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Income Taxes - Effective Tax Rate Reconciliation (Details)
12 Months Ended
Dec. 31, 2021
Dec. 31, 2020
Dec. 31, 2019
Effective Income Tax Rate Reconciliation, Amount [Abstract]      
Statutory income tax rate 21.00% 21.00% 21.00%
State income taxes, net of federal tax benefit 4.10% 3.20% 4.00%
Health insurer fee 0.00% 2.20% 0.00%
Basis difference upon disposition of subsidiary 0.00% (1.20%) 0.00%
Prior year refund claim (1.20%) 0.00% 0.00%
Other 0.30% 1.10% 1.30%
Effective income tax rate 24.20% 26.30% 26.30%