With the passage of the American Health Care Act through the House, President Donald Trump has succeeded in reviving a tremendously unpopular bill that could place his House majority in serious peril.

He has also ensured that health care — a bad issue for him — will continue to dominate headlines for months as the fight over the GOP bill moves on to the Senate.

And he has succeeded in increasing what may be the biggest risk of all for himself and his party — that this extremely controversial bill will in the end actually become law and strip tens of millions of Americans of their health coverage while making a mockery of Trump’s own campaign promises.

It is clear, then, that while this vote was indeed a “win” for Trump in the short term, it could entail some very serious political consequences for him and for the GOP in the long run.

Press coverage of House Republicans’ withdrawal of the American Health Care Act back in March portrayed it as a humiliating defeat for Trump. And though he had at first signaled that he wanted to leave health reform behind and move on to other issues, he is a man who hates losing. So he had his aides and House leaders work to revive the bill, and now it has cleared the House of Representatives, giving him the short-term victory he so craved.

And there are some real benefits to Trump from today’s vote. With his first 100 days widely viewed as disappointing and ineffective, he has won some headlines about a victory. He’s managed to pass his first big bill through a chamber of Congress. And he’s kept the GOP legislative agenda of Obamacare repeal and a big permanent tax cut alive for now.

But the policy, politics, and process of the American Health Care Act have been handled so abysmally by Republicans that even this success seems to create more and more problems for them down the road. As I’ve been writing, by not managing to put together a better and more popular bill, Trump has ended up in a no-win situation on health reform, where both passage and failure cause him immense difficulties.

The unpopular AHCA imperils Republicans’ House majority

According to the most recent Congressional Budget Office estimates — Republicans didn’t bother to wait for a score of their latest revisions — the GOP health bill is projected to result in 24 million people losing insurance by 2026. It slashes $880 billion from Medicaid. And it has particularly devastating effects on older, poorer Americans who had to buy insurance on the individual marketplaces — CBO projected a 64-year-old making $26,500 would see her premiums rise by 750 percent. Most major health care industry and patients groups have condemned the bill, and polls showed it to be incredibly unpopular.

Regardless of what happens next, Trump has now yoked 217 House Republicans — all but 21 of them — to this bill, and put them on record supporting it. And that could have very serious electoral consequences.

A paper by a group of political scientists (Brendan Nyhan, Eric McGhee, John Sides, Seth Masket, and Steven Greene) found that House Democrats who voted for President Obama’s health reform bill in 2010 ended up with a midterm election vote share on average 5.8 points lower than similar Democrats who opposed the bill. Without this drag on Obamacare supporters, the authors calculated, Democrats would have been favored to hold on to the House. Instead, of course, they lost it in 2010, and have never reclaimed it since.

Holding on to control of the House is obviously important in helping a president get his legislative priorities into law. But its importance doesn’t stop there. Whichever party controls the House sets the chamber’s investigatory agenda and has subpoena power through control of various committees.

If the president’s allies control Congress, he’s generally shielded from the worst of troublesome congressional investigations. But if his opponents do, they can make a whole lot of trouble for the administration depending on what they find. For instance, Hillary Clinton’s use of a private email address and server for her State Department work was in fact unearthed by a congressional Republican–led committee investigating the Benghazi attacks. If Republicans had not retaken the House, the email scandal may never have become public, and Clinton could well be president today.

There are a whole host of ethics concerns already related to Trump, his businesses, and his children, and how all those intermingle with government activity. Republican-led congressional committees have so far been uninterested in digging too deep into all that, but you can rest assured that Democrat-led committees would be very interested indeed. And there are a bunch of other matters that could be investigated too, not least Russia-related scandals.

All that, of course, remains hypothetical and in the future, but by forcing so many House Republicans in districts Clinton won or narrowly lost to go on record backing such an unpopular measure here, Trump likely has significantly helped Democrats’ chances of retaking the House.

The health care issue will now dominate Washington’s agenda for the foreseeable future

American voters have relatively short memories. Congressional Republicans were blamed for the tremendously unpopular two-week government shutdown of fall 2013, and it seemed they had greatly damaged their chances for the 2014 midterms. But they realized they were fighting a losing battle and smartly gave up, letting the government reopen and not waging that fight again. A year passed, other issues rose to the top of the agenda, Republicans had a chance to improve their popularity, and they won landslide midterm gains.

Some use this example to argue that the government shutdown wasn’t as bad for the GOP as it seemed, but that’s not my takeaway. Republicans’ key choice in my view was to abandon that strategy. If they had continued to keep the government shut down or waged future shutdown fights throughout 2014, things could have turned out very differently. But they smartly didn’t.

Now, President Trump has never been particularly comfortable discussing health care policy, and when the AHCA was pulled back in March, he at first seemed positively eager to move on to tax cuts, an issue that had the potential to be more popular and politically beneficial to him. In the end, however, he decided he didn’t want to move on after all, and resurrected the health bill.

So regardless of what happens next in the Senate, the consequence here is that health reform will continue to dominate headlines about the administration and Congress for the foreseeable future.

This means that yet again, Trump has passed up an opportunity to prioritize an issue that is actually popular — something like jobs or infrastructure, or even a tax cut bill — and could conceivably help turn around his dismal approval ratings. And of course, if the bill is signed into law, he will in some senses never be able to escape the health care issue, as his administration will be held responsible for implementing it.

The biggest risk of all for Trump and Republicans is that the health bill might actually become law

Now that the health bill has cleared the House, there are essentially three ways things could play out now:

The bill just dies in the Senate, with the chamber failing to pass anything and effectively ending discussion of the matter. The Senate dramatically overhauls the health bill, but the House can’t accept the changes that have been made, and the bill dies due to the failure of the two chambers to agree. The bill actually passes the Senate, the House and Senate come to an agreement, and the bill becomes law with President Trump’s signature.

If scenario 1 or 2 happens, we’ll essentially return to where things were in March when the AHCA failed in the House, only after several more weeks or months of Trump’s crucial first year have been invested into this.

The truly interesting and dangerous outcome for the GOP, though, is scenario 3: The bill becomes law (without being rewritten from scratch by the Senate into something that bears zero resemblance to what it is now, which could be the GOP’s only way out of this mess).

Because Republicans from Trump on down have been engaged in a remarkably brazen campaign of lies and deceit to sell this bill. They have repeatedly promised it will give Americans more choice and lower premiums and deductibles. Trump has promised to cover everyone, even those who can’t afford it. House Majority Leader Kevin McCarthy promised just this morning that no one would have their Medicaid taken away via the GOP bill.

All of these are flat-out lies. As mentioned, according to the CBO, the bill would cause tens of millions to lose coverage, slash hundreds of millions of dollars from Medicaid, and send premiums skyrocketing for older and poorer Americans (including many Trump voters). And if it were actually implemented, people would of course notice this.

“No legislation enacted in recent decades cut low-income programs this much — or even comes close,” Robert Greenstein, the founder and president of the Center on Budget and Policy Priorities, recently told my colleague Dylan Matthews. The amount of damage this would do to so many Americans’ benefits and pocketbooks could well be unprecedented in US politics. By reviving this bill, then, Republicans are very much playing with fire, and putting millions of Americans — and their own political futures — at risk of getting burned.