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Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2018
Sep. 30, 2017
Cash flows from operating activities:    
Net loss $ 192,451 $ (44,679)
Adjustments to reconcile net income (loss) to cash provided by operating activities:    
Provision for doubtful accounts receivable 1,129 108
Share-based compensation expense 8,106 4,006
Depreciation and amortization 30,040 26,423
Amortization of deferred financing costs and debt discount 5,602 4,203
Amortization of (discount) premium on investments 4,354 6,126
Gain on sale or disposal of assets (3,267) (3,368)
Gain on sale and deconsolidation of subsidiary (105,106) 0
Gain on bargain purchase (109,112) 0
Asset impairment expense 381 1,810
Income from equity investees (13,655) (12,667)
Impairment of investments 623 6,112
Net realized and unrealized gains on investments (49,130) (2,881)
Gain on contingent consideration 0 (6,001)
Receipt of dividends from equity investees 11,380 917
Annuity benefits 6,282 6,519
Loss on early extinguishment of debt 2,537 0
Other operating activities (613) 2,727
Changes in assets and liabilities, net of acquisitions:    
Accounts receivable (28,689) 2,725
Recoverable from reinsurers 122,327 (6,478)
Other assets (52,122) (27,274)
Life, accident and health reserves 82,036 34,841
Accounts payable and other current liabilities 9,674 45,650
Other liabilities 21,437 (1,561)
Cash provided by operating activities: 136,665 37,258
Cash flows from investing activities:    
Purchase of property, plant and equipment (32,290) (25,324)
Disposal of property, plant and equipment 4,878 1,610
Purchase of investments (515,600) (231,881)
Sale of investments 192,306 101,080
Maturities and redemptions of investments 56,532 100,691
Purchase of equity method investments (751) (11,390)
Cash received from dispositions, net 92,039 0
Cash received from acquisitions, net 729,111 0
Other investing activities (812) (1,748)
Cash provided by (used in) investing activities: 525,413 (66,962)
Cash flows from financing activities:    
Proceeds from debt obligations 266,660 108,469
Principal payments on debt obligations (163,748) (48,146)
Annuity receipts 1,815 2,190
Annuity surrenders (14,881) (14,764)
Transactions with noncontrolling interest (11,821) 665
Payment of dividends (1,500) (2,763)
Other financing activities (835) (230)
Cash provided by financing activities: 75,690 45,421
Effects of exchange rate changes on cash and cash equivalents (442) (149)
Net change in cash and cash equivalents and restricted cash 737,326 15,568
Cash and cash equivalents and restricted cash, beginning of period 98,853 115,869
Cash and cash equivalents and restricted cash, end of period 836,179 131,437
Supplemental cash flow information:    
Cash paid for interest 36,232 24,601
Cash paid for taxes 13,259 11,113
Non-cash investing and financing activities:    
Property, plant and equipment included in accounts payable 2,627 547
Investments included in accounts payable 35,029 4,785
Conversion of preferred stock to common stock 0 4,433
Declared but unpaid dividends from equity method investments included in other assets 13,293 0
Dividends payable to preferred shareholders $ 500 $ 500