
          cash paid for partial termination of 1.125% warrants
                                  -90,000,000 -321,000,000 -103,000,000 -130,000,000 -306,000,000                                              
          repayment of 1.625% convertible notes
                                                                                    
          amortization of convertible senior notes and lease financing obligations
                                     4,000,000 5,000,000 6,000,000 7,000,000 8,000,000 8,000,000 8,000,000 8,000,000 8,000,000 8,000,000 7,000,000 8,000,000 7,899,000 7,416,000 7,395,000 7,290,000 7,184,000 6,740,000 6,781,000 6,674,000 6,692,000                           
          cash received for partial settlement of 1.125% call option
                                                                                    
          repayment of principal amount of 1.625% convertible notes
                                                                                    
          repayment of principal amount of 1.125% notes
                                                                                    
          repayment of principal amount of 1.625% notes
                                                                                    
          repayment of 1.125% convertible notes
                                                                                    
          increase in restricted investments held-to-maturity
                                         -2,000,000                                           
          cash paid for financing transaction fees
                                        -5,000,000                                            
          proceeds from employee stock plans
                                         8,000,000 10,000,000 1,000,000 8,000,000   9,364,000 249,000 7,298,000 1,089,000 6,412,000 11,000 6,287,000 1,330,000 4,246,000 304,000 4,617,000 235,000 2,634,000 86,000 2,737,000 2,748,000 3,178,000 2,462,000 2,194,000 319,000               
          proceeds from common stock offering, net of issuance costs
                                                 -151,000                                  
          net increase in cash and cash equivalents
                                         -748,000,000 955,000,000 -219,000,000 379,000,000 -23,000,000 497,000,000 189,000,000 -173,000,000 164,853,000 150,328,000 143,858,000 330,961,000 -59,533,000 571,245,000 -56,018,000 147,474,000 79,339,000 113,886,000 -426,841,000 373,741,000 80,290,000 -11,612,000 209,369,000 23,896,000 28,279,000 -4,579,000 7,906,000 29,431,000 -34,530,000 22,704,000 -31,220,000 20,032,000 31,632,000 12,650,000 18,025,000 4,726,000 -42,988,000 13,271,000 -46,911,000 11,470,000 -23,908,000 51,535,000 16,317,000 
          cash and cash equivalents at beginning of period
                                         2,819,000,000 2,329,000,000 -63,000 1,539,063,000 935,895,000 795,770,000 493,827,000 455,886,000  469,501,000  387,162,000  459,064,000  403,650,000 
          cash and cash equivalents at end of period
                                         -748,000,000 955,000,000 -219,000,000 3,198,000,000 -23,000,000 497,000,000 189,000,000 2,156,000,000 164,790,000 150,328,000 143,858,000 1,870,024,000 -59,533,000 571,245,000 -56,018,000 1,083,369,000 79,339,000 113,886,000 -426,841,000 1,169,511,000 80,290,000 -11,612,000 209,369,000 517,723,000 28,279,000 -4,579,000 463,792,000  -34,530,000 22,704,000 438,281,000  31,632,000 12,650,000 405,187,000  -42,988,000 13,271,000 412,153,000  -23,908,000 51,535,000 419,967,000 
          share-based compensation, including accelerated share-based compensation
                                          3,000,000                                          
          prepaid expenses and other assets
                                          -15,000,000 -26,000,000 -12,000,000  27,000,000 59,000,000 -202,000,000  33,715,000 40,251,000 -137,278,000  15,305,000 11,136,000 -78,023,000                            
          decrease in restricted investments held-to-maturity
                                                                                    
          increase in restricted investments
                                            -7,000,000    -4,000,000 -784,000 8,986,000 -9,590,000 -4,612,000 -9,360,000 -8,679,000 -1,241,000 -14,381,000 2,132,000 -8,290,000 -1,818,000 -11,016,000 387,000 -880,000 -1,661,000 -493,000 -164,000 -1,023,000 -7,207,000 2,947,000 -3,759,000 -4,098,000 -656,000    445,000    -787,000     
          change in restricted investments
                                             -1,000,000                                      
          principal payments on convertible senior notes
                                                                                    
          changes in operating assets and liabilities, net of effects from acquisitions:
                                                                                    
          purchases of equipment
                                                     -43,163,000 -34,101,000 -19,882,000 -17,788,000 -33,623,000 -29,197,000 -24,062,000 -11,167,000 -25,597,000 -19,247,000 -19,796,000 -13,505,000 -15,055,000 -15,925,000 -14,941,000 -16,620,000 -14,395,000 -11,547,000 -5,976,000 -7,480,000 -8,466,000 -9,557,000 -10,367,000 -6,376,000 -11,216,000 -8,921,000 -8,177,000 -5,785,000 -6,074,000 -6,795,000 -3,645,000 
          proceeds from sale-leaseback transactions
                                                                                  
          purchase of call option
                                                                                    
          proceeds from issuance of warrants
                                                         75,074,000                        
          treasury stock purchases
                                                         -2,662,000 -50,000,000            -12,736,000 -14,976,000 -17,703,000 -2,271,000       
          principal payments on term loan
                                                         -47,180,000 -291,000 -283,000 -273,000 -272,000 -301,000                    
          repayment of amount borrowed under credit facility
                                                             -10,000,000                     
          proceeds from issuance of convertible senior notes, net of issuance costs
                                                                                    
          proceeds from sale of subsidiary, net of cash surrendered
                                                             9,162,000                    
          proceeds from issuance of convertible senior notes, net of financing costs paid
                                                                                    
          amount borrowed under credit facility
                                                             50,000,000 10,000,000                   
          stock–based compensation
                                                      5,659,000 4,860,000 5,596,000                            
          proceeds from issuance of convertible senior notes, net of deferred financing costs
                                                                                    
          repayment of amounts borrowed under credit facility
                                                          -40,000,000                     -10,000,000 -15,000,000 
          amortization of premium/discount on investments
                                                       2,501,000 3,023,000 3,734,000 3,755,000 2,796,000 1,502,000 1,580,000 1,551,000 1,765,000 1,850,000 1,861,000 1,795,000 1,644,000                 
          amortization of deferred financing costs
                                                       650,000 651,000 650,000 676,000 1,118,000 1,248,000 264,000 310,000 257,000 258,000 1,444,000 504,000 503,000 502,000 591,000 343,000 344,000 832,000 344,000 344,000 352,000 407,000 406,000       
          change in fair value of derivatives
                                                         -5,000 -1,000 3,503,000 -119,000                        
          change in fair value of contingent consideration liabilities
                                                       66,000 -4,265,000                            
          gain on disposal of property and equipment
                                                       90,000 -950,000                            
          tax deficiency from employee stock compensation
                                                       -28,000 -5,000 -1,000 -34,000 4,000 -42,000 -367,000 -109,000 -19,000 -31,000 -158,000 -225,000 -264,000                 
          proceeds from sale of property and equipment
                                                                                    
          change in deferred contract costs
                                                       -7,597,000 -6,145,000 3,093,000 2,551,000                          
          change in other noncurrent assets and liabilities
                                                       -336,000 -117,000     2,862,000 -392,000 -1,926,000 -2,457,000 -2,723,000 3,127,000 -937,000                 
          proceeds from issuance of 1.125% notes, net of deferred financing costs
                                                                                    
          purchase of 1.125% notes call option
                                                                                  
          excess tax benefits from employee stock compensation
                                                       234,000 877,000 436,000 -306,000 367,000 1,177,000 -31,000 21,000 85,000 3,592,000 24,000 490,000 1,076,000 -125,000 241,000 66,000 113,000             
          settlement of interest rate swap
                                                                                   
          principal payments on lease financing obligations - related party
                                                                                    
          gain on derivatives
                                                        -2,000                            
          sales and maturities of investments
                                                        147,370,000 171,795,000 78,380,000 73,773,000 75,647,000 84,341,000 76,893,000 71,005,000 65,767,000 104,979,000 60,159,000 61,275,000 39,913,000 68,357,000 63,610,000 53,226,000 54,595,000 67,478,000 46,665,000 35,627,000 57,628,000 51,091,000 55,452,000 82,353,000 44,426,000 13,175,000 34,715,000 11,402,000 
          sale of property and equipment
                                                        5,715,000                            
          principal payments on lease financing obligations
                                                        -20,000                            
          stock-based compensation
                                                         8,040,000 8,504,000 7,729,000 4,421,000 4,570,000 5,636,000 5,146,000 4,666,000 4,349,000 4,310,000 4,064,000 2,263,000 2,760,000 2,372,000 2,136,000 1,755,000 2,272,000 2,024,000 1,434,000 2,042,000 2,182,000 2,076,000 1,511,000 1,950,000 1,594,000 1,777,000 1,867,000 
          loss on disposal of property and equipment
                                                                                    
          impairment of goodwill and intangible assets
                                                                                    
          gain on acquisition
                                                                                    
          proceeds from issuance of 1.125% notes, net of deferred issuance costs
                                                           537,973,000                        
          amount borrowed under term loan
                                                                                    
          credit facility fees paid
                                                                                   
          adjustments to reconcile net income to net cash change in operating activities:
                                                                                    
          change in other non-current assets and liabilities
                                                          438,000 -7,604,000 -408,000                        
          amortization of convertible senior notes
                                                                                    
          non-cash interest on convertible senior notes
                                                            3,723,000 1,528,000 1,499,000 1,472,000 1,443,000 1,384,000 1,371,000 1,340,000 1,314,000 1,291,000 1,266,000 1,243,000 1,219,000 1,197,000 1,172,000 1,194,000         
          increase in deferred contract costs
                                                            1,756,000 7,189,000 4,256,000 -10,062,000 -12,993,000 -16,360,000 -6,770,000 -9,635,000 -8,703,000 -12,598,000               
          purchase of call option relating to 1.125% notes
                                                            -149,331,000                        
          change in fair value of interest rate swap
                                                                                    
          unrealized gain on trading securities
                                                                     -1,310,000 -2,320,000 -540,000  101,000 29,000 -3,639,000         
          loss on rights agreement
                                                                     1,196,000 2,118,000 493,000  -92,000 -27,000 3,323,000         
          change in fair value of interest rate swap agreement
                                                              184,000                      
          cash paid during the period for:
                                                                                    
          interest
                                                                   269,000   6,080,000 142,000    339,000  53,000    654,000 838,000 1,203,000 
          schedule of non-cash investing and financing activities:
                                                                                    
          retirement of common stock used for stock-based compensation
                                                                   3,161,000    1,526,000    695,000  878,000 -33,000 -333,000     
          details of business combinations adjustments:
                                                                                    
          increase in fair value of assets acquired
                                                                   -256,000                 
          decrease in fair value of liabilities assumed
                                                                   -1,045,000                 
          decrease in payable to sellers
                                                                   -1,952,000                 
          unrealized (gain) loss on trading securities
                                                                                    
          gain on rights agreement
                                                                                    
          other-than-temporary impairment on available-for-sale securities
                                                                                    
          gain on purchase of convertible senior notes
                                                                                    
          changes in operating assets and liabilities, net of effects of business combinations:
                                                                                    
          purchase of convertible senior notes
                                                                                    
          cash and cash equivalents at beginning of year
                                                                                    
          cash and cash equivalents at end of year
                                                                                    
          gain on repurchase and retirement of convertible senior notes
                                                                           -1,532,000         
          tax deficiency from employee stock compensation recorded as additional paid-in capital
                                                                     -293,000 -30,000 -353,000  -157,000 -14,000 -533,000         
          increase in other assets
                                                                     -57,000 -88,000 -244,000 -676,000 884,000 -1,053,000 -1,708,000 -8,395,000 1,599,000 -615,000 -1,562,000 -1,409,000 -2,057,000 -550,000 -314,000 
          increase in other long-term liabilities
                                                                     1,640,000 419,000 670,000 1,263,000 -16,000 -8,641,000 -131,000 1,820,000 1,601,000 2,247,000 363,000 2,721,000 2,085,000 1,307,000 3,177,000 
          proceeds from common stock offering, net of underwriting discount
                                                                                    
          equity offering costs paid
                                                                                    
          cash paid in business purchase transactions
                                                                      -131,970,000 -2,430,000             
          borrowings under credit facility
                                                                                    
          payment of credit facility fees
                                                                                -76,000   
          unrealized gain on investments
                                                                       207,000      -2,390,000 -2,738,000 -2,705,000     
          deferred taxes
                                                                       -79,000    124,000  828,000 1,646,000 550,000  -156,000 -48,000 -68,000 
          net unrealized gain on investments
                                                                       128,000      -1,562,000 -1,092,000 -2,155,000     
          accrued purchases of equipment
                                                                       71,000    139,000  -1,054,000 972,000 623,000     
          details of business purchase transactions:
                                                                                    
          other assets
                                                                           9,000,000         
          goodwill and intangible assets
                                                                           11,847,000  228,000 1,102,000     
          changes in operating assets and liabilities, net of effects of acquisitions:
                                                                                    
          net cash paid in business purchase transactions
                                                                                    
          decrease (increase) in restricted investments
                                                                                    
          purchase and retirement of convertible senior notes
                                                                                  
          proceeds from issuance of convertible senior notes
                                                                                    
          payment of convertible senior notes fees
                                                                                    
          tax benefit from employee stock compensation
                                                                                    
          proceeds from exercise of stock options and employee stock plan purchases
                                                                               172,000     
          operating activities
                                                                                    
          gain on purchase and retirement of convertible senior notes
                                                                                   
          investing activities
                                                                                    
          cash paid in business purchase transaction
                                                                                   
          financing activities
                                                                                    
          proceeds from exercise of stock options and employee stock purchases
                                                                            298,000    883,000 1,266,000 390,000 
          increase in restricted cash
                                                                             -6,635,000    -4,282,000 -126,000 -3,200,000 
          repurchase and retirement of convertible senior notes
                                                                           -9,653,000         
          unrealized loss on investments
                                                                           -156,000         
          net unrealized loss on investments
                                                                           -32,000         
          business purchase transactions adjustments:
                                                                                    
          unrealized loss on trading securities
                                                                                    
          net cash (paid) acquired in business purchase transactions
                                                                                    
          tax benefit from employee stock compensation recorded as additional paid-in capital
                                                                                    
          tax provision from employee stock compensation recorded as additional paid-in capital
                                                                                    
          supplemental cash flow information
                                                                                    
          retirement of treasury stock
                                                                                    
          cumulative effect of adoption of financial interpretation no. 48, accounting for uncertainty in income taxes
                                                                                 446,000 
          details of business purchase transaction:
                                                                                    
          fair value of assets acquired
                                                                             -4,524,000       
          common stock issued to seller
                                                                             2,524,000       
          net cash paid in business purchase transaction
                                                                             -2,000,000       
          amortization of capitalized long-term debt fees
                                                                               406,000     
          tax benefit from exercise of employee stock options recorded as additional paid-in capital
                                                                               -14,000  -88,000 214,000 428,000 
          repayments of amounts borrowed under credit facility
                                                                                    
          repayment of mortgage note
                                                                                    
          principal payments on capital lease obligations
                                                                                    
          amortization of capitalized credit facility fees
                                                                                 171,000 224,000 251,000 
          net cash acquired in purchase transactions
                                                                                    
          repurchase and retirement of common stock
                                                                                 -363,000   
          change in unrealized loss on investments
                                                                                    
          change in net unrealized loss on investments
                                                                                    
          value of stock issued for employee compensation earned in previous year
                                                                                    
          details of acquisitions:
                                                                                    
          less cash acquired in purchase transaction
                                                                                    
          change in net unrealized gain on investments
                                                                                  78,000 118,000 
          deferred tax asset related to business purchase
                                                                                 1,168,000 873,000 
          accrual for capital expenditures
                                                                                 -64,000   
          change in unrealized gain on investments
                                                                                  126,000 186,000 
          amortization of capitalized credit facility fee
                                                                                    
          prepaid and other current assets
                                                                                    
          income taxes payable and receivable
                                                                                    
          other long-term liabilities
                                                                                    
          advances to related parties and other assets
                                                                                    
          cash paid in purchase transactions, net of cash acquired and received in divestiture transaction
                                                                                    
          issuance of common stock
                                                                                    
          repayments of debt acquired in acquisition
                                                                                    
          issuance (repayment) of mortgage note
                                                                                    
          cash paid during the year for:
                                                                                    
          accrual of software license fees
                                                                                    
          accrual of equipment
                                                                                    
          value of stock issued for employee compensation earned in the previous year
                                                                                    
          fair value of assets acquired, net of assets sold
                                                                                    
          less cash acquired in purchase and divestiture transaction
                                                                                    
          liabilities assumed in purchase and divestiture transaction
                                                                                    
          net cash (acquired) paid in purchase transactions and cash received in divestiture transaction