The paradox of Mitch McConnell's repeal-only vote

But what he is doing is reasserting his own personal leadership, punishing and rewarding senators all at once—in ways that diminish everybody in his caucus other than himself.

The vote is a reward to the ultras who sabotaged repeal and replace by allowing them to posture one more time as purists who have not forsaken the true faith. It punishes the cautious senators who recoiled from huge Medicaid cuts by thrusting upon them a clear alternate they would prefer to evade. It intensifies mutual suspicion and ill-feeling inside a caucus where two senators—Nevada’s Dean Heller and Arizona’s Jeff Flake —have been explicitly threatened by the president and head of party.