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Through commercial fishing, harvesters face elevated physical and financial occupational risk. We examine harvesters' utilization of health insurance to mitigate risk, drawing data from over 2,800 survey responses from US West Coast commercial fishing vessel owners from 2017 and 2020. Respondent health insurance coverage is compared with census county-level Small Area Health Insurance Estimates. We also explore drivers of obtaining health insurance using logistic regression, categorizing drivers as corresponding to either costs or benefits of insurance. Despite elevated occupational risk, we find empirical evidence that health insurance coverage for West Coast commercial vessel owners is lower than the general population of their county-level communities. Respondent health insurance uptake is also found to be primarily driven by variables associated with costs rather than benefits of health insurance, providing evidence against strong adverse selection. These insights provide potential mechanisms for management regimes that could benefit well-being in fishing communities. [ABSTRACT FROM AUTHOR]