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Consolidated Statements of Cash Flows - USD ($)
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Cash flows from operating activities:      
Net income $ 368,800,000 $ 445,800,000 $ 375,400,000
Loss (income) from discontinued operations, net of tax 0 600,000 (1,100,000)
Adjustments to reconcile net income to net cash provided by operating activities—      
Provision for government, class action, and related settlements 2,800,000 0 52,000,000.0
Depreciation and amortization 243,000,000.0 218,700,000 199,700,000
Amortization of debt-related items 7,200,000 4,500,000 4,000,000.0
Loss on early extinguishment of debt 2,300,000 7,700,000 0
Equity in net income of nonconsolidated affiliates (3,500,000) (6,700,000) (8,700,000)
Distributions from nonconsolidated affiliates 3,800,000 6,600,000 8,300,000
Stock-based compensation 29,500,000 114,400,000 85,900,000
Deferred tax expense (benefit) 52,400,000 40,000,000.0 (9,100,000)
Gain on consolidation of Yuma Rehabilitation Hospital 0 (19,200,000) 0
Other, net 5,900,000 7,400,000 9,200,000
Changes in assets and liabilities, net of acquisitions —      
Accounts receivable (38,100,000) (22,900,000) 7,000,000.0
Prepaid expenses and other assets 100,000 (35,400,000) 11,500,000
Accounts payable 13,600,000 (6,100,000) 6,600,000
Accrued payroll 92,000,000.0 13,200,000 14,800,000
Other liabilities (74,900,000) (128,900,000) 6,100,000
Net cash (used in) provided by operating activities of discontinued operations (200,000) (4,400,000) 800,000
Total adjustments 335,900,000 188,900,000 388,100,000
Net cash provided by operating activities 704,700,000 635,300,000 762,400,000
Cash flows from investing activities:      
Acquisition of businesses, net of cash acquired (1,100,000) (231,500,000) (143,900,000)
Purchases of property and equipment (396,000,000.0) (372,400,000) (254,500,000)
Additions to capitalized software costs (8,700,000) (13,000,000.0) (16,000,000.0)
Purchases of intangible assets (3,500,000) (18,700,000) (5,700,000)
Proceeds from sale of restricted investments 12,600,000 17,600,000 11,600,000
Purchases of restricted investments (8,700,000) (32,900,000) (13,300,000)
Other, net (2,100,000) (6,500,000) (2,700,000)
Net cash used in investing activities (407,500,000) (657,400,000) (424,500,000)
Cash flows from financing activities:      
Proceeds from bond issuance 992,500,000 1,000,000,000.0 0
Principal payments on debt, including pre-payments (718,300,000) (519,500,000) (20,600,000)
Borrowings on revolving credit facility 330,000,000.0 635,000,000.0 325,000,000.0
Payments on revolving credit facility (375,000,000.0) (620,000,000.0) (390,000,000.0)
Principal payments under finance lease obligations (22,500,000) (19,500,000)  
Principal payments under finance lease obligations     (17,900,000)
Debt amendment and issuance costs (20,300,000) (21,500,000) (100,000)
Repurchases of common stock, including fees and expenses (6,100,000) (45,900,000) 0
Dividends paid on common stock (111,900,000) (108,700,000) (100,800,000)
Purchase of equity interests in consolidated affiliates (162,300,000) (162,900,000) (65,100,000)
Distributions paid to noncontrolling interests of consolidated affiliates (72,200,000) (79,800,000) (75,400,000)
Taxes paid on behalf of employees for shares withheld (15,700,000) (16,600,000) (8,300,000)
Contributions from consolidated affiliates 34,900,000 15,900,000 12,600,000
Other, net 1,000,000.0 (8,300,000) 19,400,000
Net cash (used in) provided by financing activities (145,900,000) 48,200,000 (321,200,000)
Increase in cash, cash equivalents, and restricted cash 151,300,000 26,100,000 16,700,000
Cash, cash equivalents, and restricted cash at beginning of year 159,600,000 133,500,000 116,800,000
Cash, cash equivalents and restricted cash at end of year 310,900,000 159,600,000 133,500,000
Reconciliation of Cash, Cash Equivalents, and Restricted Cash      
Cash and cash equivalents at beginning of period 94,800,000 69,200,000 54,400,000
Restricted cash at beginning of period 57,400,000 59,000,000.0 62,400,000
Restricted cash included in other long-term assets at beginning of period 7,400,000 5,300,000 0
Cash, cash equivalents, and restricted cash at beginning of year 159,600,000 133,500,000 116,800,000
Cash and cash equivalents at end of period 224,000,000.0 94,800,000 69,200,000
Restricted cash at end of period 65,400,000 57,400,000 59,000,000.0
Restricted cash included in other long-term assets at end of period 21,500,000 7,400,000 5,300,000
Cash, cash equivalents and restricted cash at end of year 310,900,000 159,600,000 133,500,000
Supplemental cash flow information:      
Interest (168,400,000) (155,700,000) (149,600,000)
Income tax refunds 1,400,000 100,000 600,000
Income tax payments (34,300,000) (104,200,000) (115,400,000)
Supplemental schedule of noncash financing activities:      
Adoption of ASC 842 $ 0 $ 349,400,000 $ 0