RALEIGH, N.C. Jennifer and Keith Gibbs say the Affordable Care Act has hurt their family, sticking them with soaring premiums and out-of-pocket costs. Claire and Allen Secrist say the law has helped them and their young daughter, making it possible to get life-changing medical care while avoiding financial ruin.

The two families live 30 miles apart, and have never met each other. But their stories show how the 2010 health care law has created both winners and losers and what the changes Republicans support would mean for each.

The heart of the GOP campaign has been a promise to improve things for people, like Jennifer and Keith, who feel the Affordable Care Act has hurt them. Ive met with so many victims of Obamacare, President Donald Trump said recently, during a speech in Nashville, Tennessee. We will replace Obamacare and make health care better for you and your families.

But amid questions about what repeal would actually entail, Republicans have also made promises to families like the Secrists, who are among the 20 million people depending on the health care law. Nobody will be worse off financially, Tom Price, Trumps secretary of health and human services, claimed in a March television interview.

This is not a vow Republicans can fulfill. And theres a very simple reason for that. In the GOP Obamacare narrative, the Affordable Care Act imposed regulations that made insurance more expensive for families like the Gibbses and then it spent a bunch of taxpayer money in ways that dont actually help them.

That narrative is more or less correct. It is also incomplete. Specifically, it leaves out the part about how those same regulations, and that same government spending, have put decent coverage within reach for families like the Secrists. Take away the rules and the money, as Republicans propose to do, and families like the Gibbses might feel better off. But the Secrists, just as surely, would suffer.

The American Health Care Act, the bill that GOP leaders tried and failed to get through the House in March, is the proof. Had it become law, a family like the Gibbses would have ended up spending less on their health insurance premiums, most likely, in exchange for a policy that would have covered less. The family would also have benefited from substantial new tax breaks the GOP proposal promised to make available to them. But a family like the Secrists would have struggled to find a policy with the comprehensive benefits they require, and even if they had found one, they would not have been able to afford it. They would probably have ended up uninsured, struggling to get medical care they desperately need.

This outcome isnt inevitable. There are ways to help the ACAs losers without hurting its winners. But those alternatives would involve different choices and trade-offs than Republicans have considered.

Their Premiums Went Up And Kept Going Up

The Gibbses are in their 40s, with two teenage daughters. Keith runs a business advising pharmaceutical and biotech companies that he started a few years ago, in part so he could have more control of his schedule and spend time at home. Jennifer works part-time for a nonprofit organization that helps former prisoners. Their neatly decorated, two-story house sits in a fast-growing neighborhood, popular with people who work in the areas Research Triangle.

They buy coverage on their own, rather than through an employer. In 2013, before the main provisions of the ACA took effect, they paid about $7,200 for a policy from Blue Cross Blue Shield of North Carolina. The plan they had was relatively generous, because it included things like inpatient rehabilitative services that employer plans routinely included but many non-group plans did not.

But the plan was cheap for a reason. It had limited mental health benefits, and it didnt cover maternity benefits at all. It also had a lifetime limit on how much it would pay out, which meant that if somebody in the Gibbs family ended up with an illness requiring years of intensive treatment say, an aggressive cancer it was possible their bills could hit that ceiling, and then theyd be on the hook for the rest.