Sen. Jeff Flake has signaled support for an amendment that aims to provide health-care consumers with a greater number of less-expensive choices in insurance. Flake, R-Ariz., revealed his backing of the "Consumer Freedom Option" on Monday with an almost offhand response to Capitol Hill reporters.

On Wednesday, he discussed that position with The Arizona Republic. In a telephone interview, he clarified his thinking on the proposal offered for the Senate GOP's Better Care Reconciliation Act by Sen. Ted Cruz, R-Texas.

A revised version of the underlying Senate Republican bill, which stalled late last month, is expected Thursday. Repealing and replacing former President Barack Obama's signature Affordable Care Act — which critics dubbed "Obamacare" — is a top priority of President Donald Trump and congressional Republicans.

QUESTION: Why did you decide to support Cruz's proposed amendment to the Senate Republican health-care bill?

ANSWER: "There seems to be kind of a misunderstanding out there that this is a whole new approach. ... It's not. It's just one amendment that would make just a small change, but an important change in my view. It doesn't touch the Medicaid side at all. Not at all. There is no impact at all on Medicaid or reimbursement."

Q: In your view, what does it do?

A: "All it does is say that if an insurer offers an 'Obamacare'-compliant policy that insures people, then they can also offer a product that is a cheaper policy or a catastrophic policy or just something that the customer would want that people can afford and isn't necessarily compliant with Obamacare.

"Here's the biggest problem: We have 183,000 people in Arizona who have paid the fine because they can't afford the insurance. They've paid the fine and they're still left without insurance. On top of that, you have a larger group that has purchased the insurance that are paying, like a friend of mine named Brent from Maricopa County, a premium of $1,500 a month. He has four kids, and by the time he satisfies the family deductible he would have paid nearly $40,000 out of pocket before the first insurance dollar kicks in. And that's not insurance for him. This would allow somebody like Brent and the 183,000 Arizonans who can't afford insurance because it's just too expensive to buy a product that meets their needs."

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Q: What about the criticism that the Cruz amendment would erode protections for people with pre-existing conditions?

A: "We would continue to do that. My position is, if we've made the decision, and we have, that pre-existing conditions need to be covered and that that's going to require a big subsidy, then it's better to pay it outright through taxes than it is to put the burden on those who are paying premiums that can't even utilize the insurance. ... We're not saying in any way that you don't cover those with pre-existing conditions. It would just be a different funding mechanism than this cross-subsidization that happens right now. Because that leaves too many Arizonans either high and dry, without insurance because they can't afford it, and they pay the fine, or with insurance that they can't utilize."

Q: Would the Cruz amendment have the effect of making the Senate health-care bill more conservative?

A: "If conservative means giving individuals more choice, then, yes, that is conservative. But the problem is the way that this has been described is that the more-conservative approach is the more people you are kicking off Medicaid and whatever else. I don't want people to get that impression. It's not 'conservative' in that way."

Q: Arizona is one of the states that expanded Medicaid under the Affordable Care Act. The state is predicting that under the Senate bill it would take a hit of $7.1 billion by the end of 2026. Sen. John McCain, R-Ariz., has said he has been in contact with Gov. Doug Ducey about the legislation. Have you?

A: "Yeah, I am. They've sent some material our way, as have the other governors in expansion states. ... The biggest concern that they have is they'll be required to treat a certain population and not be given the flexibility (to do so) in ways that they can be fiscally responsible. And I can certainly understand that."

Q: Your offices are the frequent scene of protests by activists who want to save the Affordable Care Act and who call the GOP plan "Trumpcare." How much do those demonstrations, and the personal stories of the protesters, influence your thinking on the health-care situation?

A: "I think we take it all into account. We take into account people who write in, who call in, who go to the office, and those who catch me in the grocery store or in the gym. This has been a big issue and we hear from a lot of people."

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Q: McCain has said if the Senate bill fails, Republicans will need to reach out to Democrats. Are you willing to be part of a bipartisan health-care coalition in the Senate?

A: "Those who are buying on the exchange can't afford the insurance on the exchange. I haven't seen any proposals on the other side that control costs and improve quality. I hope that we can work with them on it. Anything sustainable is going to have to be bipartisan at some point."

Nowicki is The Arizona Republic's national political reporter. Follow him on Twitter @dannowicki.

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