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Income Taxes - Reconciliation of the U.S. Federal Statutory Income Tax Rate (Details)	12 Months Ended
	Dec. 31, 2017	Dec. 31, 2016	Dec. 31, 2015
Effective income tax rate reconciliation to the statutory federal income tax rate
Statutory federal tax (benefit) rate	35.00%	35.00%	35.00%
State income provision (benefit), net of federal	0.70%	1.60%	2.40%
Nondeductible health insurer fee (HIF)	0.00%	37.00%	17.00%
Nondeductible compensation	(2.80%)	3.10%	0.60%
Nondeductible goodwill impairment	(6.60%)	0.00%	0.00%
Revaluation of net deferred tax assets	(8.80%)	0.00%	0.00%
Change in purchase agreement that increased tax basis in assets	(0.00%)	(2.20%)	(0.00%)
Other	(1.10%)	0.30%	0.50%
Effective tax (benefit) rate	16.40%	74.80%	55.50%

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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 changes in the valuation allowance for deferred tax assets.

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