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Income Taxes - Effective Tax Rate Reconciliation (Details)
12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
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 3.20% 4.10% 3.20%
Health insurer fee 0.00% 0.00% 2.20%
Legal charges 3.50% 0.00% 0.00%
Basis difference upon disposition of subsidiary 1.70% 0.00% (1.20%)
Prior year refunds and unrecognized tax benefits (2.70%) (1.20%) 0.00%
Other (0.70%) 0.30% 1.10%
Effective income tax rate 26.00% 24.20% 26.30%