In other words, there were two bills: the first to open the debate, which he voted for - after making a stirring speech about how repugnant the whole business was; and, the second to institute the 'skinny repeal' (repealing some, but not all, of Obamacare), which he voted against.

In former times, the motion to open debate was simply a matter of form - more or less everybody would vote in favour. However, during the Obama years, Mitch McConnell had the audacity to start (ab)using this formality to block any consideration of legislation the Dems wished to introduce.

At least, that's my understanding of it.