Maine lobstermen seemed a likely group to sign up for health care coverage under President Barack Obama's landmark law.
They face such job hazards as getting tangled in traps and dragged into the ocean. Ever present is the possibility of injury from the physically demanding labor. And in a field made up of independent contractors, there are no companies providing insurance, so many are uninsured.
So over the past several months, advocates set about educating lobstermen and their families about the law, listening to their concerns and signing up hundreds of the 5,000 or so lobstermen who work off the coast of Maine for insurance through the marketplaces created under the law. That signup rate is seen as a win by the advocates, who say many more have likely enrolled without their knowledge.
"The response from our outreach has been very, very good," said Brian Delaney, a spokesman for Fishing Partnership Support Services, an organization working in Maine that was responsible for reducing the percentage of uninsured fishermen in Massachusetts from 40 to 10 in just one year more than a decade ago.
In Maine, the split between those signing up and those who aren't is roughly the same as in other industries and other parts of the country. Older, sicker workers with families are paying for insurance plans, while younger lobstermen tend to go without, as are those who said cost was a concern, according to interviews with more than a dozen lobstermen and advocates who've worked with hundreds more.
Some lobstermen found they qualified for improved plans.
"It's better than any insurance that I've have in the last 30 years," said Arnold Gamage, a 61-year-old lobsterman from South Bristol who stopped paying for health insurance last year because, with an estimated annual salary of $60,000, he could no longer afford a plan that covered heart medication he needs.
His new plan, through one of the two providers on Maine's insurance marketplace, costs $480 a month, compared with the $780 he paid before. The deductible for him and his wife was cut in half, to $5000.
Delaney's group and the Maine Lobstermen's Association have spoken to 1,600 lobstermen and their spouses at more than 70 events. They estimate they have signed up several hundred lobstermen directly, though it is not clear how many of those people were already insured. Neither group tracked that figure.
Still, a quarter of licensed lobstermen in Maine fish without the safety net of insurance, according to a Gulf of Maine Research Institute survey conducted in 2005, the most recent data available. That tally doesn't include crew members.
Gamage's younger colleagues are mainly choosing to go without, saying the cost of insurance outweighs the risks of the job. Such so-called young invincibles are a prime target of the law; their relatively good health balances out the sicker, older people signing up for insurance and lowers the overall risk for insurers and prices for consumers. But even the perils of life on a lobster boat have not been enough to draw this group to insurance.
"The young ones, in my experience, don't care about signing up," said Sheila Dassatt, director of the Downeast Lobstermen's Association.
The cost of health insurance is a common concern among lobstermen, even after they figure in the subsidies from the government that reduce the monthly payments as well as deductibles through federal aid and tax credits, said April Gilmore of the Lobstermen's Association. She is working as a navigator, a person who helps educate people on the law and sign them up for insurance.
In addition to income, young lobstermen also cited startup costs as they enter the trade as a reason for going without insurance.
"I'm only 21, so I am going to forgo it and bet on the fact that I am young and physically able," said Will Lent, who lives on Cliff Island and fishes off the coast of Portland. He found a plan on the government marketplace for $115 a month but said that was too much considering a major injury would prevent him from earning a living regardless of whether he had insurance.
"You really got to weigh if what you are spending equals what you are getting," he said.
It's not that lobstermen don't want insurance, Gilmore said. Many just can't afford it, she said.
Insurance representatives in Maine have said the greatest factors affecting subsidies are family and income, which must be estimated, taking into account fluctuating lobster prices, seasonal income and unpredictable catches. They also must declare boats worth hundreds of thousands of dollars and worry that such assets will prevent them for qualifying for federal aid.
While lobstermen trying to buy insurance can base their income on past years, many worry that underestimating their income could result in fines for receiving undeserved subsidies, further complicating the application process, Gilmore said.
"They don't have a human resources department," she said.