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Income Taxes - Reconciliation of the U.S. Federal Statutory Income Tax Rate (Details)	12 Months Ended
	Dec. 31, 2016	Dec. 31, 2015	Dec. 31, 2014
Effective income tax rate reconciliation to the statutory federal income tax rate
Statutory federal tax rate	35.00%	35.00%	35.00%
State income taxes, net of federal benefit	1.60%	2.40%	0.40%
Change in unrecognized tax benefits	0.50%	0.90%	(0.10%)
Nondeductible health insurer fee (HIF)	37.00%	17.00%	22.90%
Nondeductible compensation	3.10%	0.60%	(4.10%)
Change in purchase agreement that increased tax basis in assets	(2.20%)	(0.00%)	(0.00%)
Other	(0.20%)	(0.40%)	(0.30%)
Effective tax rate	74.80%	55.50%	53.80%

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Effective Income Tax Rate Reconciliation, Change In Tax Basis Of Assets Acquired

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Percentage of current income tax expense (benefit) and deferred income tax expense (benefit) pertaining to continuing operations.

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Percentage of domestic federal statutory tax rate applicable to pretax income (loss).

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Percentage of the difference between reported income tax expense (benefit) and expected income tax expense (benefit) computed by applying the domestic federal statutory income tax rates to pretax income (loss) from continuing operations attributable to equity-based compensation costs.

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Percentage of the difference between reported income tax expense (benefit) and expected income tax expense (benefit) computed by applying the domestic federal statutory income tax rates to pretax income (loss) from continuing operations attributable to income tax contingencies. Includes, but not limited to, domestic tax contingency, foreign tax contingency, state and local tax contingency, and other contingencies.

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