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Income Taxes - Effective Tax Rate Reconciliation (Details)
12 Months Ended
Dec. 31, 2019
Dec. 31, 2018
Dec. 31, 2017
Effective Income Tax Rate Reconciliation, Amount [Abstract]      
Statutory income tax rate 21.00% 21.00% 35.00%
State income taxes, net of federal tax benefit 4.00% 27.70% 4.10%
Effect of the Tax Cuts and Jobs Act 0 (0.071) (0.183)
Health insurer fee 0.00% 2.20% 0.00%
Goodwill impairments 0.00% 89.50% 0.80%
Sale of subsidiary 0.00% 5.00% 0.00%
Other 1.30% 4.10% (1.80%)
Effective income tax rate 26.30% 142.40% 19.80%