We provide an initial look at our follow up study on the impact of the Affordable Care Act (ACA) on U.S. commercial fisheries. Earlier work found that in the years immediately preceding the passage of the ACA, North Carolina’s commercial fishermen were more likely to purchase health insurance coverage on the private market if they worked in a more dangerous environment or were more highly vested in fishing. Our preliminary results show that North Carolina’s commercial fishermen are indeed purchasing health insurance through the ACA in significant numbers. Insurance coverage has risen overall, although some fishermen are still choosing to remain uninsured. We provide early estimates on the size of the ACA subsidies and changes in fishing behavior and investment.