WASHINGTON — The 14 Republicans in California’s House delegation helped give their party its biggest victory to date Thursday in its seven-year campaign against the Affordable Care Act, voting to gut the law in defiance of Democratic threats to have them “tattooed” with the decision come next year’s elections.

The state’s GOP contingent voted unanimously for a Republican bill to replace the health-insurance law commonly known as Obamacare, including seven members who represent districts that President Trump lost in November. All seven had said until Thursday that they were undecided on the repeal-and-replace bill, and many were intensely lobbied by the president and House GOP leaders.

The 217-to-213 vote left the GOP almost no room for error. No Democrats voted for the bill, which would remove the mandate that all adults carry insurance, let states strip coverage requirements for such services as emergency care, and allow insurers to charge higher premiums for people with past or current health problems.

The legislation now goes to the Senate, where majority Republicans have looked warily on the House effort and are certain to make changes — if they pass anything at all.

Trump, whose first 100 days in office were notably short on legislative wins, said after the vote that “this is a great plan. I actually think it will get even better. ... Premiums will be coming down. Yes, deductibles will be coming down.”

Many of the California Republicans who voted for the bill had stayed on the fence until the last moment. Some such as Reps. Darrell Issa of Vista (San Diego County) and Ed Royce of Fullerton (Orange County) ducked reporters seeking to interview them, issuing press releases instead.

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With 20 Republicans from other states, many of them also in vulnerable districts, voting “no,” House Majority Leader Kevin McCarthy of Bakersfield needed GOP colleagues in his state on board.

Gov. Jerry Brown, who described the bill as “an abomination,” called out three California Republicans just before the vote for their co-sponsorship of an amendment that won over some center-right Republicans.

Brown listed the members by name and the estimated number of their constituents who could lose coverage under the bill: Reps. David Valadao of Hanford (Kings County), 111,000; Jeff Denham of Turlock (Stanislaus County), 109,000; and Steve Knight of Lancaster (Los Angeles County), 76,000.

Valadao and Denham, who said in a Facebook post last month that he opposed the bill as it was written then, retorted that Brown has “prioritized access to health care for those living in urban areas and along the coast,” while neglecting people in the San Joaquin Valley. They said Brown needed to work to improve Medicaid reimbursement rates to attract more doctors to their districts.

Republican leaders said their bill, the American Health Care Act, would lower insurance costs for younger and healthy people, provide customers with more options, and supply funding to help people who have health problems, or pre-existing conditions, pay what could be sharply higher premiums.

“We know we can have fair health care that helps those who need it without trapping everyone in a government-run system dreamed up by Washington central planners,” McCarthy said.

House Speaker Paul Ryan, R-Wis., said the vote heralded “a new era of reform based on liberty and self-determination.”

Democrats cited independent analyses indicating that millions of people who gained coverage under the Affordable Care Act would lose it under the GOP measure. They hope both to kill the bill in the Senate and use the House vote to bludgeon Republicans in the 2018 midterm elections.

“Most Americans don’t know their member of Congress, but they will now,” said House Democratic leader Nancy Pelosi of San Francisco, a chief architect of the Affordable Care Act. She told Republicans, “You have every provision of this bill tattooed on your forehead. You will glow in the dark.”

California Democrats said the bill would prove devastating in their home state, especially lower-income areas where many of the working poor could be stripped of Medi-Cal coverage. The bill could cost the state $24 billion in federal Medicaid funds alone.

Democratic Rep. Mark DeSaulnier of Concord said many Republicans complaining about the Affordable Care Act’s problems cited states that refused to work to implement the law. “I’m in shock that they would do this,” he said of Thursday’s vote.

But one of the California Republicans who had said he was undecided, Rep. Doug LaMalfa of Richvale (Butte County), said he was hearing from constituents who complained about high premiums that they are paying under the current health law.

“We had to do something,” LaMalfa said. “Middle-income people were pleading that we can’t do this anymore.”

Other California Republicans voting for the bill were Reps. Devin Nunes of Tulare, Mimi Walters of Irvine, Dana Rohrabacher of Costa Mesa (Orange County), Ken Calvert of Corona (Riverside County), Paul Cook of Yucca Valley (San Bernardino County), Duncan Hunter of Alpine (San Diego County) and Tom McClintock of Elk Grove (Sacramento County).

The Affordable Care Act has been a GOP target ever since it became then-President Barack Obama’s main domestic priority in his first term. Trump said during the campaign that he wanted to sign a repeal bill on his first day in office, voiced frustration with both Republicans and Democrats when an earlier version of the bill stalled in March, and lobbied hard for the latest measure.

As attention focused on how Republicans would replace the Affordable Care Act, public support for the law grew. Throughout Obama’s presidency, it was opposed by more Americans than backed it, according to the RealClear Politics’ average of opinion polls. Now, however, it is backed by 49.6 to 42.1 percent. A Quinnipiac poll in March showed that 17 percent of Americans supported the GOP replacement.

The Republican proposal was retooled in recent weeks to appease far-right GOP members of the Freedom Caucus. They won the provision allowing states to opt out of the ban on charging more for people with pre-existing conditions. They also won a provision that would let states end requirements that insurers offer “essential benefits” in any policy they sell, such as coverage for prescription drugs, maternity care and emergency room services.

The amendment co-sponsored by Denham, Valadao and Knight that was key to winning over moderates added $8 billion over five years to help people with pre-existing conditions pay for health insurance. Democrats and other critics of the measure derided the total as far too little to cover the number of people who would be at risk of skyrocketing premiums.

Republicans held the vote without an analysis by the Congressional Budget Office, the nonpartisan arm of Congress that assesses the effects of legislation on the public. Rep. Chris Collins, R-N.Y., said Republicans did not need a new analysis because there were only minor changes to the original repeal-and-replace legislation that Republicans withdrew just before a vote in March.

The budget office said that legislation would cause 24 million people to lose or drop their insurance by 2026, and that premiums in the individual market could spike as much as 20 percent in the first two years before leveling off. California officials estimated that 3 million people in the state could lose their coverage.

Many of those who lose insurance qualified for coverage under the Affordable Care Act’s expansion of Medicaid. The Republican bill guts funding for that expansion.

In addition, the measure would repeal the Affordable Care Act’s requirement that all adults who can afford it carry health insurance or pay a tax penalty. That was one of the main sources of funding for covering people who had been unable to obtain coverage before the act’s passage.

It would also repeal taxes on high-income people, prescription drugs, medical devices and indoor tanning that had paid for expanded coverage.

To replace at least some of that money, the GOP bill would let insurers impose a 30 percent surcharge on people who go more than 63 days without coverage, then seek a new policy.

One little-noticed detail in the legislation could further punish California by denying the state’s residents even the basic tax credits it would provide to help lower-income people buy insurance. That’s because California requires insurance policies to cover abortion, and the GOP legislation would ban any federal aid for abortion.

Republicans said California would have to change its law to gain access to the tax credits.

Carolyn Lochhead is The San Francisco Chronicle’s Washington correspondent. Email: clochhead@sfchronicle.com Twitter: @carolynlochhead