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Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($) $ in Thousands | Dec. 31, 2020 | Dec. 31, 2019
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Income Tax Disclosure [Abstract] |  |
Accrued expenses and reserve liabilities | $ 52,000 | $ 35,000
Other accrued medical costs | 15,000 | 11,000
Net operating losses | 11,000 | 13,000
Fixed assets and intangibles | 0 | 26,000
Unearned premiums | 18,000 | 11,000
Lease financing obligation | 8,000 | 5,000
Tax credit carryover | 7,000 | 11,000
Other | 4,000 | 0
Valuation allowance | (17,000) | (24,000)
Total deferred income tax assets, net of valuation allowance | 98,000 | 88,000
Fixed assets and intangibles | (7,000) | 0
Prepaid expenses | (10,000) | (6,000)
Unrealized gains and losses | (12,000) | (1,000)
Other | 0 | (2,000)
Total deferred income tax liabilities | (29,000) | (9,000)
Net deferred income tax asset | $ 69,000 | $ 79,000

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